Contribution of local area deprivation to cultural-linguistic inequalities in foetal growth restriction: trends over time in a Canadian metropolitan centre

Infant mortality among Arabic-speakers in Quebec, Canada, 1989-2017

BACKGROUND

We assessed trends in infant mortality for Arabic-speakers in Quebec, Canada between 1981 and 2017.

METHODS

We computed infant mortality rates for Arabic versus French and English-speakers in Quebec over time. We used adjusted risk ratios (aRR) and 95% confidence intervals (CI) to investigate trends among Arabic-speakers according to socioeconomic status, age, and cause of death.

RESULTS

Infant mortality rates were 3.0 for Arabic-speakers and 5.1 for French and English-speakers per 1,000 live births. Infant mortality increased for Arabic-speakers between 1989-1995 and 2010-2017 (aRR 2.07; 95% CI, 1.04-4.12), but decreased for French and English-speakers (aRR 0.77; 95% CI, 0.73-0.81). The increase in infant mortality was greater for socioeconomically advantaged Arabic-speakers (aRR 2.52; 95% CI, 1.20-5.28) and early neonatal mortality (aRR 1.64; 95% CI, 0.98-2.76).

DISCUSSION

Arabic-speakers in Quebec have a lower risk of infant mortality than French and English-speakers, but increasing infant mortality among Arabic-speakers is narrowing the gap.

Emerging Lingo-Cultural Inequality in Infant Autopsy in Quebec, Canada

We investigated trends in infant autopsy for Francophones and Anglophones in Quebec, Canada. Using death certificates, we extracted 8214 infant deaths between 1989 and 2013. We computed rates of non-autopsy by language, socioeconomic disadvantage, age at death, and period. Using Kitagawa's method, we decomposed non-autopsy rates over time for both language groups. Infant non-autopsy rates increased from 38.6 to 56.2 per 100 for Francophones, and from 41.2 to 57.2 per 100 for Anglophones, between 1989-1995 and 2008-2013. Trends in English-speakers were driven by socioeconomically disadvantaged Anglophones, and were accelerated by a larger proportion of deaths in this group over time. For French-speakers, rates increased in all socioeconomic groups. The increase in non-autopsy rates was larger at early neonatal ages for both languages. These findings suggest that disadvantaged Anglophones are less likely to use infant autopsy over time, and that rates can be improved by targeting early neonatal deaths.

Identifying emerging reproductive vulnerability: an approach to decompose differences in total fertility

PURPOSE

We introduce a method to partition the difference in total fertility between two groups.

METHODS

We computed the total fertility rate for Francophones and Anglophones of Quebec, Canada, between 1989-1993 and 2004-2008. We partitioned the difference in excess fertility for one group relative to the other into the number of children contributed by maternal age, origin, material deprivation, education, and offspring birth order. We calculated the change in total fertility over time and the factors that contributed.

RESULTS

The total fertility rate was higher by 0.18 children for Francophones in 1989-1993, but the gap reversed in 2004-2008, with total fertility higher for Anglophones by 0.12 children. Francophones had higher fertility in 1989-1993 due mainly to women who were Canadian born, aged 15-29 years, without secondary diploma, or living in socioeconomic deprivation. The reversal in 2004-2008 was caused by a reduction in fertility for Francophones aged 15-29 years and an increase in the contribution of Anglophones who were foreign born, aged 30-49 years or socioeconomically disadvantaged.

CONCLUSIONS

Through decomposition of differences in total fertility, we identified populations with emerging reproductive vulnerability in a large Canadian province. Socioeconomically disadvantaged Anglophones in Quebec have increasing fertility, a potential sign of increasing reproductive risk.

Language and infant mortality in a large Canadian province

OBJECTIVES

Infant mortality in minority populations of Canada is poorly understood, despite evidence of ethnic inequality in other countries. We studied infant mortality in different linguistic groups of Quebec, and assessed how language and deprivation impacted rates over time.

STUDY DESIGN

Population-level study of vital statistics data for 1,985,287 live births and 10,283 infant deaths reported in Quebec from 1989 through 2012.

METHODS

We computed infant mortality rates for French, English, and foreign languages according to level of material deprivation. Using Kitagawa's method, we evaluated the impact of changes in mortality rates, and population distribution of language groups, on infant mortality in the province.

RESULTS

Infant mortality declined from 6.05 to 4.61 per 1000 between 1989-1994 and 2007-2012. Most of the decline was driven by Francophones who contributed 1.39 fewer deaths per 1000 births over time, and Anglophones of wealthy and middle socio-economic status who contributed 0.13 fewer deaths per 1000 births. The foreign language population and poor Anglophones contributed more births over time, including 0.08 and 0.02 more deaths per 1000 births, respectively. Mortality decreased for Francophones and Anglophones in each level of deprivation. Rates were lower for foreign languages, but increased over time, especially for the poor.

CONCLUSIONS

Infant mortality rates decreased for Francophones and Anglophones in Quebec, but increased for foreign languages. Poor Anglophones and individuals of foreign languages contributed more births over time, and slowed the decrease in infant mortality. Language may be useful for identifying inequality in infant mortality in multicultural nations.

Stillbirth in an Anglophone minority of Canada

OBJECTIVES

We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority.

METHODS

We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR) by decade from 1981 to 2010, adjusting for maternal characteristics. We analyzed temporal trends by gestational interval and cause of fetal death.

RESULTS

Stillbirth rates decreased in Quebec during the three decades, due to improved rates in Francophones. Rates decreased for Anglophones in 1991-2000, but increased in 2001-2010 at term, during the second trimester, and for most causes of fetal death. In the 2000s, the hazard of stillbirth for Anglophones was nearly the same as the hazard for Francophones in the 1980s (HR 0.93, 95 % confidence interval 0.82, 1.05).

CONCLUSIONS

Stillbirth rates declined in both Francophones and Anglophones before the turn of the century, but increased thereafter for Anglophones, suggesting that linguistic inequalities in stillbirth may be emerging in Quebec. Linguistic status may be a useful marker for surveillance of inequalities in stillbirth.

Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes

Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.