Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada – CMAJ

May 29, 2017

  1. Hua He, MD MSc,
  2. Lin Xiao, MS,
  3. Jill Elaine Torrie, MSc,
  4. Nathalie Auger, MD MSc,
  5. Nancy Gros-Louis McHugh, MSc,
  6. Hamado Zoungrana, MSc,
  7. Zhong-Cheng Luo, MD PhD

Author Affiliations

  1. Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que.
  1. Correspondence to: Zhong-Cheng Luo, zc_luo@yahoo.com


BACKGROUND: Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada.

METHODS: We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010.

RESULTS: Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99–2.11; fully adjusted RR 1.43, 95% CI 1.37–1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87–2.05; fully adjusted RR 1.37, 95% CI 1.24–1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for First Nations infants in 12 of 16 disease categories and for Inuit infants in 7 of 16 disease categories. Maternal characteristics (age, education, marital status, parity, rural residence and Northern residence) partly explained the risk elevations, but maternal chronic illnesses and gestational complications had negligible influence overall. Acute bronchiolitis (risk difference v. non-Indigenous infants, First Nations 37.0 per 1000, Inuit 39.6 per 1000) and pneumonia (risk difference v. non-Indigenous infants, First Nations 41.2 per 1000, Inuit 61.3 per 1000) were the 2 leading causes of excess hospitalizations in Indigenous infants.

INTERPRETATION: First Nations and Inuit infants had substantially elevated burdens of hospitalizations as a result of diseases of multiple systems. The findings identify substantial unmet needs in disease prevention and medical care for Indigenous infants.


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