Death investigations are the bedrock upon which public health builds prevention efforts around SUIDs. In Naomi Harada Thyden’s previous role at the Minnesota Department of Health (MDH), she was in charge of data surveillance for sudden unexpected infant deaths (SUIDs), work that led her to wonder what the public health system could do differently to prevent SUIDs. She was especially concerned by the racial inequities of infants who died suddenly and unexpectedly. Thyden’s initial analysis with Minnesota data showcased the need to do further research on the topic. At the University of Minnesota School of Public Health and in collaboration with Minnesota Population Center members Jaime Slaughter-Acey, Rachel Widome, John Robert Warren, and Theresa Osypuk, Thyden was able to expand her analysis to a nationwide look at which infants are more likely to receive an incomplete death investigation. The results of their study were recently published in the Journal of Public Health Management and Practice.

Summary of Findings

• 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

Read the article in JPHMP

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. 

“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.

For more information, read “Structural Bias in the Completeness of Death Investigations for Sudden Unexpected Infant Deaths (SUIDs)” in the March 2024 issue of the Journal of Public Health Management and Practice.

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.

A slightly different version of this article was previously published on the Minnesota Population Center website and is reposted here with permission from the author.