title: Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010.
abstract: BACKGROUND
  Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada.
  
  
  METHODS
  We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death.
  
  
  RESULTS
  Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all p<0.001). Compared to non-Aboriginal births, preterm birth rates were persistently (1.7-1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7-3.0 times) higher in First Nations births over the study period. Between 1996-2000 and 2006-2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and First Nations infants (all p<0.001).
  
  
  CONCLUSIONS
  Aboriginal vs. non-Aboriginal disparities in adverse birth outcomes, perinatal and infant mortality are persistent or worsening over the recent decade in Quebec, strongly suggesting the needs for interventions to improve perinatal and infant health in Aboriginal populations, and for monitoring the trends in other regions in Canada.
authors.affiliation: Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
authors.forename: Lu
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada; Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada.
authors.forename: Lin
authors.initials: L
authors.lastname: Xiao
authors.affiliation: University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Institut National de Santé Publique du Québec, Montreal, Quebec, H2P 1E2, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Auger
authors.affiliation: Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Torrie
authors.affiliation: First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, G0A 4V0, Canada.
authors.forename: Nancy Gros-Louis
authors.initials: NG
authors.lastname: McHugh
authors.affiliation: Nunavik Regional Board of Health and Social Services, Kuujjuaq, Quebec, J0M1C0, Canada.
authors.forename: Hamado
authors.initials: H
authors.lastname: Zoungrana
authors.affiliation: Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China; Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
authors.forename: Zhong-Cheng
authors.initials: ZC
authors.lastname: Luo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016017:Odds Ratio; D036801:Parturition; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011792:Quebec