Birth outcomes and infant mortality by the degree of rural isolation among first nations and non-first nations in Manitoba, Canada.
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.
Luo
Zhong-Cheng
ZC
Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada. zhong-cheng.luo@recherche-ste-justine.qc.ca
Wilkins
Russell
R
Heaman
Maureen
M
Martens
Patricia
P
Smylie
Janet
J
Hart
Lyna
L
Simonet
Fabienne
F
Wassimi
Spogmai
S
Wu
Yuquan
Y
Fraser
William D
WD
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
Paediatr Perinat Epidemiol. 2008 Jul;22(4):341-9
18578747
Acta Obstet Gynecol Scand. 1989;68(2):113-7
2589038
Paediatr Perinat Epidemiol. 2004 Jan;18(1):40-50
14738546
J Paediatr Child Health. 2006 Jul-Aug;42(7-8):445-51
16898883
Pediatrics. 2001 Aug;108(2):E35
11483845
J Rural Health. 1992 Summer;8(3):162-70
10121544
Can J Public Health. 2002 Nov-Dec;93 Suppl 2:S21-6
12580386
Med J Aust. 2001 Aug 20;175(4):185-9
11587276
Lancet. 2006 May 27;367(9524):1758-66
16731271
Pediatrics. 2002 Nov;110(5):e64
12415070
J Public Health Med. 1992 Sep;14(3):290-9
1419207
Int J Epidemiol. 2006 Oct;35(5):1211-9
16987848
Int J Circumpolar Health. 2004;63 Suppl 2:80-5
15736627
Pediatrics. 2002 Apr;109(4):627-33
11927707
Chronic Dis Can. 2000;21(1):8-13
10813688
Int J Epidemiol. 2004 Dec;33(6):1252-9
15319396
Am J Epidemiol. 2002 Sep 15;156(6):493-7
12225996
J Biosoc Sci. 2003 Jan;35(1):15-31
12537153
Can J Public Health. 2002 Nov-Dec;93 Suppl 2:S33-8
12580388
J Rural Health. 2007 Winter;23(1):42-8
17300477
J Rural Health. 1991 Summer;7(3):246-65
10114086
Am J Public Health. 2002 Sep;92(9):1491-7
12197982
Am J Public Health. 2006 Dec;96(12):2222-7
17077400
JAMA. 1994 Mar 16;271(11):845-50
8114239
Public Health Nurs. 1999 Jun;16(3):176-81
10388334
J Biosoc Sci. 2006 Jul;38(4):537-51
16762089
J Rural Health. 2005 Summer;21(3):259-62
16092301