Abstract
Objectives
We evaluated temporal and regional inequalities in adverse birth outcomes between Anglophones and Francophones of a Canadian province.
Methods
Odds ratios and rate differences in preterm birth (PTB, <37 gestational weeks) and small-for-gestational-age (SGA) birth were computed for Anglophones relative to Francophones for singleton live births in Québec from 1981 to 2008 (N = 2,292,237), adjusting for maternal characteristics. Trends over time and residential region were evaluated.
Results
Rates of PTB and SGA birth overall were lower for Anglophones relative to Francophones, but temporal and regional trends varied by outcome. Although PTB rates increased over time, inequalities between Francophones and Anglophones were relatively stable. In contrast, inequalities in SGA birth narrowed over time as Francophone rates declined more than Anglophones. Inequalities in SGA birth favored Anglophones overall, but the gap gradually reversed in Montréal (the largest metropolitan center) to currently favor Francophones.
Conclusions
PTB and SGA birth rates favored Anglophones over Francophones. The linguistic gap was generally stable over time for PTB, but narrowed or reversed for SGA birth. Language may be used to capture inequalities in perinatal health in countries where different linguistic groups predominate.
Résumé
Objectif
Nous avons évalué les tendances temporelles et régionales de la santé périnatale d’une province canadienne entre anglophones et francophones.
Méthodes
Les rapports de cotes et les différences de taux pour la prématurité et le retard de croissance intra-utérin (RCI) entre anglophones et francophones ont été calculés par période et par région pour 2,292,237 naissances simples au Québec de 1981 à 2008.
Résultats
Les taux de prématurité et de RCI étaient plus faibles pour les anglophones comparativement aux francophones, par contre les tendances temporelles et régionales variaient. Les taux de prématurité augmentaient dans le temps, mais les inégalités linguistiques sont restés stables. Les inégalités linguistiques pour le RCI se sont rétrécies dans le temps à cause d’une réduction plus rapide des taux francophones. Les taux de RCI favorisaient néanmoins globalement les anglophones, à l’exception de Montréal où les inégalités se sont inversées.
Conclusions
Les issues de naissance étaient généralement plus favorables chez les Anglophones. Les inégalités linguistiques étaient stables pour la prématurité et se sont réduites ou inversées pour le RCI. L’appartenance linguistique pourrait être utilisée pour identifier les inégalités de santé périnatale dans d’autres pays.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ananth CV, Misra DP, Demissie K, Smulian JC (2001) Rates of preterm delivery among Black women and White women in the United States over two decades: an age-period-cohort analysis. Am J Epidemiol 154:657–665
Auger N, Denis G (2012) Late pregnancy abortions: an analysis of Québec stillbirth data, 1981–2006. Int J Public Health 57:443–446
Auger N, Roncarolo F, Harper S (2011) Increasing educational inequality in preterm birth in Quebec, Canada, 1981–2006. J Epidemiol Community Health 65:1091–1096
Auger N, Delézire P, Harper S, Platt RW (2012a) Maternal education and stillbirth: Estimating gestational-age-specific and cause-specific associations. Epidemiology 23:247–254
Auger N, Harper S, Barry AD, Trempe N, Daniel M (2012b) Life expectancy gap between the Francophone majority and Anglophone minority of a Canadian population. Eur J Epidemiol 27:27–38
Barker DJP (2006) Adult consequences of fetal growth restriction. Clin Obstet Gynecol 49:270–283
Barros FC, Victora CG, Horta BL (2001) Ethnicity and infant health in Southern Brazil. A birth cohort study. Int J Epidemiol 30:1001–1008
Branum AM, Schoendorf KC (2002) Changing patterns of low birthweight and preterm birth in the United States, 1981–1998. Paediatr Perinat Epidemiol 16:8–15
Bryant AS, Worjoloh A, Caughey AB, Washington AE (2010) Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol 202:335–343
Dearden L, Mesnard A, Shaw J (2006) Ethnic differences in birth outcomes in England. Fisc Stud 27:17–46
Floch W, Pocock J (2008) The Socio-economic status of English-speaking Quebec: those who left and those who stayed. In: Bourhis R (ed) The vitality of the english-speaking communities of Quebec: from community decline to revival. CEETUM, Université de Montréal, Montréal, pp 35-62. http://www.ceetum.umontreal.ca/pdf/Bourhis%20resume.pdf
Ford C, Harawa NT (2010) A new conceptualization of ethnicity for social epidemiologic and health equity research. Soc Sci Med 71:251–258
Health Canada (2008) Francophones and tobacco use in Canada lessons learned from the Tobacco Demand Reduction Strategy 1994–1997. Health Canada, Ottawa, ON. http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/ftuc-tcfc/index-eng.php
Hyyppa MT, Maki J (2001) Why do Swedish-speaking Finns have longer active life? An area for social capital research. Health Promot Int 16:55–64
Institut national de santé publique du Québec (2006) Portrait de santé du Québec et de ses régions 2006 : les analyses—deuxième rapport national sur l’état de santé de la population du Québec. Government of Québec, Québec, QC, pp 1–131. http://www.inspq.qc.ca/pdf/publications/546-PortraitSante2006_Analyses.pdf
Jedwab J (2008) How shall we define thee? Determining who is an english-speaking Quebecer and assessing its demographic vitality. In: Bourhis R (ed) The vitality of the english-speaking communities of Quebec: from community decline to revival. CEETUM, Université de Montréal, Montréal, pp 1–18. http://www.ceetum.umontreal.ca/pdf/Bourhis%20resume.pdf
Kramer MR, Hogue CR (2008) Place matters: variation in the Black/White very preterm birth rate across U.S. metropolitan areas, 2002–2004. Public Health Rep 123:576–585
Kramer MS, Platt R, Yang H, Joseph KS, Wen SW, Morin L, Usher RH (1998) Secular trends in preterm birth: a hospital-based cohort study. JAMA 280:1849–1854
Kramer MS, Séguin L, Lydon J, Goulet L (2000) Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly? Paediatr Perinat Epidemiol 14:194–210
Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, Blondel B, Breart G (2001) A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 108:e35
Luo Z-C, Wilkins R, Platt R, Kramer M (2004) Risks of adverse pregnancy outcomes among Inuit and North American Indian women in Quebec, 1985–97. Paediatr Perinat Epidemiol 18:40–50
Malin M, Gissler M (2009) Maternal care and birth outcomes among ethnic minority women in Finland. BMC Public Health 9:84
Mason SM, Kaufman JS, Daniels JL, Emch ME, Hogan VK, Savitz DA (2011) Neighborhood ethnic density and preterm birth across seven ethnic groups in New York City. Health Place 17:280–288
McNiven C, Puderer H, Darryl J (2000) Census metropolitan area and census agglomeration influenced zones (MIZ): a description of the methodology. Catalogue no. 92F0138MIE, no. 2002-2. Statistics Canada, Ottawa, ON, pp 1–13. http://www.statcan.gc.ca/bsolc/olc-cel/olc-cel?lang=eng&catno=92F0138M2000002
Moutquin JM (2003) Classification and heterogeneity of preterm birth. BJOG 110(Suppl 20):30–33
Nyqvist F, Finnas F, Jakobsson G, Koskinen S (2008) The effect of social capital on health: the case of two language groups in Finland. Health Place 14:347–360
Osypuk TL, Acevedo-Garcia D (2008) Are racial disparities in preterm birth larger in hypersegregated areas? Am J Epidemiol 167:1295–1304
Pickett KE, Collins J, Masi CM, Wilkinson RG (2005) The effects of racial density and income incongruity on pregnancy outcomes. Soc Sci Med 60:2229–2238
Platt RW, Zeitlin J (2009) Challenges in measuring changes in health and social indicators over time. J Epidemiol Community Health 63:267–268
Pocock J (2008) Quebec’s Social and Health Survey Information: Baseline Data Report 2007–2008. Community Health and Social Services Network, Québec, QC, pp 1–197. http://www.chssn.org/En/BDR/docs/BDR_2007-08_final.pdf
Pocock J, Warnke J, Carter J (2010) Socio-Economic Profiles of Quebec’s English-speaking Communities: Companion Report to the CHSSN online table series. Community Health and Social Services Network, Québec, pp 1–112. Available: http://www.chssn.org/En/pdf/Socio-econ_profiles_Companion_Report_FINAL_version_Oct18.pdf
Rudy J (2005) The freedom to smoke: tobacco consumption and identity, 1st edn. McGill-Queen’s University Press, Montréal, pp 1–232
Saigal S, Doyle LW (2008) An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 371:261–269
Salihu HM, Wilson RE (2007) Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev 83:713–720
Sipila P, Martikainen P (2010) Language-group mortality differentials in Finland: the effects of local language composition. Health Place 16:446–451
Smith P, Begley L, O’Loughlin JL, Snider J (2005) Smoking behaviour. 2002 Youth Smoking Survey—technical report. Health Canada, Ottawa, pp 41–84. http://www.hc-sc.gc.ca/hc-ps/pubs/tobac-tabac/yss-etj-2002/index-eng.php
Sparks PJ (2009) Do biological, sociodemographic, and behavioral characteristics explain racial/ethnic disparities in preterm births? Soc Sci Med 68:1667–1675
Statistics Canada (2007) The Evolving Linguistic Portrait, 2006 Census. Catalogue no. 97-555-XIE. Statistics Canada, Ottawa, ON, pp 1–36. Available: http://www12.statcan.ca/census-recensement/2006/as-sa/97-555/index-eng.cfm
Stein CR, Savitz DA, Janevic T, Ananth CV, Kaufman JS, Herring AH, Engel SM (2009) Maternal ethnic ancestry and adverse perinatal outcomes in New York City. Am J Obstet Gynecol 201:584
Thomas PE, Beckmann M, Gibbons K (2010) The effect of cultural and linguistic diversity on pregnancy outcome. Aust N Z J Obstet Gynaecol 50:419–422
Troe EJ, Raat H, Jaddoe VW, Hofman A, Looman CW, Moll HA, Steegers EA, Verhulst FC, Witteman JC, Mackenbach JP (2007) Explaining differences in birthweight between ethnic populations: The Generation R Study. BJOG 114:1557–1565
Vahratian A, Buekens P, Alexander G (2006) State-specific trends in preterm delivery: are rates really declining among non-Hispanic African Americans across the United States? Matern Child Health J 10:27–32
Warnke J (2008) English mother tongue by Health Regions in Quebec—comparative tables & graphs 1991–2006. CHSSN, Québec, pp 1–28. Available: http://www.chssn.org/En/pdf/Vol1_2006_stats.pdf
Yang H, Kramer MS, Platt RW, Blondel B, Bréart G, Morin I, Wilkins R, Usher R (2002) How does early ultrasound scan estimation of gestational age lead to higher rates of preterm birth? Am J Obstet Gynecol 186:433–437
Acknowledgments
The authors acknowledge with appreciation funding provided by the McGill Training and Retention of Health Professionals Project Research Development Program for Québec Institutions. The authors thank Normand Trempe for comments on the manuscript.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics statement
Research ethics approval was waived by the institutional review board of the University of Montréal Hospital Centre. This study conformed to the 2010 Tri-Council Policy Statement for ethical conduct of research involving humans in Canada.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Auger, N., Park, A.L. & Harper, S. Francophone and Anglophone perinatal health: temporal and regional inequalities in a Canadian setting, 1981–2008. Int J Public Health 57, 925–934 (2012). https://doi.org/10.1007/s00038-012-0372-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-012-0372-y