Stillbirth and infant mortality in Aboriginal communities in Quebec (original) (raw)
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Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec
Canadian Medical Association Journal, 2013
A ttention has recently been drawn to the paucity of data on rates and causes of stillbirth, a pregnancy outcome that is largely ignored compared with later deaths. 1 Aboriginal populations in Canada rank at the top of the list of disadvantaged groups with the highest rates of stillbirth in the Western world. 1 First Nations and Inuit, 2 distinct Aboriginal populations in Canada, have stillbirth rates that are 2-3 times that among non-Aboriginal Canadians. 1,2 Although these trends are alarming, little data exist to guide prevention efforts among Aboriginal Canadians. Not much is known about how stillbirth rates in Aboriginal populations vary by gestational age or cause of death, despite evidence that prevention requires knowledge on the timing and cause of stillbirth. 3 Opportunities for preventing stillbirth are typically greater after 28 weeks of gestation, 4 particularly at term, but the absence of gestational age-and cause-specific comparisons between Aboriginal and non-Aboriginal Canadians is a major impediment to reducing stillbirth rates. To gain a better understanding of the timing and causes of stillbirth in Inuit and First Nations populations, we estimated gestational age-and cause-specific fetal death rates in the Aboriginal and non-Aboriginal populations in the province of Quebec, where Inuit and First Nations people can be identified by parental information on birth registration forms. Methods Data and variables Data included singleton stillbirths (n = 9983) and live births (n = 2 397 971) in Quebec from 1981 to 2009. We excluded 464 voluntary pregnancy terminations (International Classification of Disease [ICD]-9 code 779.6 and ICD-10 code P96.4). To maximize comparability with the prevailing literature, 5 and because recording was Background: Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age-and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. Methods: Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. Results: Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. Interpretation: Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.
PloS one, 2015
Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to no...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2015
Using a large administrative dataset we examined stillbirth epidemiology in First Nations and non-First Nations pregnancies in Alberta, focusing on previously unexplored longitudinal trends. We undertook a retrospective analysis of de-identified data from 426 945 delivery records for the years 2000 to 2009. Age-adjusted prevalence of antepartum and intrapartum stillbirth were calculated and compared by ethnicity, as were longitudinal changes via average annual percent change analyses. Risk factors were explored via multivariable logistic regression analysis. Overall age-adjusted prevalence of antepartum and intrapartum stillbirth was significantly higher (P < 0.001) in First Nations pregnancies than in non-First Nations pregnancies, and prevalence remained stable over time in both groups. Pre-existing diabetes was a strong predictor of stillbirth. Stillbirth prevalence remains higher in First Nations pregnancies than in non-First Nations. Improved awareness of pre-existing diabet...
Open Women's …, 2010
Objective: Little is known about the possible impacts of neighborhood socioeconomic status on birth outcomes and infant mortality among Aboriginal populations. We assessed birth outcomes and infant mortality by neighborhood socioeconomic status among First Nations and non-First Nations in Manitoba. Study Design: We conducted a retrospective birth cohort study of all live births (26,176 First Nations, 129,623 non-First Nations) to Manitoba residents, 1991-2000. Maternal residential postal codes were used to assign four measures of neighborhood socioeconomic status (concerning income, education, unemployment, and lone parenthood) obtained from 1996 census data. Results: First Nations women were much more likely to live in neighborhoods of low socioeconomic status. First Nations infants were much more likely to die during their first year of life [risk ratio (RR) =1.9] especially during the postneonatal period (RR=3.6). For both First Nations and non-First Nations, living in neighborhoods of low socioeconomic status was associated with an increased risk of infant death, especially postneonatal death. For non-First Nations, higher rates of preterm and small-for-gestational-age birth were consistently observed in low socioeconomic status neighborhoods, but for First Nations the associations were less consistent across the four measures of socioeconomic status. Adjusting for neighborhood socioeconomic status, the disparities in infant and postneonatal mortality between First Nations and non-First Nations were attenuated. Conclusion: Low neighborhood socioeconomic status was associated with an elevated risk of infant death even among First Nations, and may partly account for their higher rates of infant mortality compared to non-First Nations in Manitoba.
Social Science & Medicine, 1999
Infant mortality is investigated for a period of thirty years at the beginning of the 20th century in the Aboriginal Nations community of Fisher River, Manitoba. Infant mortality rates were generated from parish records of infant burials from the Methodist mission at Fisher River and later archived at the United Church Archives in Winnipeg, Man. The average infant mortality rate (IMR) for the total period (1910±1939) was 249 per 1000 live births, an exceedingly high rate compared to modern IMRs and even higher than those in developing countries today. Acute respiratory infections were found to be the cause of death in the majority of cases. These infectious diseases and high rates of postneonatal infant mortality point to conditions of poverty associated with malnutrition as the major precipitating factor in infant death. Fisher River, like other early 20th century First Nations communities in Canada, experienced socioeconomic deprivation because of the decline of the fur trade and the underdevelopment of a reserve economy competing for resources with the Canadian government and Euro-Canadian settlers. These conditions of economic and political marginalization are concluded to be the ultimate causes of high rates of infant mortality and are incorporated in a disease ecology model.
Risks of adverse pregnancy outcomes among Inuit and North American Indian women in Quebec, 1985-97
Paediatric and Perinatal Epidemiology, 2004
We used Statistics Canada's linked stillbirth, live birth and infant death files to assess the risks of adverse pregnancy outcomes among Inuit and North American Indian vs. other ethnic women in Quebec, 1985-97 (1 125 462 singleton births). Mother tongue was used to define ethnicity, with the largest French language group as the reference. Main outcome measures are adjusted odds ratios (AOR) for preterm birth, smallfor-gestational-age (SGA), stillbirth, neonatal and postneonatal death controlled for maternal age, education, marital status, parity, infant sex, community size, and community-level random effects using multilevel logit models.
Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010
PloS one, 2016
Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1...