Margaret A.WinkerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor
To the Editor.—The articles regarding ethnoracial differences in nicotine metabolism and intake1,2 suggest a potential explanation for differences in the rates of sudden infant death syndrome (SIDS) found in blacks and whites. SIDS is the leading cause of postneonatal mortality in the United States, accounting for 3397 infant deaths in 1995.3 The SIDS rate among blacks (1.79/1000 live births) is almost 3 times higher than that among whites (0.71/1000 live births).3 Maternal smoking during pregnancy and exposing the infant to environmental tobacco smoke after birth are known to be powerful risk factors for SIDS.4 It is not known through what mechanism(s) tobacco acts to cause this increased risk. It is possible that increased nicotine intake and diminished nonrenal clearance among blacks contributes to their higher SIDS rate through this currently unknown mechanism.
Krous HF, Hauck FR. Racial and Ethnic Differences in Serum Cotinine Levels. JAMA. 1998;280(24):2075-2076. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-24-jbk1223