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Individual- and Community-Level Disparities in Birth Outcomes and Infant Mortality among First Nations, Inuit and Other Populations in Quebec~!2009-12-01~!2010-04-12~!2010-07-06~!

Fabienne Simonet · Spogmai Wassimi · Maureen I. Heaman · Janet K. Smylie · Patricia Joan Martens · Nancy Gros-Louis McHugh +4 more

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Indigenous Health, Education, and Rights Maternal and Neonatal Healthcare Indigenous Health and Education

Abstract

OBJECTIVE: We assessed individual- and community-level disparities and trends in birth outcomes and infant mortality among First Nations (North American Indians) and Inuit versus other populations in Quebec, Canada. METHODS: A retrospective birth cohort study of all births to Quebec residents, 1991-2000. At the individual level, we examined outcomes comparing births to First Nations and Inuit versus other mother tongue women. At the community level, we compared outcomes among First Nations and Inuit communities versus other communities. RESULTS: First Nations and Inuit births were much less likely to be small-for-gestational-age but much more likely to be large-for-gestational-age compared to other births at the individual or community level, especially for First Nations. At both levels, Inuit births were 1.5 times as likely to be preterm. At the individual level, total fetal and infant mortality rates were 2 times as high for First Nations, and 3 times as high for Inuit. Infant mortality rates were 2 times as high for First Nations, and 4 times as high for Inuit. There were no reductions in these disparities between 1991-1995 and 1996-2000. Modestly smaller disparities in total fetal and infant mortality were observed for First Nations at the community level (risk ratio=1.6), but for Inuit there were similar disparities at both levels. These disparities remained substantial after adjusting for maternal characteristics. CONCLUSION: There were large and persistent disparities in fetal and infant mortality among First Nations and Inuit versus other populations in Quebec based on individual- or community-level assessments, indicating a need to improve socioeconomic conditions as well as perinatal and infant care for Aboriginal peoples.

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2009Indigenous health part 1: determinants and disease patterns 1996Aboriginal health.2006Understanding the health of Indigenous peoples in Canada: key methodological and conceptual challenges 2006Patterns, trends, and increasing disparities in mortality for Aboriginal and non-Aboriginal infants born in Western Australia, 1980–2001: population database study 2000An assessment of the validity of a computer system for probabilistic record linkage of birth and infant death records in Canada. The Fetal and Infant Health Study Group.2009Indigenous children's health report: health assessment in action.

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