title: Birth outcomes in the Inuit-inhabited areas of Canada.
abstract: BACKGROUND
  Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada.
  
  
  METHODS
  We conducted a cohort study of all births in Canada during 1990-2000 using linked vital data. We identified 13,642 births to residents of Inuit-inhabited areas and 4,054,489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death.
  
  
  RESULTS
  Compared with the rest of Canada, Inuit-inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38-1.52), stillbirth (RR 1.68, 95% CI 1.38-2.04) and infant death (RR 3.61, 95% CI 3.17-4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturity-related conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death remained when the comparisons were restricted to other rural or northern areas of Canada.
  
  
  CONCLUSIONS
  The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas.
authors.affiliation: Department of Obstetrics and Gynecology, Hôpital Sainte-Justine and Université de Montréal, Montréal, Quebec. zhong-cheng.luo@recherche-ste-justine.qc.ca
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo
authors.forename: Sacha
authors.initials: S
authors.lastname: Senécal
authors.forename: Fabienne
authors.initials: F
authors.lastname: Simonet
authors.forename: Eric
authors.initials: E
authors.lastname: Guimond
authors.forename: Christopher
authors.initials: C
authors.lastname: Penney
authors.forename: Russell
authors.initials: R
authors.lastname: Wilkins
mesh_terms: D002170:Canada / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality / Q000208:ethnology* / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*