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→Evidence of association with circumcision: Add text.
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Elhaik found Anglophone countries practice significantly more non-therapeutic neonatal circumcision than non-Anglophone countries and have a significantly higher SIDS rate than non-Anglophone countries.<ref name="elhaik2019" /> Elhaik found great variation in the SIDS mortality rate. Of the 15 countries studied, The Netherlands, where the Dutch do not practice infant circumcision, was the lowest at 0.06 per 1000 births, while the United States where non-therapeutic infant circumcision is commonplace had the highest at 0.82 per 1000 births.<ref name="elhaik2019" /> Hispanic people do not favor circumcision, so relatively few Hispanic boys are circumcised. Elhaik reported a lower incidence of unexplained neonatal death in states with a high Hispanic population.
Elhaik reported that the incidence of SIDS in states where Medicaid pays for non-therapeutic circumcision is higher than that of states where Medicaid does not pay for non-therapeutic circumcision.<ref name="elhaik2019" />
Elhaik pointed out why infant circumcision has such an effect:
<blockquote>
Our finding that MNC is associated with SIDS is not surprising. Circumcision is associated with intra-operative and postoperative risks, including bleeding, shock, sepsis, circulatory shock, hemorrhage, pain, and long-term consequences – all of which contribute toward allostatic load and, thereby, SIDS through various mechanisms. For instance, during circumcision there is an increase in the blood pressure, breathing rate, and heart rate. Even with the most advanced techniques, bleeding occurs in over 15% of the cases, in which case there is a danger that a lower blood volume would result in low blood pressure and reduced amount of oxygen that reaches the tissues. Reduced blood pressure has been associated with obstructive sleep apnea (OSA), a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing. Unsurprisingly, SIDS victims experienced significantly more frequent episodes of OSA. Preterm neonates experience over twice the rate of bleeding complications than full-term neonates. MNC-related complications are unavoidable. For instance, in 1949, Gairdner reported that 16 out of 100,000 UK boys under 1-year old died due to circumcision. In tandem with the lack of evidence of a meaningful and relevant health benefits to the infant, several countries chose to opt out of the operation.<ref name="elhaik2019" />
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