title: Trends in socioeconomic inequalities in risk of sudden infant death syndrome, other causes of infant mortality, and stillbirth in Scotland: population based study.
abstract: OBJECTIVE
  To compare changes in inequalities in sudden infant death syndrome with other causes of infant mortality and stillbirth in Scotland, 1985-2008.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Scotland 1985-2008, analysed by four epochs of six years.
  
  
  METHODS
  Singleton births of infants with birth weight >500 g born at 28-43 weeks' gestation.
  
  
  METHODS
  Sudden infant death syndrome, other causes of postneonatal infant death, neonatal death, and stillbirth. Odds ratios expressed as the association across the range of seven categories of Carstairs deprivation score.
  
  
  RESULTS
  The association between deprivation and the risk of all cause stillbirth and infant death varied between the four epochs (P=0.04). This was wholly explained by variation in the risk of sudden infant death syndrome (P<0.001 for interaction). Among women living in areas of low deprivation, there was a sharp decline in the rate of sudden infant death syndrome from 1990 to 1993. Among women living in areas of high deprivation, there was a slower decline in sudden infant death syndrome rates between 1992 and 2004. Consequently, the odds ratio for the association between socioeconomic deprivation and sudden infant death syndrome increased from 2.04 (95% confidence interval 1.53 to 2.72) in 1985-90, to 7.52 (4.62 to 12.25) in 1991-6, and 9.50 (5.46 to 16.53) in 1997-2002 but fell to 1.78 (0.87 to 3.65) in 2002-8. The interaction remained significant after adjustment for maternal characteristics.
  
  
  CONCLUSIONS
  The rate of sudden infant death syndrome declined throughout Scotland in the early 1990s. The decline had a later onset and was slower among women living in areas of high deprivation, probably because of slower uptake of recommended changes in infant sleeping position. The effect was to create a strong independent association between deprivation and sudden infant death syndrome where one did not exist before.
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Wood
authors.forename: Dharmintra
authors.initials: D
authors.lastname: Pasupathy
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
authors.forename: Michael
authors.initials: M
authors.lastname: Fleming
authors.forename: Gordon C S
authors.initials: GC
authors.lastname: Smith
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D011247:Pregnancy; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D013398:Sudden Infant Death / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult