Regarding the apparent decrease in SIDS here is part of an editorial by Scripps Howard News Service published on October 12, 2007 which casts doubt on the often cited statistic that there has been an approximately 50% decline in SIDS since the Back to Sleep Campaign began in 1992:
“In the early '90s, the 'Back to Sleep' campaign was launched to persuade parents to have their newborns sleep exclusively on their backs. And the campaign appeared to have dramatic results, with authorities claiming that by 2004 SIDS deaths had fallen by more than half.
But an investigation by Scripps Howard News Service reporters Thomas Hargrove and Lee Bowman casts deep doubt on the accuracy of those figures. Because of sloppy procedures, manipulation of statistics and lack of standardization, the success of public health efforts against SIDS has been substantially overstated.
The harsh fact is that while deaths attributed to SIDS appear to have fallen dramatically, the overall number of sudden infant deaths has declined only slightly. Researchers believe that much of this apparent reduction is only on paper, what is called "code shifting." Instead of a diagnosis of SIDS, the death certificates now often list other, vaguer causes such as ‘threats to breathing’ or simply ‘undetermined cause.’
That would explain why 15 years ago SIDS was listed as the cause of 80 percent of sudden infant deaths versus just over 50 percent today. It also explains the wide disparity in SIDS diagnoses -- North Dakota reports four times the rate of New York -- and suggests that a finding of SIDS is often a function of geography, not medicine.”
http://www.sids-network.org/experts/scripps_editorial.htm
In addition to the editorial above here are three other reasons why I am skeptical that there has been a 50% decline in the rate of SIDS. In addition, these three reasons explain why that to the extent that there has been an actual decrease in the rate of SIDS I am skeptical that the increase in the back sleeping position is the primary factor for this decrease:
I. In 2002, smoking during pregnancy was reported by 11.4% of all women giving birth in the United States, a decrease of 38% from 1990, when 18.4% reported smoking (1). Considering that smoking has been shown to correlate with a 3 fold increase in the rate of SIDS (2) I think that the decrease in SIDS between 1990 and 2002 is at least partially attributable to the decrease in smoking rates during that time period.
II. Between 1996 and 2004 there was a 14% year over year increase in Accidental Suffocation and Strangulation in Bed (ASSB) according to a CDC report by Shapiro-Mendoza, et al. (3). WebMD interviewed Shapiro-Mendoza (4) regarding this story and here are two paragraphs from the article - Paragraph 1:"The decline in SIDS rates has been offset by an increase in other sudden unexplained infant deaths, a new category called SUIDs. ASSB death, a subgroup of SUIDs, is a leading cause of infant mortality, says Shapiro-Mendoza." Paragraph 2: "Shapiro-Mendoza tells WebMD that infant deaths attributed to ASSB increased from 2.8 to 12.5 deaths per 100,000 live births between 1984 and 2004. She says such deaths increased dramatically between 1996 and 2004 (14% average yearly increase), a period in which mortality attributed to SIDS declined."
III. Here are 2 paragraphs from a Scripps News Investigation published on October 8, 2007 and written by Hargrove and Bowman (5). Paragraph 1: "'A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting,' said John Kattwinkel, chairman of the Centers for Disease Control and Prevention's special task force on SIDS." Paragraph 2:"Among the other findings of the Scripps investigation:-- In some states and counties, investigators are told not to issue a SIDS diagnosis if any other cause is suspected, causing the rate at which the syndrome is reported to the Centers for Disease Control and Prevention to plummet to just a fraction of the national average. Several large metro areas reported no SIDS cases during the five-year period even though there were dozens of sudden infant deaths."
References:
(1) Martin JA, et al.; Births: final data for 2002. Natl Vital Stat Rep 2003;52(10):1--113.
(2) MacDorman MF, et al.; Am J Epidemiol 1997; 146(3):249-257.
(3) Shapiro-Mendoz, et al; Am J Epidemiol. 2006 Apr 15;163(8):762-9
(4) Hendric, Bill. WebMD. Infant Suffocation Deaths are Rising. Website:(5) Bowman and Hargove. Scripps News Service. Saving Babies: Exposing Sudden Infant Death in America. Website:http://www.scrippsnews.com/node/27463http://www.webmd.com/parenting/baby/news/20090123/infant-suffocation-deaths-are-rising
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