title: Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings.
abstract: Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths.
  
  
  
  We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths were compared using the χ2test and multivariate logistic regressions.
  
  
  
  A total of 11 717 deaths were analyzed. Infants who died out-of-home were more likely to be in a stroller/car seat (adjusted odds ratio, 2.6; 95% confidence interval, 2.1–3.4; P < .001) and other locations (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.3; P < .001), and placed prone (adjusted odds ratio, 1.18; 95% confidence interval, 1.05–1.32; P < .01. There were no differences in sleeping on a couch/chair or objects in the sleep environment.
  
  
  
  Sleep-related infant deaths in the out-of-home setting have higher odds of having certain risk factors, such as prone placement for sleep and location in a stroller/car seat, rather than in a crib/bassinet. Caregivers should be educated on the importance of placing infants to sleep supine in cribs/bassinets to protect against sleep-related deaths, both in and out of the home.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Hilina
authors.initials: H
authors.lastname: Kassa
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Rachel Y
authors.initials: RY
authors.lastname: Moon
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri jdcolvin@cmh.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Colvin
mesh_terms: D001513:Beds; D002423:Cause of Death; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004777:Environment; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D016684:Prone Position; D012189:Retrospective Studies; D018570:Risk Assessment; D012890:Sleep / Q000502:physiology; D013398:Sudden Infant Death / Q000453:epidemiology / Q000209:etiology*; D016683:Supine Position; D014481:United States