Community Characteristics and Inuit Birth Outcomes in Quebec
Background: Inuit is the smallest Aboriginal group in Canada. Inuit women are at much higher risks of adverse birth outcomes than their non-indigenous counterparts. Both fetal and infant mortality have been reported to be much higher among Canadian Inuit vs. non-indigenous populations in some regional studies. Both individual and community-level risk factors may affect Inuit birth outcomes. Understanding the effects of community-level risk factors may be critically important for developing effective maternal and infant health promotion programs to improve birth outcomes in Inuit communities. Little is known about the relationships between community characteristics and Inuit birth outcomes.
Hypothesis: Community-level characteristics are important determinants of birth outcomes and may contribute substantially to the poor birth outcomes among Inuit women and the disparities versus non-Inuit women in Quebec.
Methodology and analysis plan: This is a postal code linkage-based birth cohort study to assess the effects of community characteristics on Inuit birth outcomes, based on the already linked stillbirth/live birth/infant death data files for all births in Quebec, from 1991 to 2000. Community characteristics included rural vs. urban, north vs. south locality, community size (<1000 vs. ≥1000), community-level primary birthing attendants: Inuit midwives in local languages or Western physicians needing translators, and neighborhood socioeconomic characteristics (neighborhood income, percentages of unemployment, of adults without completing high school, and of single-parent families). Birth outcomes include preterm, small for gestational age, large for gestational age, low birth weight or high birth weight birth, stillbirth, neonatal death, perinatal death (stillbirth + neonatal death), postneonatal death, infant death, total fetal and infant death (stillbirth + infant death). The mother's residential postal code on birth registrations is used to link area-level “community” characteristics to each birth record through postal code geocoding using a program developed by Statistics Canada.
Significance and relevance: The study will provide the first and most comprehensive assessment of community characteristics and Inuit birth outcomes. Such information may be useful for developing strategies to improve Inuit birth outcomes.
Transdisciplinarity and Knowledge Transfer: This project is relevant and important for Inuit communities, and need transdisciplinary inputs from social, ethical, clinical, and health service and policy perspectives. The project is involving researchers from multiple disciplines from multiple institutions, including indigenous health, perinatal care and surveillance, health policy and community health, clinician scientist, anthropology and health statistics expert, and Inuit community stakeholders (Nunavik Regional Board of Health and Social Services). Members of the study group bring in obviously transdisciplinary perspectives to the project, and provide frequent feedbacks on result interpretations and analytic framework from transdisciplinary perspective including community perspective. A community-oriented report has been completed in collaboration with Inuit Center of the National Aboriginal Health Organization and Nunavik Regional Board of Health and Social Services for knowledge translation to Inuit communities and potential efforts to improve Inuit birth outcomes.
Questions for feedback:
1. What other community charateristic would you consider?
2. What definition of “community” would you give, as the distinction between community and neighbourhood is not well established in the literature.
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I think you have included
I think you have included the relevant characteristics for communities. Considering birth outcomes you are interested in, is it possible to add mode of delivery to your birth outcomes? As well, can you include data on breastfeeding initiation and, if possible, duration?
Is it relevant to have community defined by the participants? It may be that it is the residents' sense of community that is the most meaningful definition.
Jo
Jo Watson RN(EC) PhD(c)
Director Women and Babies Program
Sunnybrook Health Sciences Centre
Hi Fabienne, I have to agree
Hi Fabienne,
I have to agree with Jo. The definition of community should primarily be defined by your participants. What they as inuit and we as non-indigenous define community as are probably very different. You could give both types of definitions. It is possible you will see a significant difference in one of your outcomes with one definition and not the other. I think a neighbourhood can be considered a community depending on the nature of the interaction of the individuals residing there.
One of the community characteristics you may be interested in including would be time till presence of primary birth attendent. I live in rural Saskatchewan on a farm and it takes 20 minutes for us to get to town to the hospital and it may be longer before the doctor is there depending on if he is working or is on call and out of the hospital. It may be an interesting community factor to look at.
Thanks for you presentation,
Heather
Very interesting research
Very interesting research project. I guess I am wondering about the general context of your study. Is it part of a larger project? Do you have any contact with Innuit women that you are studying? If yes or no, what do you see as the advantages/disadvantages of having this contact or not as a researcher? I was also wondering if you have any preliminary results since it sounds so interesting.
Good luck with the research,
Alex.
Thank you Jo and Heather for
Thank you Jo and Heather for your relevant inputs.
Unfortunately, considering the nature of the database that we have, it is not possible to account for the characteristics you mentioned.
Fabienne
Hi Alex, My research
Hi Alex, My research project is indeed being conducted within the context of a larger CIHR-funded project “community characteristics and birth outcomes among Canadian aboriginal women”.I don’t have contacts with Inuit women I am studying since it is a retrospective database-based analysis. It is not really a problem in this type of study, especially because we have an Inuit advisory board member who helped in refining the study protocol, to make it more useful and relevant for Inuit communities. But on the other hand, I would say that it is important to see the global daily reality of people enrolled in a study, to reduce this “distance” between the researcher and the researched! Some preliminary results have already been published; I have enclosed a paper comparing the two birthing attendant types. Thank you for your interest. Fabienne
Thanks for that Fabienne and
Thanks for that Fabienne and for your thoughtful response: interaction with participants.
Hi Fabienne, Thank you for
Hi Fabienne,
Thank you for your presentation, it is as far as it can be from my domain of study, and was very refreshing to read.
Do you have access to the age of the mother and the number of prior pregnancies? Both of these are important biological factors for birth outcome. It also seems to me that those factors might also be looked at as community-level characteristics. Does your analysis account for possible sex-specific outcomes? For example, males generally have a poorer outcome when it comes to premature births. Males are also more susceptible to certain environmental pollutants (ex.: BPA). This could also contribute to difference amongst communities concerning birth-outcome. Some pollutants tend to accumulate at higher levels in northern regions. Also differences in diet (rural vs urban ; hunthing vs fishing vs non-traditional) amongst communities could make some difference. I doubt your data base includes data concerning the levels of specific pollutants in the communities that you have studied, but it might wield interesting results.
Good luck,
Eric
Hi Eric, I do have access
Hi Eric, I do have access to maternal age and parity, and both of them are taken into account in the analysis.My analysis does not account for sex-specific outcomes, but that’s a good point.You are absolutely right about the possible impact of pollutants on birth outcomes, but unfortunately I do not have access to this kind of data. Thank you very much for your comments. Fabienne