CMAJ recently drew attention to Alberta's high infant mortality rate and implicated babies from neighbouring provinces, multiple births and “a large First Nations population that experiences higher rates of alcohol and tobacco use.”1 However, as the Canadian Perinatal Surveillance System has consistently maintained, infant mortality comparisons are compromised if they do not account for differences in birth registration practices, especially those pertaining to live births at the borderline of viability.2,3,4,5,6 For instance, an increasing temporal trend in the registration of live births less than 500 g (without a corresponding increase in other low-birth-weight categories) was deemed responsible for the increase in Canada's infant mortality rate in 1993.2
The registration of live births less than 500 g and less than 24 weeks gestation is more meticulous in Alberta than elsewhere in Canada (Table 1).2,7,8 Such differential registration (of a subgroup at very high risk of infant death) explains Alberta's poor infant mortality ranking and also the increase in mortality rates in Alberta (in 2002) and in Canada (in 1993 and 2002).
Table 1
Although more detailed analyses are warranted, it is evident (and ironic) that the province with good birth registration practices is being singled out for criticism. On the other hand, Ontario, which has a dismal record in terms of registering births, is rarely mentioned by the news media. Problems in Ontario include under- registration of births (especially among vulnerable subpopulations such as single mothers) because of fees for birth registration,9 missing birth registrations for 25% of infant deaths6 and delays in reporting that affect the timeliness of Canadian vital statistics and surveillance reports.
K.S. Joseph Dalhousie University Halifax, NS Michael S. Kramer McGill University Montréal, Que. Alexander C. Allen Dalhousie University Halifax, NS Reg Sauve University of Calgary Calgary, Alta.
References
- 1.Gregoire L. Alberta infant mortality high. CMAJ 2004;171(11):1336.
- 2.Joseph KS, Kramer MS. Recent trends in Canadian infant mortality rates: effect of changes in the registration of live newborns weighing less than 500 g. CMAJ 1996;155(8):1047-52. [PMC free article] [PubMed]
- 3.Svenson LW, Schopflocher DP, Sauve RS, Robertson CMT. Alberta's infant mortality rate: the effect of the registration of live newborns weighing less than 500 grams. Can J Public Health 1998;89:188-9. [DOI] [PMC free article] [PubMed]
- 4.Canadian perinatal health report 2000. Ottawa: Health Canada; 2000.
- 5.Kramer MS, Platt RW, Yang H, Haglund B, Cnattingius S, Bergsjo P. Registration artifacts in international comparisons of infant mortality. Paediatr Perinat Epidemiol 2002;16:16-22. [DOI] [PubMed]
- 6.Canadian perinatal health report 2003. Ottawa: Health Canada; 2003. [DOI] [PMC free article] [PubMed]
- 7.Births 2002. Ottawa: Statistics Canada; 2004. Cat no. 84F0210XIE. Available: www.statcan.ca/english/freepub/84F0210XIE/2002000/index.htm (accessed 2004 Nov 29).
- 8.Deaths 2002. Ottawa: Statistics Canada; 2004. Cat no. 84F0211XIE. Available: www.statcan.ca/english/freepub/84F0211XIE/2002000/index.htm (accessed 2004 Nov 29).
- 9.Woodward GL, Bienefeld MK, Ardal S. Under-reporting of live births in Ontario: 1991-1997. Can J Public Health 2003;94:463-7. [DOI] [PMC free article] [PubMed]