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Birth outcomes and infant mortality among First Nations Inuit, and non-Indigenous women by northern versus southern residence, Quebec


Background In circumpolar countries such as Canada, northern regions represent a unique geographical entity climatically, socioeconomically and environmentally. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions.

Methods A cohort study of all births by maternal mother tongue to residents of northern (2616 First Nations (North American Indians), 2388 Inuit and 5006 non-Indigenous) and southern (2563 First Nations, 810 643 non-Indigenous) Quebec, 1991–2000.

Results Compared with births to southern non-Indigenous mother tongue women, births to northern women of all three mother tongue groups were at substantially elevated risks of infant death (adjusted OR (aOR) 1.7–2.9), especially postneonatal death (aOR 2.2–4.4) after controlling for maternal education, age, marital status and parity. The risk elevation in perinatal death was greater for southern First Nations (aOR 1.6) than for northern First Nations (aOR 1.2). Infant macrosomia was highly prevalent among First Nations in Quebec, especially in the north (31% vs 24% in the south). Within northern regions, Inuit births were at highest risk of preterm delivery (aOR 1.4) and infant death (aOR 1.6).

Conclusion All northern infants (First Nations, Inuit or non-Indigenous) were at substantially elevated risk of infant death in Quebec, despite a universal health insurance system. Southern First Nations newborns have not benefited from the more advanced perinatal care facilities in southern regions. Environmental influences may partly account for the very high prevalence of macrosomia among First Nations in northern Quebec.

  • Aboriginal populations
  • infant mortality
  • maternal mother tongue
  • North American Indians
  • perinatal epidemiology
  • perinatal mortality
  • post-neonatal mortality
  • pregnancy

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  • Funding This study was supported by a research grant from the Canadian Institutes of Health Research, Institute of Aboriginal Peoples' Health (CIHR-IAPH grant no 73551 to ZCL). ZCL was supported by a clinical epidemiology junior scholar award from the Fonds de Recherche en Santé du Québec (FRSQ), and a CIHR new investigator award. FS was supported by a PhD studentship from the CIHR Strategic Training Initiative in Research in Reproductive Health Science and Quebec Training Network in Perinatal Research. MH was supported by a CIHR new investigator award and a CIHR chair in gender and health. JS was supported by a CIHR new investigator award. PJM was supported by a CIHR new investigator award and a CIHR/Public Health Agency of Canada applied public health chair award. WDF was supported by a CIHR Canada research chair award.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the research ethics board of Sainte-Justine Hospital, University of Montreal, the Nunavik Nutrition and Health Committee and First Nations of Quebec and Labrador Health and Social Services Commission.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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