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Adverse birth outcomes and infant mortality according to registered First Nations status and First Nations community residence across Canada

  • Quantitative Research
  • Published:
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Abstract

Objective

Studies of perinatal health outcomes in Canadian First Nations populations have largely focused on limited geographical areas and have been unable to examine outcomes by registered status and community residence. In this study, we compare rates of adverse birth outcomes among First Nations individuals living within vs. outside of First Nations communities and those with vs. without registered status.

Methods

Data included 13,506 singleton pregnancies from the 2006 Canadian Birth-Census Cohort. Outcomes examined included preterm birth (PTB), small- and large-for-gestational-age birth (SGA, LGA), stillbirth, overall infant mortality, and neonatal and postneonatal mortality. Risk ratios (RRs) were estimated with adjustment for maternal age, education, parity, and paternal education.

Results

Mothers living in First Nations communities and those with status had elevated adjusted risks of LGA (RR for First Nations community residence = 1.22, 95% CI = 1.09–1.35; RR for status = 1.50, 95% CI = 1.16–1.93). Rates of SGA were significantly lower among mothers with status (adjusted RR = 0.62, 95% CI = 0.44–0.86). Rates of PTB did not vary substantially by residence or by status. Adjusted differences in fatal outcomes could not be estimated, owing to small cell sizes. However, mothers living in First Nations communities had higher crude rates of infant mortality (10.9 vs. 7.7 per 1000), particularly for neonatal mortality (6.1 vs. 2.9).

Conclusion

Future investigations should explore risk factors, including food security and access to health care services, that may explain disparities in SGA and LGA by status and residence within First Nations populations.

Résumé

Objectif

Les études examinant les issues de santé périnatale des populations canadiennes des Premières Nations examinent, pour la plupart d’entre elles, des étendues géographiques limitées. De plus, ces études n’ont pas pu examiner les issues de santé périnatale selon la statut (statut d’Indien inscrit), ni selon la résidence dans les communautés des Premières Nations. Dans cette étude, notre objectif est d’examiner la prévalence des diverses issues néonatales selon la résidence dans une communauté des Premières Nations ainsi que selon le statut.

Méthodes

13 506 grossesses simples de la cohorte canadienne de naissance du Recensement de 2006 ont été examinées. Les complications néonatales étudiées comprenaient la naissance prématurée, le nouveau-né avec un petit ou un grand poids pour l’âge gestationnel (PAG, GAG), la mortinaissance, la mortalité infantile totale ainsi que la mortalité néonatale et post-néonatale. Les données ont été examinées selon la résidence dans une communauté des Premières Nations ou non et selon l’obtention ou non de statut. Les risques relatifs (RR) ont été estimés avec l’ajustement pour l’âge maternel, le niveau de scolarité de la mère, la parité et le niveau de scolarité du père.

Résultats

Les mères habitant dans une communauté des Premières Nations ainsi que celles qui avaient de statut avaient un risque ajusté élevé de nouveau-né GAG (RR pour la résidence dans une communauté des Premières Nations = 1,22, IC de 95 % : 1,09, 1,35; RR pour le statut = 1,50, IC de 95 % : 1,16, 1,93). La prévalence de nouveau-nés PAG était significativement plus basse chez les mères ayant du statut (RR ajusté = 0,62, IC de 95 % : 0,44, 0,86) comparativement à celles n’ayant pas de statut. La prévalence des naissances prématurées n’a pas significativement varié selon la résidence, ni selon le statut. Les différences ajustées pour les issues fatales n’ont pas pu être estimées en raison de la taille de l’échantillon. Cependant, les mères qui habitaient dans une communauté des Premières Nations avaient un taux brut de mortalité infantile plus élevé (10,9 par 1 000, c. 7,7 par 1000), particulièrement pour la mortalité néonatale (6,1 c. 2,9), comparativement à celles n’habitant pas dans une communauté des Premières Nations.

Conclusion

De futures études sont nécessaires afin d’examiner les facteurs, tel que la sécurité alimentaire et l’accès aux services de santé, pouvant expliquer les différences de prévalence de nouveau-nés PAG et GAG selon le statut et la résidence au sein des populations des Premières Nations.

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Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada

    Gabriel D. Shapiro, Michael S. Kramer, Jay S. Kaufman & Seungmi Yang

  2. Aboriginal Cancer Care Unit, Cancer Care Ontario, Toronto, Canada

    Amanda J. Sheppard

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Amanda J. Sheppard & Angela Mashford-Pringle

  4. Statistics Canada, Ottawa, Canada

    Tracey Bushnik

  5. Department of Pediatrics, McGill University, Montreal, Canada

    Michael S. Kramer

Authors
  1. Gabriel D. Shapiro
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  2. Amanda J. Sheppard
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  3. Tracey Bushnik
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  4. Michael S. Kramer
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  5. Angela Mashford-Pringle
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  6. Jay S. Kaufman
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  7. Seungmi Yang
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Correspondence to Gabriel D. Shapiro.

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Shapiro, G.D., Sheppard, A.J., Bushnik, T. et al. Adverse birth outcomes and infant mortality according to registered First Nations status and First Nations community residence across Canada. Can J Public Health 109, 692–699 (2018). https://doi.org/10.17269/s41997-018-0134-6

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  • DOI: https://doi.org/10.17269/s41997-018-0134-6

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