title: Individual- and Community-Level Disparities in Birth Outcomes and Infant Mortality among First Nations, Inuit and Other Populations in Quebec.
abstract: OBJECTIVE: We assessed individual- and community-level disparities and trends in birth outcomes and infant mortality among First Nations (North American Indians) and Inuit versus other populations in Quebec, Canada.  METHODS: A retrospective birth cohort study of all births to Quebec residents, 1991-2000. At the individual level, we examined outcomes comparing births to First Nations and Inuit versus other mother tongue women. At the community level, we compared outcomes among First Nations and Inuit communities versus other communities.  RESULTS: First Nations and Inuit births were much less likely to be small-for-gestational-age but much more likely to be large-for-gestational-age compared to other births at the individual or community level, especially for First Nations. At both levels, Inuit births were 1.5 times as likely to be preterm. At the individual level, total fetal and infant mortality rates were 2 times as high for First Nations, and 3 times as high for Inuit. Infant mortality rates were 2 times as high for First Nations, and 4 times as high for Inuit. There were no reductions in these disparities between 1991-1995 and 1996-2000. Modestly smaller disparities in total fetal and infant mortality were observed for First Nations at the community level (risk ratio=1.6), but for Inuit there were similar disparities at both levels. These disparities remained substantial after adjusting for maternal characteristics.  CONCLUSION: There were large and persistent disparities in fetal and infant mortality among First Nations and Inuit versus other populations in Quebec based on individual- or community-level assessments, indicating a need to improve socioeconomic conditions as well as perinatal and infant care for Aboriginal peoples.
authors.affiliation: Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Canada.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Simonet
authors.forename: Spogmai
authors.initials: S
authors.lastname: Wassimi
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.forename: Patricia
authors.initials: P
authors.lastname: Martens
authors.forename: Nancy G L
authors.initials: NG
authors.lastname: McHugh
authors.forename: Elena
authors.initials: E
authors.lastname: Labranche
authors.forename: Russell
authors.initials: R
authors.lastname: Wilkins
authors.forename: William D
authors.initials: WD
authors.lastname: Fraser
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo