Department of Obstetrics and Gynecology, Hôpital Sainte-Justine and Université de Montréal, Montréal, Quebec.
CMAJ. 2010 Feb 23;182(3):235-42. doi: 10.1503/cmaj.082042. Epub 2010 Jan 25.
Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada.
We conducted a cohort study of all births in Canada during 1990-2000 using linked vital data. We identified 13,642 births to residents of Inuit-inhabited areas and 4,054,489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death.
Compared with the rest of Canada, Inuit-inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38-1.52), stillbirth (RR 1.68, 95% CI 1.38-2.04) and infant death (RR 3.61, 95% CI 3.17-4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturity-related conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death remained when the comparisons were restricted to other rural or northern areas of Canada.
The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas.
了解原住民和非原住民之间的健康差距信息对于制定旨在减少此类差距的公共卫生计划至关重要。加拿大因纽特人和非因纽特人群之间在出生结果方面的数据不足，促使我们比较了因纽特人居住地区与该国其他地区以及加拿大其他农村和北部地区的出生结果。
我们使用链接的生命数据对 1990-2000 年期间加拿大的所有出生情况进行了队列研究。我们确定了 13642 例因纽特人居住地区居民的分娩和 4054489 例其他所有地区居民的分娩。主要结局指标为早产、死产和婴儿死亡。
与加拿大其他地区相比，因纽特人居住地区的早产率（风险比[RR]1.45，95%置信区间[CI]1.38-1.52）、死产率（RR1.68，95%CI1.38-2.04）和婴儿死亡率（RR3.61，95%CI3.17-4.12）均高得多。这些结果的风险比和风险差异随时间变化不大。所有婴儿死亡的主要原因（包括先天性异常[RR1.64]、与不成熟相关的疾病[RR2.96]、窒息[RR2.43]、婴儿猝死综合征[RR7.15]、感染[RR8.32]和外部原因[RR7.30]）的死亡率均过高。产妇特征仅占风险差异的一小部分。当将比较限制在加拿大其他农村或北部地区时，早产、死产和婴儿死亡的风险比仍较高。
与加拿大其他地区和其他农村和北部地区相比，因纽特人居住地区的早产、死产和婴儿死亡率要高得多。迫切需要采取更有效的干预措施来改善因纽特人居住地区的母婴健康。
