title: Community Remoteness, Perinatal Outcomes and Infant Mortality among First Nations in Quebec.
abstract: OBJECTIVE: Little is known about community remoteness in relation to birth outcomes among Indigenous populations. We assessed whether community remoteness matters for perinatal outcomes and infant mortality in Quebec First Nations communities.  STUDY DESIGN: A retrospective cohort study of all births (n=11,033) to residents of First Nations communities in Quebec 1991-2000, using linked vital statistics data. First Nations communities were grouped by community remoteness into four zones from the least to most remote.  RESULTS: Preterm birth rates declined progressively from the least remote (8.0%) to the most remote (5.7%) zones (p=0.002). In contrast, total fetal and infant mortality rose progressively from the least remote (10.4 per 1000) to the most remote (22.7 per 1000) zones (p<0.001). The excess infant mortality in the more remote zones was mainly due to higher rates of postneonatal mortality. Similar patterns were observed after adjusting for maternal age, education, parity and marital status. Substantially elevated risks in most remote communities remained for perinatal death (adjusted OR=2.1), postneonatal death (adjusted OR=2.7), and total fetal and infant death (adjusted OR=2.3).  CONCLUSION: Living in more remote First Nations communities was associated with a substantially higher risk of fetal and infant death, especially postneonatal death, despite a lower risk of preterm delivery. There is a need for more effective perinatal and infant care programs in more remote First Nations communities to reduce perinatal and infant mortality.
authors.affiliation: Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Canada.
authors.forename: Spogmai
authors.initials: S
authors.lastname: Wassimi
authors.forename: Nancy G L
authors.initials: NG
authors.lastname: McHugh
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: Fabienne
authors.initials: F
authors.lastname: Simonet
authors.forename: William D
authors.initials: WD
authors.lastname: Fraser
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo