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The Incidence of SIDS in Italy

Although the incidence of SIDS has been described for many countries, no direct data have ever been reported for Italy. The only exception is a retrospective study for the years 1970-1976l conducted by our own group using, however, the surrogate method proposed by Peterson et a1.’ We have now studied prospectively the incidence of SIDS in an area of northern Italy, i.e., the city of Milan and 19 suburban towns. The population studied includes 46,793 live births in the period 1984-1986. We analyzed all the deaths which occurred between 7 days and 1 yr of age, as recorded at the bureau of vital statistics of each area included in the study. This procedure made possible the acquisition of an accurate diagnosis of the cause of death in each case and the identification of the real SIDS group (TABLE 1). The global incidence of SIDS in the period observed is 0.55/1,000, with an infant mortality of 10.4/1,000. The SIDS group differs statistically (p < 0.001) from the group of deaths from other causes by (1) the age at death (mean 14.8, median 10.7 weeks for SIDS vs. mean 8.4, median 3.9 weeks for non-SIDS) (FIG. l), and (2) the prevalence of death during the cold season (85% for SIDS vs. 51% for non-SIDS). SIDS is more frequent in males (62%) and is distributed homogeneously during the weekdays. There is not a substantially different incidence between the city of Milan (29,882 live births, 18 cases of SIDS: 0.6/1,000) and the suburban area (16,471 live births, 8 cases of SIDS: 0.49/1,000). The striking difference between this direct estimate of incidence and the previous indirect one could be explained by the fact that the surrogate method proposed by Peterson does not fit with our population characteristics and also by the fact that the total infant mortality in Italy has impressively decreased in the last years (1970: 29/1,000; 1977: 17.9/1,000; 1985: 10.5/1,000).3-5 SIDS seems to have a surprisingly low incidence in this part of Italy. An extrapolation from these data to the whole Italian population should be done with caution, considering the small sample studied (about 3% of total live births in the entire country) and the significant socioeconomic gaps existing between northern and southern Italy. Nonetheless, the methodology of this study can be utilized in the entire country and we should soon be able to determine the SIDS incidence in a larger and more representative population. All other epidemiologic features are in agreement with previous reports. SIDS is confirmed to be the most frequent single cause of death during the first year of life after the neonatal period.