Abstract

Aims: To investigate the influence of analytical design on the variability of published results in studies of sudden infant death syndrome (SIDS).

Methods: The results of a prospective case-control study, of 203 cases of SIDS, and 622 control infants are presented. All variables significant on univariate analysis were included in a multivariate model analysed in nine stages, starting with sociodemographic variables, then sequentially and cumulatively adding variables relating to pregnancy history, current pregnancy, birth, the interval from birth to the week prior to death, the last week, the last 48 hours, and the last sleep period. A ninth stage was created by adding placed to sleep prone for the last sleep period.

Results: As additional variables are added, previously published SIDS risk factors emerged such as social deprivation, young maternal age, ⩾3 previous live births, maternal smoking and drinking, urinary tract infection in pregnancy, reduced birth weight, and the infant having an illness, regurgitation, being sweaty, or a history of crying/colic in the interval from birth to the week before death, with co-sleeping and the lack of regular soother use important in the last sleep period. As the model progressed through stages 1–9, many significant variables became non-significant (social deprivation, young maternal age, maternal smoking and drinking) and in stage 9 the addition of placed to sleep prone for the last sleep period caused ⩾3 previous live births and a reduced birth weight to become significant.

Conclusion: The variables found to be significant in a case-control study, depend on what is included in a multivariate model.