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Increasing educational inequality in preterm birth in Québec, Canada, 1981–2006
  1. Nathalie Auger1,2,3,
  2. Federico Roncarolo4,
  3. Sam Harper5
  1. 1Institut national de santé publique du Québec, Montréal, Québec, Canada
  2. 2Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada
  3. 3Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
  4. 4Department of Preventive, Occupational and Community Medicine, Hygiene Section, University of Pavia, Pavia, Italy
  5. 5Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
  1. Correspondence to Dr Nathalie Auger, Institut national de santé publique du Québec, 190, boulevard Crémazie Est, Montréal, Québec H2P 1E2, Canada; nathalie.auger{at}


Background Few studies have evaluated the relationship between preterm birth (PTB) and maternal education over time. We sought to determine whether educational inequalities in PTB have increased in Québec, Canada.

Methods The authors analysed 2 124 909 singleton live births from 1981 to 2006, and computed the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) with 95% CIs for the relationship between maternal education and extreme, very or moderate PTB (≤27, 28–31, and 32–36 completed weeks of gestation, respectively) for five periods (1981–1985, 1986–1990, 1991–1995, 1996–2000, 2001–2006), adjusting for maternal age, marital status, birthplace, language spoken at home, parity and infant sex.

Results Average rates of extreme and moderate PTB increased over time but decreased for very PTB. A statistically significant increase in the RII over time was present for extreme and moderate PTB. The adjusted RII for extreme PTB increased from 1.58 (95% CI 1.24 to 2.01) in 1981–1985 to 3.11 (95% CI 2.54 to 3.81) in 2001–2006. For moderate PTB, the corresponding RIIs were 1.53 (95% CI 1.44 to 1.61) and 1.91 (95% CI 1.81 to 2.01). Absolute differences in the PTB proportion between the least and most educated mothers increased from 1981 to 2006 for extreme (adjusted SII 0.11% vs 0.28%) and moderate PTB (adjusted SII 1.67% vs 3.11%). Absolute differences in the proportion very PTB did not increase.

Conclusions Relative and absolute educational inequalities in extreme and moderate PTB have increased over time in Québec. Relative increases were largest for extreme PTB, and absolute increases were largest for moderate PTB.

  • Educational status
  • premature birth
  • social class
  • socio-economic factors
  • trends
  • perinatal epidemiology
  • premature infants
  • social inequalities
  • socio-economic

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  • Funding This research was not financed with external funds. SH was supported by a Chercheur Boursier Junior 1 from the Fonds de la Recherche en Santé du Québec. The funding sources did not participate in study design, data collection, analysis or interpretation, writing of the report, or in the decision to submit the paper for publication.

  • Competing interests None.

  • Ethics approval This study was performed under the Québec Population Health Surveillance Plan of the health ministry, and ethics approval for the plan was provided by the Comité d'éthique de santé publique.

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