Sacha Senécal

Birth outcomes in the Inuit-inhabited areas of Canada

Background: Information on health disparities between Aboriginal and non-Aboriginal populations is essential for developing public health programs aimed at reducing such disparities. The lack of data on disparities in birth outcomes between Inuit and non-Inuit populations in Canada prompted us to compare birth outcomes in Inuit-inhabited areas with those in the rest of the country and in other rural and northern areas of Canada. Methods: We conducted a cohort study of all births in Canada during 1990–2000 using linked vital data. We identified 13 642 births to residents of Inuit-inhabited areas and 4 054 489 births to residents of all other areas. The primary outcome measures were preterm birth, stillbirth and infant death. Results: Compared with the rest of Canada, Inuit-inhabited areas had substantially higher rates of preterm birth (risk ratio [RR] 1.45, 95% confidence interval [CI] 1.38–1.52), stillbirth (RR 1.68, 95% CI 1.38–2.04) and infant death (RR 3.61, 95% CI 3.17–4.12). The risk ratios and absolute differences in risk for these outcomes changed little over time. Excess mortality was observed for all major causes of infant death, including congenital anomalies (RR 1.64), immaturity-related conditions (RR 2.96), asphyxia (RR 2.43), sudden infant death syndrome (RR 7.15), infection (RR 8.32) and external causes (RR 7.30). Maternal characteristics accounted for only a small part of the risk disparities. Substantial risk ratios for preterm birth, stillbirth and infant death remained when the comparisons were restricted to other rural or northern areas of Canada. Interpretation: The Inuit-inhabited areas had much higher rates of preterm birth, stillbirth and infant death compared with the rest of Canada and with other rural and northern areas. There is an urgent need for more effective interventions to improve maternal and infant health in Inuit-inhabited areas.

The relationship between socio-economic and geographic factors and asthma among Canada's Aboriginal populations

Objectives. To examine the prevalence, exacerbations and management of asthma among Canada’s Aboriginal populations, and its relationship to socio-economic and geographic factors. Study design. Secondary analysis of a national cross-sectional questionnaire survey. Methods. Data were collected in 2000 and 2001 through a survey of Aboriginal children and adults residing on-and off-reserve as part of the 2001 Aboriginal People’s Survey (APS). The asthma related outcome variables — physician-diagnosed asthma, attack in past year and regular use of inhalants — were examined in relation to socio-economic and geographic factors such as income, education, housing and location of residence. Statistical analyses were based on weighted univariate and multivariate logistic regressions. Results. The results show variations in asthma diagnosis, attacks and inhalant use across geographic location, socio-economic and demographic characteristics. Geographic location was found to be significantly associated with asthma for both adults and children, with those living in the northern territories, on-reserve or rural locations being the least likely to be diagnosed. Geographic location and Aboriginal identity were also found to be significantly associated with asthma medication use. Conclusions. While these findings may suggest a “healthier” population in more remote locations, they alternatively point to a general pattern of under-diagnosis, potentially due to poor health care access, as is typical in more remote locations.

Fuzzy Definitions and Demographic Explosion of Aboriginal Populations in Canada from 1986 to 2006

In their common desire to conduct research and gather information on Aboriginal social issues, demographers and other specialists in populations, both Aboriginal and non-Aboriginal, have often neglected two basic questions: Why is it so hard to define Aboriginal populations in Canada? How can the recent demographic explosion be explained? The answer to these questions is essential, since they play a significant role in the enumeration of Aboriginal populations (Which definition shall be used?), in the monitoring of their socio-economic characteristics (How shall recent trends be interpreted?) and in the development of policies and programs aimed at improving the living conditions of Aboriginal populations (Who are the recipients?). The purpose of this article is to examine these two fundamental questions using a demographic perspective.