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ABSTRACT: An important step in monitoring progress toward reducing or eliminating inequalities in health is to determine the distribution of mortality rates across various groups defined by education, occupation, income, language, ethnicity, and Aboriginal, visible minority and disability status. This article describes the methods used to link census data from the long-form questionnaire to mortality data, and reports simple findings for the major groups.
Mortality from June 4, 1991 to December 31, 2001 was tracked among a 15% sample of the adult population of Canada, who completed the 1991 census long-form questionnaire (about 2.7 million, including 260,000 deaths). Age-specific and age-standardized mortality rates were calculated across the various groups, as were hazard ratios and period life tables.
Compared with people of higher socio-economic status, mortality rates were elevated among those of lower socio-economic status, regardless of whether status was determined by education, occupation or income. The findings reveal a stair-stepped gradient, with bigger steps near the bottom of the socio-economic hierarchy.
Health reports / Statistics Canada, Canadian Centre for Health Information = Rapports sur la santé / Statistique Canada, Centre canadien d'information sur la santé 10/2008; 19(3):25-43. · 3.26 Impact Factor
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ABSTRACT: Evidence points to an association between a mother's place of residence and her newborn's health, independent of individual characteristics. Neighbourhood constructs such as immigrant density, deprivation and crime have all been separately associated with birth outcomes. Little research has considered the joint influence of variables representing a spectrum of neighbourhood constructs. Subjective vs. objective measures of neighbourhood constructs (e.g. reported vs. perceived crime) are often not considered. We sought to evaluate the relationship between neighbourhood measures of reported crime, neighbourhood perceived security, immigrant density, material/social deprivation, residential stability and the odds of small-for-gestational-age (SGA) birth in an urban setting in Canada. Neighbourhood was defined as police districts (n = 49). We linked Montreal livebirths 1997-2001 (n = 98 330) to police district crime measures, survey data on perceived security, and 2001 census data. We used multi-level analysis to calculate odds ratios (OR) for neighbourhood effects on SGA birth accounting for individual characteristics. Mothers residing in neighbourhoods with the most favourable perception had a lower odds of SGA birth than neighbourhoods with the least favourable perception [OR 0.87, 95% CI 0.77, 0.97]. Mothers in neighbourhoods with lower proportions of immigrants had lower odds of SGA birth relative to neighbourhoods with the highest proportion of immigrants. Reported crime, residential stability and material/social deprivation (accounting for neighbourhood perception) were not associated with SGA birth. Immigrant density and subjective perceptions of neighbourhood security are associated with SGA birth. Public health strategies to improve fetal growth should target neighbourhoods with low perceived security and high immigrant density.
Paediatric and Perinatal Epidemiology 10/2008; 22(5):467-77. · 2.31 Impact Factor
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ABSTRACT: After studying the epidemiologic transition’s situation in Canada, it is determined that the delimitation of temporal stages within the epidemiologic transition as put forward by Omran (1971, 1998), Olshansky and Ault (1986), Rogers and Hackenberg (1987) and Olshansky et al. (1998) does not suit the Canadian evolution. Many of the researchers’ postulates on the epidemiologic transition were not confirmed, which leads us to assert that, since 1958, the epidemiologic transition is best described as an evolution process rather than specific stages confined within time limits.
Demographic Research 02/2008; 18(19):531-568. · 1.20 Impact Factor
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ABSTRACT: Interpregnancy interval (IPI), marital status, and neighborhood are independently associated with birth outcomes. The joint contribution of these exposures has not been evaluated. We tested for effect modification between IPI and marriage, controlling for neighborhood.
We analyzed a cohort of 98,330 live births in Montréal, Canada from 1997-2001 to assess IPI and marital status in relation to small for gestational age (SGA) birth. Births were categorized as subsequent-born with short (<12 months), intermediate (12-35 months), or long (36+ months) IPI, or as firstborn. The data had a 2-level hierarchical structure, with births nested in 49 neighborhoods. We used multilevel logistic regression to obtain adjusted effect estimates.
Marital status modified the association between IPI and SGA birth. Being unmarried relative to married was associated with SGA birth for all IPI categories, particularly for subsequent births with short (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31-1.95) and intermediate (OR 1.48, 95% CI 1.26-1.74) IPIs. Subsequent births had a lower likelihood of SGA birth than firstborns. Intermediate IPIs were more protective for married (OR 0.50, 95% CI 0.47-0.54) than unmarried mothers (OR 0.65, 95% CI 0.56-0.76).
Being unmarried increases the likelihood of SGA birth as the IPI shortens, and the protective effect of intermediate IPIs is reduced in unmarried mothers. Marital status should be considered in recommending particular IPIs as an intervention to improve birth outcomes.
BMC Pregnancy and Childbirth 01/2008; 8:7. · 2.83 Impact Factor
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ABSTRACT: Abstract
Background
Interpregnancy interval (IPI), marital status, and neighborhood are independently associated with birth outcomes. The joint contribution of these exposures has not been evaluated. We tested for effect modification between IPI and marriage, controlling for neighborhood.
Methods
We analyzed a cohort of 98,330 live births in Montréal, Canada from 1997–2001 to assess IPI and marital status in relation to small for gestational age (SGA) birth. Births were categorized as subsequent-born with short (<12 months), intermediate (12–35 months), or long (36+ months) IPI, or as firstborn. The data had a 2-level hierarchical structure, with births nested in 49 neighborhoods. We used multilevel logistic regression to obtain adjusted effect estimates.
Results
Marital status modified the association between IPI and SGA birth. Being unmarried relative to married was associated with SGA birth for all IPI categories, particularly for subsequent births with short (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.31–1.95) and intermediate (OR 1.48, 95% CI 1.26–1.74) IPIs. Subsequent births had a lower likelihood of SGA birth than firstborns. Intermediate IPIs were more protective for married (OR 0.50, 95% CI 0.47–0.54) than unmarried mothers (OR 0.65, 95% CI 0.56–0.76).
Conclusion
Being unmarried increases the likelihood of SGA birth as the IPI shortens, and the protective effect of intermediate IPIs is reduced in unmarried mothers. Marital status should be considered in recommending particular IPIs as an intervention to improve birth outcomes.
BMC Pregnancy and Childbirth. 01/2008;
