Sudden infant death syndrome (SIDS) is one of the most common causes of death during the first year of life In a large cohort study, the investigators followed the course of nearly 56,000 pregnancies in the USA Among 53,271 infants who were born alive and survived the neonatal period, 193 babies died of SIDS (Kraus et al , 1989) The crude (unadjusted) risk of SIDS was found to be 40 higher (RR 1 4) in infants of Black mothers compared to non Black mothers However Black mothers tended to have lower income and lower levels of education than other mothers and both low income and low education are associated with higher risks of SIDS Discuss whether each of the three criteria for causal inference apply to this scenario Based on that reasoning, do you think the RR of 1 4 shows causality or not, and why You may also discuss the scenario in the context of the other frameworks for causal inference The risk of SIDS was inversely related to maternal age compared to children born to mothers aged 35 41 years, the risk of SIDS was more than twice as high (RR 2 3) among infants born to mothers aged 18 19 However, this analysis did not consider the possibility that the data were confounded by parity (number of births the mother has had) On average, older mothers had more children than younger mothers and the risk of SIDS increased with the number of previous children a woman had If we were to adjust for parity, would the adjusted RR for the association with young maternal age be higher or lower than the unadjusted RR Explain or display your reasoning A separate study was conducted to investigate the effect of maternal smoking during pregnancy on SIDS Previous studies had shown that smoking during pregnancy considerably increases the risk of pre term delivery and low birthweight Pre term delivery and low birthweight are also known risk factors for SIDS Should birth weight and gestation (pre versus full term delivery) be considered as potential confounders in the analysis Explain how you arrived at your conclusion and share a directed acyclic graph (DAG) to support your reasoning Describe how you would test for confounding Why is it important to identify confounders when investigating SIDS as a public health issue References Kraus, J F , Greenland, S and Bulterys, M (1989) Risk factors for sudden infant death syndrome in the US Collaborative Perinatal Project International Journal of Epidemiology, 18 113 120 Questions Adapted from Webb, P , and Bain, C (2010) Essential Epidemiology, 2nd ed Cambridge University Press

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Sudden infant death syndrome (SIDS) is one of the most common causes of death during the first year of life. In a large cohort study,

Sudden infant death syndrome (SIDS) is one of the most common causes of death during the first year of life. In a large cohort study, the investigators followed the course of nearly 56,000 pregnancies in the USA. Among 53,271 infants who were born alive and survived the neonatal period, 193 babies died of SIDS. (Kraus et al., 1989).

The crude (unadjusted) risk of SIDS was found to be 40% higher (RR=1.4) in infants of Black mothers compared to non-Black mothers. However Black mothers tended to have lower income and lower levels of education than other mothers and both low income and low education are associated with higher risks of SIDS. Discuss whether each of the three criteria for causal inference apply to this scenario. Based on that reasoning, do you think the RR of 1.4 shows causality or not, and why? You may also discuss the scenario in the context of the other frameworks for causal inference.
The risk of SIDS was inversely related to maternal age: compared to children born to mothers aged 35-41 years, the risk of SIDS was more than twice as high (RR=2.3) among infants born to mothers aged 18-19. However, this analysis did not consider the possibility that the data were confounded by parity (number of births the mother has had). On average, older mothers had more children than younger mothers and the risk of SIDS increased with the number of previous children a woman had. If we were to adjust for parity, would the adjusted RR for the association with young maternal age be higher or lower than the unadjusted RR? Explain or display your reasoning.
A separate study was conducted to investigate the effect of maternal smoking during pregnancy on SIDS. Previous studies had shown that smoking during pregnancy considerably increases the risk of pre-term delivery and low birthweight. Pre-term delivery and low birthweight are also known risk factors for SIDS. Should birth-weight and gestation (pre- versus full-term delivery) be considered as potential confounders in the analysis? Explain how you arrived at your conclusion and share a directed acyclic graph (DAG) to support your reasoning. Describe how you would test for confounding.

Why is it important to identify confounders when investigating SIDS as a public health issue?

References:

Kraus, J. F., Greenland, S. and Bulterys, M. (1989). Risk factors for sudden infant death syndrome in the US Collaborative Perinatal Project. International Journal of Epidemiology, 18: 113-120.
Questions Adapted from: Webb, P., and Bain, C. (2010) Essential Epidemiology, 2nd ed. Cambridge University Press.