Infant mortality among First Nations versus non-First Nations in British Columbia: temporal trends in rural versus urban areas, 1981-2000.
BACKGROUND
Increasingly more First Nations (FN) people have moved from rural to urban areas. It is unknown how disparities in infant mortality among FN versus non-FN women have changed over time in urban versus rural areas.


METHODS
We conducted a birth cohort-based study of all 877 925 live births (56 771 FN and 821 154 non-FN) registered in British Columbia, 1981-2000. Main outcomes included rates, risk differences, and relative risks of neonatal, postneonatal, and overall infant death.


RESULTS
Both neonatal and postneonatal mortality rates for FN infants showed a steady decline in rural areas but a rise-and-fall pattern in urban areas. Relative risks for overall infant death among FN versus non-FN infants declined steadily from 2.75 (95% CI: 2.04, 3.72) to 1.87 (95% CI: 1.24, 2.81) in rural areas from 1981-1984 to 1997-2000, but rose from 1.59 (95% CI: 1.27, 1.99) (1981-1984) to 2.80 (2.33-3.37) (1989-92) and then fell to 1.89 (1.44-2.49) (1997-2000) in urban areas. Risk differences for neonatal death among FN versus non-FN infants declined substantially over time in rural but not urban areas. The disparities in neonatal death among FN versus non-FN were largely explained by differences in preterm birth, while the disparities in postneonatal death were not explained by observed maternal and pregnancy characteristics.


CONCLUSIONS
Reductions in disparities in infant mortality among FN versus non-FN women have been less substantial and consistent over time in urban versus rural areas of British Columbia, suggesting the need for greater attention to FN maternal and infant health in urban areas.
Department of Epidemiology and Biostatistics, McGill University, Canada.
Zhong-Cheng
ZC
Luo
William J
WJ
Kierans
Russell
R
Wilkins
Robert M
RM
Liston
Soo-Hong
SH
Uh
Michael S
MS
Kramer
D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008429:Maternal Welfare; D011247:Pregnancy; D011256:Pregnancy Outcome; D012306:Risk; D012424:Rural Population; D014505:Urban Population; D044465:White People