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a Medical Birth Registry of Norway, University
of Bergen, Norway, b Division of Preventive Medicine, Department of Public Health
and Primary Health Care, University of Bergen, Norway, c Division of Medical Statistics, Department of Public Health
and Primary Health Care, University of Bergen, Norway
Correspondence to: Dr Anne Kjersti Daltveit, Medical Birth Registry of Norway, University of Bergen, Armauer Hansen Building, Haukeland Hospital, N-5021 Bergen, Norway.
Accepted 18 March 1997
Time trends on the association of maternal age, birth order,
and marital status with the risk of sudden infant death syndrome (SIDS)
and non-SIDS deaths in Norway were analysed: 2356 postperinatal SIDS
deaths and 4069 postperinatal non-SIDS deaths were ascertained during
1967-93. The SIDS incidence was 1.25 per 1000 in 1967, reached a peak
of 2.69 in 1988, and fell to 1.22 in 1990 after the initiation of an
intervention programme to avoid prone sleeping. In the entire period,
young maternal age, high birth order, and unmarried motherhood were
associated with SIDS. The adverse effects of young maternal age and
high birth order increased continuously with time. From 1967-71 to
1990-93, the relative risk for maternal age < 20 years
v maternal age 25-29 changed from 2.5 (95% confidence interval 2.0 to 3.2) to 7.0 (95% CI 4.2 to 11.9) (p < 0.0001), and
for birth order 4+ v birth order 1 from 3.2 (95% CI 2.5 to 4.2) to 14.4 (95% CI 8.3 to 24.9) (p < 0.0001). Effects on
non-SIDS deaths were far weaker and no secular trends were observed.
The strong association of young maternal age, high birth order, and marital status in SIDS, but not in non-SIDS, provides evidence that
SIDS is an epidemiological entity. The increasing effects of young
maternal age and high birth order, which continued after the sudden
drop in the SIDS rate in 1990, suggest that further efforts to prevent
SIDS should be aimed particularly at identifying causal mechanisms in
high risk groups.
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