What are the national rates for Sudden Infant Death Syndrome for Aboriginal and Torres Strait Islander infants?

Research from Western Australia has shown that Sudden Infant Death Syndrome (SIDS) is the most important cause of death for infants born to Aboriginal and Torres Strait Islander mothers in that State.1 Moreover, the success of the campaign to ‘reduce the risks of SIDS’ did not extend to Indigenous infants. Indeed, the disparity between Indigenous and non-Indigenous infants increased.1 Recent data from Western Australia suggests that this situation has not changed; the rate of SIDS for infants born to Indigenous mothers in 1998 being 6.0 per 1000 live births compared with 0.5 per 1000 for those born to non-Indigenous mothers (pers. comm. V Gee, Midwives’ Notification System, Health Department of Western Australia). How do these figures compare with national data? It is very difficult to know as only those States and Territories that routinely link registered deaths with individual birth records (where Indigenous status should be recorded) can produce reliable and accurate rates.2 In recent publications, the Australian Bureau of Statistics consider that only South Australia, Western Australia and the Northern Territory have publishable data on live births by Indigenous status.3 Hence, it is not possible to obtain accurate denominator data for the calculation of mortality rates by any cause. In Western Australia, perinatal, post-neonatal and childhood deaths are routinely linked to births in the total population Maternal and Child Health Research Data Base.4 This enables the calculation of mortality rates for infants according to the Indigenous status of their mothers. It should be noted that infants with non-Indigenous mothers and Indigenous fathers will not be included in these figures. Apart from Western Australia, the Northern Territory is the only State/Territory with both a sizeable number of births to Indigenous mothers (n = 1244 in 1995)5 and reliable estimates of infant mortality rates. For infants born to Indigenous mothers in 1995, the SIDS rate was 2.4 per 1000 live births, approximately six-fold the rate for infants of non-Indigenous mothers.5 We know little about SIDS among Indigenous infants in States with the most births to Indigenous mothers (New South Wales and Queensland).2 Thus, the publication of separate infant mortality rates by cause of death for Australian Indigenous and non-Indigenous infants has not been possible. This issue of the Journal of Paediatrics and Child Health includes two articles from north Queensland where efforts have been made to estimate SIDS rates by Indigenous status, and to assess the prevalence of the recognized risk factors for SIDS.6,7 Unfortunately, these studies highlight the inadequacies of our current methods of data collection, and the paucity of appropriate and good quality research nationally in the area of sudden and unexpected death in infancy in Aboriginal and Torres Strait Islander populations. In one study, the authors estimate that the SIDS rate for Indigenous infants is almost three-fold higher than the rate for non-Indigenous infants.6 This is a conservative estimate, given that Indigenous status was unknown for 36% of the infants who died and these were assumed to be non-Indigenous. The authors point out that their results are similar to those for the whole of Queensland for 1997, but, given the acknowledged limitations of the latter data,8 caution is required in interpretation. In another study, the authors aimed to assess the prevalence of SIDS risk factors in the Indigenous and non-Indigenous community of north Queensland by surveying a small convenience sample of women with young children.7 There are methodological problems with this research. The sample size is small and non-representative. The age range of the sample is wide and includes few very young infants (n = 8 younger than 3 months). Thirty per cent of the infants were older than 12 months, leaving an effective sample size of 42 infants. However, despite these limitations, the paucity of information in this area means that the results are of interest. The data are consistent with those from a large, representative, population-based study in Perth,9 and highlight the need for a specific and appropriate ‘reducing the risks of SIDS’ campaign for the Indigenous community. The solid evidence on SIDS rates from Western Australia and the Northern Territory, together with the suggested similarities from Queensland, indicate that renewed efforts must be made to ascertain not only the national SIDS rates for Indigenous and non-Indigenous infants, but also the rates for other causes of infant and childhood deaths. The current work of the Australian Bureau of Statistics and the Australian Institute of Health and Welfare in aiming to ensure that Aboriginal and Torres Strait Islander people throughout Australia are completely and correctly identified is acknowledged.10 Additionally, it is most important that all infants and children who die suddenly and/or unexpectedly have a thorough post-mortem examination, in accordance with accepted and standardised practice for a diagnosis of SIDS.11 This should be conducted by a specialized pathologist whenever possible, but should also be accompanied by appropriate support and counselling for the bereaved families. In the meantime, and in close collaboration with Aboriginal and Torres Strait Islander communities, methodologically sound research to establish the prevalence of known risk factors for SIDS and to implement and evaluate preventive programmes should proceed. AW READ Research Fellow TVW Telethon Institute for Child Health Research Centre for Child Health Research Faculty of Medicine and Dentistry University of Western Australia Western Australia, Australia jackie@ichr.uwa.edu.au