Sleep-related infant deaths and socio-economic disadvantage

On average, 13 infants die suddenly and unexpectedly each year in South Australia. Most of these deaths occur in the infants’ sleep environments, and in almost all cases at least one safe sleeping risk factor is identified. As we discussed in a previous blog post, these risk factors are not necessarily causes of death in their own right, but rather behaviours that increase the risk of infants dying after being placed to sleep. These risks can be eliminated with education about, and adoption of, safe sleeping practices.

Through prevention campaigns by organisations like Red Nose, Kidsafe, and SA Health, the number of infant deaths involving safe sleeping risks has declined over the past fifteen years (Figure 1 – use the interactive app below to view figures). However, unsafe infant sleep practices – including unsafe bedding and bed-sharing – are still common and continue to contribute to the deaths of infants.

The most common risk factor identified in infant deaths – unsafe bedding – refers to any loose items present in the infant’s sleep environment. When placing a baby to sleep, it is important to ensure there are no choking hazards in the cot – these include any toys, pillows, and loose blankets. Between 2005 and 2019, unsafe bedding was present in over three quarters of all sleep-related infant deaths in South Australia (see Figure 2).

Almost half of all sleep-related infant deaths occur in the State’s most socio-economically disadvantaged areas. Infants in these areas are four times as likely to die suddenly and unexpectedly than infants who live in the least disadvantaged areas (see Figure 3).

The decline in infant deaths over the years proves that prevention messaging and education work – but there is an ongoing need for targeted efforts to stop preventable sleep-related infant deaths, especially in South Australia’s most disadvantaged areas.

If you have not done so already, please read about the safe sleeping guidelines to help ensure that every baby sleeps safely.

Geographic Disparities in Child Death

Over the last 13 years, the Child Death and Serious Injury Review Committee has documented the higher death rates for children living in more remote regions of the State. The death rate for children living in different parts of South Australia can be seen in more detail in the interactive visualisation below. This map includes all deaths of children who were residents of South Australia and who died in South Australia between 2005 and 2016 inclusive.

This higher rate of death in more remote regions of South Australia is evident across all categories of death. For instance, children outside of metropolitan Adelaide are three times more likely than children in metropolitan Adelaide to die in a transport crash. This example illustrates some of the challenges of providing services to remote areas. Even if roads in remote areas were of comparable safety to roads in metropolitan Adelaide, children in remote areas may spend more time in vehicles accessing services than their metropolitan counterparts, which may expose them to greater risk of dying in a transport crash. The figure below illustrates these differences across major categories of death.

The World Health Organization states that equity is ‘the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically.’ The geographic disparity between metropolitan and non-metropolitan areas of South Australia is a remediable difference. The continued disparity in death rates across the regions of this State is contrary to the view that all children in South Australia should have equal rights.

Go to the Committee’s latest Annual Report to learn more about how it defines both remoteness and these categories of death as well as what the Committee has recommended to address issues arising from the deaths of children in South Australia.

Death and Disadvantage

More children die in areas of South Australia where there are greater levels of social disadvantage. The Committee has documented this association over the past 12 years and published data showing this relationship in its 2016-17 Annual Report.

In countries like Australia, this relationship between child death and social disadvantage is well known:

‘Relative poverty is highlighted as the most important social determinant for child deaths in high-income countries. The authors identify a persistent – across all causes and in time – inverse association between socioeconomic status and child mortality in high-income countries.’ The Lancet V p830. Child deaths: inequity and inequality in high-income countries.

The relationship between South Australian child deaths and disadvantage, across different categories of death, can be explored in more detail in this interactive visualisation. This includes all deaths of children in the listed categories that occurred in South Australia between 2005 and 2016 inclusive.

The Committee’s analysis shows that, between 2005 and 2016 and across all categories of death:

  • There is a broad pattern of increasing deaths with increasing levels of disadvantage across all age groups.
  • A consistent pattern of low numbers of deaths in the age range 5 to 14 years, and two peaks, one in the youngest age group and one in the oldest.
  • An increase in the number of deaths at younger and older ages is greater at higher levels of socioeconomic disadvantage. The impact of this disadvantage is demonstrated by the particularly high number of deaths in children under one year of age at higher levels of SEIFA.

Some key points to notice about disadvantage and different categories of death:

  • There is a strong association between social disadvantage and children dying from natural causes and in transport crashes. But these two categories are mirror opposites with respect to age, with natural causes involving greater numbers of younger children and transport related deaths involving greater numbers of older children.
  • Fire-related deaths, drowning and deaths resulting from the deliberate act of another person all involved greater numbers of children from areas of greater social disadvantage.
  • The distribution of deaths in these three categories also highlights the vulnerability of toddler and pre-school aged children since they had more deaths in the 1 to 4 age range than any other age.
  • Suicide deaths stand out because there is the least evident effect of social disadvantage.

Go to the Committee’s latest Annual Report to learn more about how the Committee defines ‘disadvantage’ and ‘categories of death’ and what the Committee is doing to address issues arising from the deaths of children in South Australia.