Changing infant death rates: diagnostic shift, success story, or both?

Excerpt

Over the past 20 years there have been remarkable and gratifying falls in the rates of infant deaths in many Western countries due to declining numbers of cases attributed to sudden infant death syndrome (SIDS). This reduction in unexpected infant fatalities has been due in large part to the effects of the “Reduce the Risks” campaigns where community awareness programs were undertaken by local and national SIDS organizations to warn parents and carers of the potential dangers of prone sleeping, cigarette smoke exposure, head covering and overheating [1]. However, in the late 1970s changes in infant mortality had also been noted in a number of jurisdictions which were not due to a real reduction in lethal events, but were due instead to pathologists reassigning causes of death—in this instance from respiratory infections to SIDS [2]. This was termed a diagnostic shift and was clearly identified by a lack of change in overall infant mortality figures. Diagnostic shift was regarded as an unfortunate event which had the potential to influence the recording of mortality figures. …