Research Paper: Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs) published in the Journal of Public Health Management & Practice
Naomi Harada Thyden’s previous job at the Minnesota Department of Health (MDH) was an important one - she was in charge of the data surveillance system for sudden unexpected infant deaths (SUIDs) in Minnesota. The difficult work led her to wonder what the public health system could do differently to prevent SUIDs. She was especially concerned by the racial inequities of which infants died suddenly and unexpectedly.
Death investigations are the bedrock public health builds off of for prevention efforts around SUIDs. Thyden’s initial analysis with Minnesota data showcased the need to do further research on the topic. At the University of Minnesota at the School of Public Health and in collaboration with Minnesota Population Center members Jaime Slaughter-Acey, Rachel Widome, John Robert Warren, and Theresa Osypuk, she was able to expand her analysis to a nationwide look at which infants are more likely to receive an incomplete death investigation.
- 24% of SUIDs had incomplete death investigations
- Deaths in rural places were 1.51 times more likely to have incomplete investigations
- Death investigations led by law enforcement were less likely to be complete compared to those led by medical examiners
- American Indian/Alaskan Native SUIDs were more likely than any other group to have an incomplete investigation and were more likely to be rural and led by law enforcement
There are best practices laid out for SUIDs death investigations by the National Association of Medical Examiners, but not every community has the resources to follow those best practices. Rural areas are often less equipped to carry out high quality infant death investigations.
“One solution could be to recruit other health professionals, such as nurses, to do part of the death investigations in rural areas, especially aspects that involve interacting with the families,” Thyden suggested. She pointed to research on a similar program that was successful in England.
“Our public health system collects the worst quality data on sudden, unexpected infant deaths in Indigenous Peoples, the same group that experiences the highest rates of infant deaths,” Thyden said. “As public health practitioners, we need to do more to examine our own systems and their role in propagating inequities.”
The researchers conclude it is important to regularly assess public health infrastructure for structural inequities among underserved and marginalized groups of people. SUIDs should be investigated by a coroner’s or medical examiner’s office rather than law enforcement. And public health agencies should seek out the expertise of Tribal Nations and American Indian/Alaskan Native organizations to get a better understanding of the barriers and needs regarding SUID death investigations.
Funding for this research was provided by the Health Resources and Services Administration and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.