Structural bias in the quality of information from death investigations for SUIDs

OBJECTIVE: To assess Sudden Unexpected Infant Death (SUID) investigations for structural inequities by race/ethnicity and geography. METHODS: The SUID Case Registry compiles data on death investigations. We analyzed cases from 2015 to 2018 (N=3,847) to examine likelihood of an incomplete death investigation, defined as: missing autopsy, missing scene investigation, or missing detailed information about where and how the body was found. We also analyzed which specific components of death investigations led to the greatest number of incomplete investigations. RESULTS: 24% of SUIDs had incomplete death investigations. Death scenes in rural places had 1.51 times the odds of incomplete death investigations (95% CI 1.19–1.92) compared to urban areas. Scene investigations led by law enforcement were more likely to result in incomplete death investigations (OR=1.49, 95% CI 1.18–1.88) compared to those led by medical examiners. American Indian/Alaska Native SUIDs were more likely than other racial groups to have an incomplete investigation (OR= 1.49, 95% CI 0.92–2.42), more likely to occur in rural places (p=0.055), and more likely to be investigated by law enforcement (p<0.001). If doll reenactments had been performed, 358 additional cases would have had complete investigations, and if SUID investigation forms had been performed, 243 additional cases would have had complete investigations. American Indian/Alaska Native SUIDs were also more likely to be missing specific components of death investigations. CONCLUSIONS: To produce equitable public health surveillance data used in prevention efforts, it is crucial to improve SUID investigations, especially in rural areas and among American Indian/Alaska Native babies.