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Editor,—Kerr et alreport a highly significant association between H pylori infection and SIDS. This finding raises the possibility of (and a plausible mechanism for) a link between dwelling crowding and SIDS, as there are a number of studies that have documented a strong relation between dwelling crowding and H pylori infection.1 2 Close person to person contact and increased exposure to the infective agent is a likely cause of this relationship. Dwelling crowding has also been associated with increased passive exposure to tobacco smoke, and this, coupled with parental smoking being strongly associated with SIDS,3provides yet another clear link between dwelling crowding and SIDS.
There are likely to be many causes of dwelling crowding. It has often been associated with low socioeconomic status, but the study by Elitsuret al 4 suggests that there may be a direct link between crowding and H pylori infection, which is independent of socioeconomic status. SIDS has also been associated with lower environmental temperature and it is possible that the increase in SIDS rate during winter is in part relate to the increased dwelling crowding during such times.
Very few studies have examined the links between dwelling crowding and SIDS. One recently published study found only a non-significant increase in relative risk for SIDS associated with dwelling crowding.5 Given the importance of SIDS and the growing body of evidence suggesting H pylori as a cause of SIDS, it would be pertinent for future studies to consider dwelling crowding in more detail.
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