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International comparison of sudden unexpected death in infancy rates using a newly proposed set of cause-of-death codes
  1. Barry J Taylor1,
  2. Joanna Garstang2,
  3. Adele Engelberts3,
  4. Toshimasa Obonai4,
  5. Aurore Cote5,
  6. Jane Freemantle6,
  7. Mechtild Vennemann7,
  8. Matt Healey1,
  9. Peter Sidebotham2,
  10. Edwin A Mitchell8,
  11. Rachel Y Moon9,10
  1. 1Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  2. 2Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
  3. 3Department of Pediatrics, Orbis Medical Center, Sittard, The Netherlands
  4. 4Department of Pediatrics, Tama-Hokubu Medical Center, Higashi-Murayama, Japan
  5. 5Respiratory Medicine Division, Montreal Children's Hospital, McGill University, Montreal, Canada
  6. 6Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
  7. 7Institute of Legal Medicine, University Hospital Munster, Munster, Germany
  8. 8Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  9. 9Division of General Pediatrics and Community Health, Children's National Health System, Washington DC, USA
  10. 10Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA
  1. Correspondence to Dr Rachel Y Moon, Division of General Pediatrics and Community Health, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA; rmoon{at}


Background Comparing rates of sudden unexpected death in infancy (SUDI) in different countries and over time is difficult, as these deaths are certified differently in different countries, and, even within the same jurisdiction, changes in this death certification process have occurred over time.

Aims To identify if International Classification of Diseases-10 (ICD-10) codes are being applied differently in different countries, and to develop a more robust tool for international comparison of these types of deaths.

Methods Usage of six ICD-10 codes, which code for the majority of SUDI, was compared for the years 2002–2010 in eight high-income countries.

Results There was a great variability in how each country codes SUDI. For example, the proportion of SUDI coded as sudden infant death syndrome (R95) ranged from 32.6% in Japan to 72.5% in Germany. The proportion of deaths coded as accidental suffocation and strangulation in bed (W75) ranged from 1.1% in Germany to 31.7% in New Zealand. Japan was the only country to consistently use the R96 code, with 44.8% of SUDI attributed to that code. The lowest, overall, SUDI rate was seen in the Netherlands (0.19/1000 live births (LB)), and the highest in New Zealand (1.00/1000 LB). SUDI accounted for one-third to half of postneonatal mortality in 2002–2010 for all of the countries except for the Netherlands.

Conclusions The proposed set of ICD-10 codes encompasses the codes used in different countries for most SUDI cases. Use of these codes will allow for better international comparisons and tracking of trends over time.

  • SIDS
  • Mortality

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