Comparing factors associated with infant sleep related deaths in singleton births less than 12 months old by Medicaid and private insurance patients Open Access

Abstract

Abstract

Comparing factors associated with infant sleep related deaths in singleton births less than 12 months old by Medicaid and private insurance patients

By Sara Jo Johnson

Objectives: Evaluate factors associated with Sleep-Related Infant Deaths and how these factors differ by insurance type.

Methods: The data for this case control study come from the Georgia Department of Public Health and includes a cohort of births from 2010 - 2014 where all infant deaths due to Sudden Unexpected Infant Death (SUID) causes were included as cases and a 1% systematic random sample of live births were included as controls. Covariates included in the analysis were: insurance type, maternal tobacco use during pregnancy, maternal race and ethnicity, maternal age at birth, maternal education, number of previous live births still living, number of prenatal visits, birthweight. A stratified analysis was conducted of SUID by insurance type. Collinearity and interaction assessments were performed prior to logistic regression analysis. Interaction was assessed using Hierarchal Backwards Elimination.

Results: The stratified analysis showed ORs and 95% CI for each covariate were primarily in the same direction between Medicaid and privately insured births, but estimates for privately insured births tended to be further from the null. The overall OR was 4.10 (95% CI: 3.22, 5.23). Effect modification was observed in many of the strata in the stratified analysis. The collinearity assessment did not indicate any variables needed to be removed from the final model and the stepwise logistic regression did not indicate that interaction terms should be included, though it did indicate that maternal education should be dropped. An adjusted OR of 2.06 (95% CI: 1.50, 2.83) was obtained when controlling for maternal tobacco use during pregnancy, maternal race and ethnicity, maternal age at birth, number of previous live births still living, number of prenatal visits, and birthweight.

Conclusions: Each of the aforementioned factors were associated with SUID and the associations were consistent across insurance type. Those most at risk for SUID include pregnancies with tobacco use, low birthweight infants, and those of Black non-Hispanic race/ethnicity. More studies should be done to further examine factors that determine insurance type which would lead to a better understanding of risk factors for SUID.

Table of Contents

Table of Contents
Background/Literature Review 1
Methods 7
Data Source 7
Study Design 7
Hypothesis 7
Variables 8
Data Analysis 9
Results 10
Descriptive Statistics 10
Stratified Analysis 12
Logistic Regression 12
Discussion 14
Strengths and Weaknesses 16
Future Directions 17
References 19
Tables 21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Infant Sleep Related Deaths Sudden Unexpected Infant Death Maternal Child Health Medicaid SIDS Epidemiology SUID Sudden Infant Death Syndrome
Committee Chair / Thesis Advisor	Carter, John T, GDPH
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local health department

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