title: Birth outcomes and infant mortality by the degree of rural isolation among first nations and non-first nations in Manitoba, Canada.
abstract: BACKGROUND
  It is unknown whether rural isolation may affect birth outcomes and infant mortality differentially for Indigenous versus non-Indigenous populations. We assessed birth outcomes and infant mortality by the degree of rural isolation among First Nations (North American Indians) and non-First Nations populations in Manitoba, Canada, a setting with universal health insurance.
  
  
  METHODS
  A geocoding-based birth cohort study of 25,143 First Nations and 125,729 non-First Nations live births to Manitoban residents, 1991-2000. Degree of rural isolation was defined by an indicator of urban influence (no, weak, moderate/strong) based on the percentage of the workforce commuting to urban areas.
  
  
  RESULTS
  Preterm birth and low birth weight rates were somewhat lower in all rural areas regardless of the degree of isolation as compared to urban areas for both First Nations and non-First Nations. Infant mortality rates were not significantly different across areas for First Nations (10.7, 9.9, 7.9, and 9.7 per 1,000 in rural areas with no, weak, moderate/strong urban influence, and urban areas, respectively), but rates were significantly lower in less isolated areas for non-First Nations (7.4, 6.0, 5.6, and 4.6 per 1,000, respectively). Adjusted odds ratios showed similar patterns.
  
  
  CONCLUSIONS
  Living in less isolated areas was associated with lower infant mortality only among non-First Nations. First Nations infants do not seem to have similarly benefited from the better health care facilities in urban centers, suggesting a need to improve urban First Nations' infant care in meeting the challenges of increasing urban migration.
authors.affiliation: Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada. zhong-cheng.luo@recherche-ste-justine.qc.ca
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo
authors.forename: Russell
authors.initials: R
authors.lastname: Wilkins
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.forename: Patricia
authors.initials: P
authors.lastname: Martens
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.forename: Lyna
authors.initials: L
authors.lastname: Hart
authors.forename: Fabienne
authors.initials: F
authors.lastname: Simonet
authors.forename: Spogmai
authors.initials: S
authors.lastname: Wassimi
authors.forename: Yuquan
authors.initials: Y
authors.lastname: Wu
authors.forename: William D
authors.initials: WD
authors.lastname: Fraser
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D007226:Infant Mortality / Q000208:ethnology / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D012189:Retrospective Studies; D012424:Rural Population; D055815:Young Adult
references.citation: Paediatr Perinat Epidemiol. 2008 Jul;22(4):341-9
references.pmid: 18578747
references.citation: Acta Obstet Gynecol Scand. 1989;68(2):113-7
references.pmid: 2589038
references.citation: Paediatr Perinat Epidemiol. 2004 Jan;18(1):40-50
references.pmid: 14738546
references.citation: J Paediatr Child Health. 2006 Jul-Aug;42(7-8):445-51
references.pmid: 16898883
references.citation: Pediatrics. 2001 Aug;108(2):E35
references.pmid: 11483845
references.citation: J Rural Health. 1992 Summer;8(3):162-70
references.pmid: 10121544
references.citation: Can J Public Health. 2002 Nov-Dec;93 Suppl 2:S21-6
references.pmid: 12580386
references.citation: Med J Aust. 2001 Aug 20;175(4):185-9
references.pmid: 11587276
references.citation: Lancet. 2006 May 27;367(9524):1758-66
references.pmid: 16731271
references.citation: Pediatrics. 2002 Nov;110(5):e64
references.pmid: 12415070
references.citation: J Public Health Med. 1992 Sep;14(3):290-9
references.pmid: 1419207
references.citation: Int J Epidemiol. 2006 Oct;35(5):1211-9
references.pmid: 16987848
references.citation: Int J Circumpolar Health. 2004;63 Suppl 2:80-5
references.pmid: 15736627
references.citation: Pediatrics. 2002 Apr;109(4):627-33
references.pmid: 11927707
references.citation: Chronic Dis Can. 2000;21(1):8-13
references.pmid: 10813688
references.citation: Int J Epidemiol. 2004 Dec;33(6):1252-9
references.pmid: 15319396
references.citation: Am J Epidemiol. 2002 Sep 15;156(6):493-7
references.pmid: 12225996
references.citation: J Biosoc Sci. 2003 Jan;35(1):15-31
references.pmid: 12537153
references.citation: Can J Public Health. 2002 Nov-Dec;93 Suppl 2:S33-8
references.pmid: 12580388
references.citation: J Rural Health. 2007 Winter;23(1):42-8
references.pmid: 17300477
references.citation: J Rural Health. 1991 Summer;7(3):246-65
references.pmid: 10114086
references.citation: Am J Public Health. 2002 Sep;92(9):1491-7
references.pmid: 12197982
references.citation: Am J Public Health. 2006 Dec;96(12):2222-7
references.pmid: 17077400
references.citation: JAMA. 1994 Mar 16;271(11):845-50
references.pmid: 8114239
references.citation: Public Health Nurs. 1999 Jun;16(3):176-81
references.pmid: 10388334
references.citation: J Biosoc Sci. 2006 Jul;38(4):537-51
references.pmid: 16762089
references.citation: J Rural Health. 2005 Summer;21(3):259-62
references.pmid: 16092301