Comparison of stillbirth rates by cause among Haitians and non-Haitians in Canada.
OBJECTIVE
To compare rates of stillbirth among Haitians and non-Haitians in Canada.


METHODS
A retrospective cohort study was performed using data on all stillborn and live-born singletons weighing at least 500 g in the province of Quebec, Canada, from 1981 to 2010. Stillbirth rates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for Haitians relative to non-Haitians. The main outcome measure was stillbirth by cause of death.


RESULTS
Data for 9657 stillbirths (124 Haitian) and 2 414 751 live births (17 165 Haitian) were included. Stillbirth rates were higher for Haitians than non-Haitians (7.17 [95% CI 5.91-8.43] vs 3.96 [95% CI 3.88-4.04] per 1000 births), particularly for cord prolapse (adjusted HR 1.87, 95% CI 1.10-3.18) and placental abruption (adjusted HR 2.84, 95% CI 1.95-4.15). Haitians had higher risks of stillbirth due to cord prolapse and abruption at every week of pregnancy. Risks were not elevated for stillbirth due to congenital anomaly, a cause less responsive to urgent intervention.


CONCLUSIONS
Stillbirth rates among Haitians are disproportionately high in Canada, particularly fetal death due to cord prolapse and placental abruption. The potential to reduce stillbirth rates through optimal emergency care in vulnerable minorities requires further investigation.
Institut national de santé publique du Québec, Montreal, QC, Canada; University of Montreal Hospital Research Centre, Montreal, QC, Canada. Electronic address: nathalie.auger@inspq.qc.ca.
Nathalie
N
Auger
Department of Anthropology, McGill University, Montreal, QC, Canada.
André
A
Costopoulos
Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Ashley I
AI
Naimi
Institut national de santé publique du Québec, Montreal, QC, Canada; University of Montreal Hospital Research Centre, Montreal, QC, Canada.
Fulvia
F
Bellingeri
Université Claude Bernard de Lyon, Lyon, France.
Léa
L
Vecchiato
Department of Obstetrics and Gynecology, University of Sherbrooke Hospital Research Centre, Quebec, QC, Canada.
William D
WD
Fraser
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D005260:Female; D006205:Haiti / Q000208:ethnology; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology* / Q000208:ethnology
Emergencies; Placental abruption; Pregnancy complications; Stillbirth; Vulnerable populations