Abstract
Following reports of high infant mortality in Central Vancouver Island, total and cause-specific infant death rates (IDR) for Status Indians and for Other Residents of Vancouver Island (VI) were compared to those for their counterparts in the rest of the province (RoP). Data for 1991–97, in which Status Indians had been identified through record linkage, were obtained from BC Vital Statistics. The IDR was higher on VI than in RoP for Status Indians (IR=1.84: 95%CI; 1.43, 3.37), but not for Other Residents (IR=0.91: 95%CI; 0.79, 1.05). SIDS and perinatal conditions were responsible for most of the increase, with SIDS accounting for about half. This study demonstrates that, in addition to the well-recognized difference in infant mortality between Status Indians and Other Residents, important regional differences exist within the Status Indian population itself. As these differences are relevant to effective health planning and evaluation, health information systems should enable calculation of separate rates for Status Indians.
Résumé
À la suite de rapports de mortalité infantile élevée au centre de l’île de Vancouver, nous avons comparé les taux de mortalité infantile (TMI) totaux et par cause chez les Indiens inscrits et les autres habitants de l’île de Vancouver à ceux du reste de la province. La consultation des statistiques de l’état civil de la Colombie-Britannique nous a permis d’obtenir les données de 1991 à 1997 et d’identifier les Indiens inscrits par couplage des données. Le TMI était plus élevé sur l’île de Vancouver que dans le reste de la province pour les Indiens inscrits (RI=1,84: 95 % IC; 1,43, 3,37), mais pas pour les autres habitants (RI=0,91: 95 % IC; 0,79, 1,05). La mort subite du nourrisson et les conditions périnatales étaient responsables de la plus grande partie de cette augmentation (la MSN y contribuant pour environ la moitié). L’étude montre qu’en plus des différences bien connues entre les Indiens inscrits et les autres habitants en ce qui a trait à la mortalité infantile, il existe d’importants écarts régionaux au sein même de la population des Indiens inscrits. Comme ces écarts importent pour une planification et une évaluation efficaces de la santé, les systèmes d’information sanitaire devraient permettre de calculer séparément les taux des Indiens inscrits.
Footnotes
This study was jointly funded by Central Vancouver Island Health Region, Capital Health Region and Upper Island Central Coast Community Health Service Society.
References
- 1.VanLandingham MJ, Hogue CJ. Birthweight-specific infant mortality risks for Native Americans and whites, United States, 1960 and 1984. Soc Biol. 1995;42(1–2):83–94. doi: 10.1080/19485565.1995.9988889. [DOI] [PubMed] [Google Scholar]
- 2.Decrease in infant mortalitysudden infant death syndrome among Northwest American IndiansAlaskan Natives–Pacific Northwest, 1985–1996. MMWR. 1999;48(9):181–84. [PubMed] [Google Scholar]
- 3.Nakamura RM, King R, Kimball EH, et al. Excess infant mortality in an American Indian population, 1940 to 1990. JAMA. 1991;266(16):2244–48. doi: 10.1001/jama.1991.03470160076035. [DOI] [PubMed] [Google Scholar]
- 4.Oyen N, Bulterys M, et al. Sudden unexpected infant deaths among American Indians and whites in North and South Dakota. Paediatr Perinat Epidemiol. 1990;4(2):175–83. doi: 10.1111/j.1365-3016.1990.tb00636.x. [DOI] [PubMed] [Google Scholar]
- 5.Adams MM. The descriptive epidemiology of sudden infant deaths among natives and whites in Alaska. Am J Epidemiol. 1985;122(4):637–43. doi: 10.1093/oxfordjournals.aje.a114143. [DOI] [PubMed] [Google Scholar]
- 6.BC Ministry of HealthMinistry Responsible for Seniors . Division of Vital Statistics. Selected Vital Statistics and Health Status Indicators. Victoria: BC Vital Statistics; 1995. [Google Scholar]
- 7.BC Ministry of HealthMinistry Responsible for Seniors . Division of Vital Statistics. Analysis of Status Indians in British Columbia: 1991–1997. Victoria: BC Vital Statistics; 1998. [Google Scholar]
- 8.Greenland S, Rothman KJ. Introduction to Categorical Analysis. In: Rothman KJ, Greenland S, editors. Modern Epidemiology. 2nd. Philadelphia: Lippincott-Raven; 1998. [Google Scholar]
- 9.BC Ministry of HealthMinistry Responsible for Seniors . Division of Vital Statistics. Status Indian Trend Analysis by Four Areas Over the Period 1987 to 1997. Victoria: BC Vital Statistics; 1999. [Google Scholar]
- 10.Golding J. Sudden infant death syndrome and parental smoking–A literature review. Paediatr Perinat Epidemiol. 1997;11(1):67–77. doi: 10.1046/j.1365-3016.1997.d01-12.x. [DOI] [PubMed] [Google Scholar]
- 11.Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics. 1992;90(6):905–8. [PubMed] [Google Scholar]
- 12.Angus Reid Group. Tobacco Use in British Columbia 1997 [report to the Heart and Stroke Foundation of BC & Yukon] 1997. [Google Scholar]
- 13.Williams SM, Taylor BJ, Mitchell EA, et al. Sudden infant death syndrome: Insulation from bedding and clothing and its effect modifiers. Int J Epidemiol. 1996;25(2):366–75. doi: 10.1093/ije/25.2.366. [DOI] [PubMed] [Google Scholar]
- 14.Schlaud M, Kleemann WJ, Poets CF, et al. Smoking during pregnancy and poor antenatal care: Two major preventable risk factors for sudden infant death syndrome. Int J Epidemiol. 1996;25(5):959–65. doi: 10.1093/ije/25.5.959. [DOI] [PubMed] [Google Scholar]
- 15.American Academy of Pediatrics. Task Force on Infant Sleeping Position and Sudden Infant Death Syndrome. Changing concepts of sudden infant death syndrome: Implications for infant sleeping environment and sleep position. Pediatrics. 2000;105(3Pt1):650–56. doi: 10.1542/peds.105.3.650. [DOI] [PubMed] [Google Scholar]