# Global, regional, and national burden of sudden infant death syndrome and the impact of COVID-19: a trend and health inequality analysis based on the global burden of disease study 2021

## TL;DR

This study examines the global decline in sudden infant death syndrome (SIDS) and how the pandemic may have slowed progress, especially in low-income regions.

## Contribution

The study provides the first comprehensive analysis of SIDS trends and health inequalities during the COVID-19 pandemic using GBD 2021 data.

## Key findings

- Global SIDS burden decreased by 58.97% from 1990 to 2021, but low-SDI regions still face disproportionately higher rates.
- The pandemic may have caused a plateau in SIDS reduction, reversing prior downward trends in some areas.
- Higher sociodemographic status is linked to lower SIDS burden, highlighting persistent health inequalities.

## Abstract

Current sudden infant death syndrome (SIDS) epidemiological patterns and COVID-19 impacts remain uncertain. We therefore conducted this global, regional, and national epidemiological study using data from the Global Burden of Disease Study (GBD) 2021.

This study analyzed GBD-based population data on SIDS disability-adjusted life years (DALYs). Age-standardized DALY rates (ASDR; per 100,000 population) with 95% uncertainty intervals (UIs) were calculated for 204 countries and territories, stratified by age, location, and socio-demographic index (SDI).

In 2021, the ASDR of SIDS accounted for 44.16 (95% UI: 25.70–59.26) per 100,000 population globally, which was a 58.97% decrease from 1990. The low and low-middle SDI quintiles exhibited a disproportionately higher disease burden of SIDS among the five SDI quintiles in 2021. Higher sociodemographic status showed an inverse association with SIDS burden, with high-SDI countries demonstrating a greater reduction compared to low-SDI counterparts from 1990 to 2021 based on age-period-cohort analysis. Although the global burden of SIDS had maintained a sustained downward trend prior to the pandemic, COVID-19 disruptions may have attenuated mitigation progress, with trend analysis suggesting a possible plateau in SIDS burden during this period rather than continued decline. Study findings indicate that although the global incidence of SIDS has shown a steady decline, persistent regional disparities underscore long-standing public health challenges.

The burden of SIDS-related DALYs remains substantial, and its post-pandemic evolution trends necessitate dynamic tracking through robust epidemiological surveillance systems.