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Huang R, Xiao L, Zhu J, Cheng J, Torrie J, McHugh NGL, Auger N, Luo ZC. Population-based birth cohort study on diabetes in pregnancy and infant hospitalisations in Cree, other First Nations and non-Indigenous communities in Quebec. BMJ Open 2023; 13:e074518. [PMID: 38040430 PMCID: PMC10693854 DOI: 10.1136/bmjopen-2023-074518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES Diabetes in pregnancy, whether pre-gestational (chronic) or gestational (de novo hyperglycaemia), increases the risk of adverse birth outcomes. It is unclear whether gestational diabetes increases the risk of postnatal morbidity in infants. Cree First Nations in Quebec are at high risk for diabetes in pregnancy. We assessed whether pre-gestational or gestational diabetes may increase infant hospitalisation (an infant morbidity indicator) incidence, and whether this may be related to more frequent infant hospitalisations in Cree and other First Nations in Quebec. DESIGN Population-based birth cohort study through administrative health data linkage. SETTING AND PARTICIPANTS Singleton infants (≤1 year) born to mothers in Cree (n=5070), other First Nations (9910) and non-Indigenous (48 200) communities in rural Quebec. RESULTS Both diabetes in pregnancy and infant hospitalisation rates were much higher comparing Cree (23.7% and 29.0%) and other First Nations (12.4% and 34.1%) to non-Indigenous (5.9% and 15.5%) communities. Compared with non-diabetes, pre-gestational diabetes was associated with an increased risk of any infant hospitalisation to a greater extent in Cree and other First Nations (relative risk (RR) 1.56 (95% CI 1.28 to 1.91)) than non-Indigenous (RR 1.26 (1.15 to 1.39)) communities. Pre-gestational diabetes was associated with increased risks of infant hospitalisation due to diseases of multiple systems in all communities. There were no significant associations between gestational diabetes and risks of infant hospitalisation in all communities. The population attributable risk fraction of infant hospitalisations (overall) for pre-gestational diabetes was 6.2% in Cree, 1.6% in other First Nations and 0.3% in non-Indigenous communities. CONCLUSIONS The study is the first to demonstrate that pre-gestational diabetes increases the risk of infant hospitalisation overall and due to diseases of multiple systems, but gestational diabetes does not. High prevalence of pre-gestational diabetes may partly account for the excess infant hospitalisations in Cree and other First Nations communities in Quebec.
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Affiliation(s)
- Rong Huang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
| | - Lin Xiao
- Sainte-Justine Hospital Research Center, Montreal, Québec, Canada
| | - Jane Zhu
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Cheng
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Torrie
- Public-Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, Montreal, Québec, Canada
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Dubeau C, Aker A, Caron-Beaudoin É, Ayotte P, Blanchette C, McHugh NGL, Lemire M. Perfluoroalkyl acid and bisphenol-A exposure via food sources in four First Nation communities in Quebec, Canada. Public Health Nutr 2023; 26:106-121. [PMID: 35272726 PMCID: PMC11077462 DOI: 10.1017/s1368980022000581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To document perfluoroalkyl acids (PFAA) and bisphenol-A (BPA) exposure in four First Nation communities in northern Quebec compared with the Canadian Health Measures Survey (CHMS Cycle 5 2016-2017) and examine the associations between dietary consumption and chemical exposure. DESIGN We used cross-sectional data from the JES-YEH! project conducted in collaboration with four First Nation communities in 2015. A FFQ collected information on diet, and PFAA and BPA were measured in biological samples. We used generalised linear models to test the associations between food intake and chemical biomarkers. SETTING Northern Quebec. PARTICIPANTS Youth aged 3-19 years (n 198). RESULTS Mean perfluorononanoic acid (PFNA) levels were significantly higher in JES-YEH! than CHMS, and BPA levels were higher among those aged 12-19 years compared with CHMS. Dairy products were associated with PFNA among Anishinabe and Innu participants (geometric mean ratio 95 % CI: 1·53 (95 % CI 1·03, 2·29) and 1·52 (95 % CI 1·05, 2·20), respectively). PFNA was also associated with ultra-processed foods (1·57 (95 % CI 1·07, 2·31)) among Anishinabe, and with wild fish and berries (1·44 (95 % CI 1·07, 1·94); 1·75 (95 % CI 1·30, 2·36)) among Innu. BPA was associated with cheese (1·72 (95 % CI 1·19, 2·50)) and milk (1·53 (95 % CI 1·02, 2·29)) among Anishinabe, and with desserts (1·71 (95 % CI 1·07, 2·74)), processed meats (1·55 (95 % CI 1·00, 2·38)), wild fish (1·64 (95 % CI 1·07, 2·49)) and wild berries (2·06 (95 % CI 1·37, 3·10)) among Innu. CONCLUSIONS These results highlight the importance of better documenting food-processing and packaging methods, particularly for dairy products, and their contribution to endocrine disruptors exposures as well as to promote minimally processed and unpackaged foods to provide healthier food environments for youth in Indigenous communities and beyond.
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Affiliation(s)
- Claudelle Dubeau
- Département de Médecine Sociale et Préventive, Institut de
Biologie Intégrative et des Systèms, Université Laval,
Québec, QC, Canada
| | - Amira Aker
- Département de Médecine Sociale et Préventive, Institut de
Biologie Intégrative et des Systèms, Université Laval,
Québec, QC, Canada
- Axe Santé Des Populations et Pratiques Optimales en Santé, Centre
de Recherche du CHU de Québec, Université Laval, 1050 Ch Ste-Foy,
Québec, QCG1S 4L8, Canada
| | - Élyse Caron-Beaudoin
- Department of Health and Society, University of
Toronto Scarborough, Toronto, ON,
Canada
- Centre for Clinical Epidemiology and Evaluation,
University of British Columbia, Vancouver Coastal Health
Research Institute, Research Pavilion, Vancouver, BC,
Canada
| | - Pierre Ayotte
- Axe Santé Des Populations et Pratiques Optimales en Santé, Centre
de Recherche du CHU de Québec, Université Laval, 1050 Ch Ste-Foy,
Québec, QCG1S 4L8, Canada
- Institut National de Santé Publique du
Québec, Quebec, Canada
| | - Caty Blanchette
- Axe Santé Des Populations et Pratiques Optimales en Santé, Centre
de Recherche du CHU de Québec, Université Laval, 1050 Ch Ste-Foy,
Québec, QCG1S 4L8, Canada
| | - Nancy Gros-Louis McHugh
- Commission de Santé et de Services Sociaux Des
Premières Nations Québec Labrador, Wendake, QC,
Canada
| | - Mélanie Lemire
- Département de Médecine Sociale et Préventive, Institut de
Biologie Intégrative et des Systèms, Université Laval,
Québec, QC, Canada
- Axe Santé Des Populations et Pratiques Optimales en Santé, Centre
de Recherche du CHU de Québec, Université Laval, 1050 Ch Ste-Foy,
Québec, QCG1S 4L8, Canada
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Tahir E, Ayotte P, Little M, Bélanger RE, Lucas M, Mergler D, Laouan Sidi EA, McHugh NGL, Lemire M. Anemia, iron status, and associated protective and risk factors among children and adolescents aged 3 to 19 years old from four First Nations communities in Quebec. Can J Public Health 2020; 111:682-693. [PMID: 32170646 PMCID: PMC7501325 DOI: 10.17269/s41997-020-00304-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec. METHODS The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations. RESULTS The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, fruit, and fruit juice (natural and powdered)-via their positive association with vitamin C intake-were the only food variables positively associated with SF (coefficient [95% CI] 0.017 [0.000, 0.114]; 0.090 [0.027, 0.161]; and 0.237 [0.060, 0.411]). Male sex was also associated with higher SF (0.295 [0.093, 0.502]). Inflammation status (hs-CRP > 5 mg/L) was inversely associated with Hb (- 0.015 [- 0.025, - 0.005]), whereas SF was positively associated with Hb (0.066 [0.040, 0.096]). Fruit and juice consumption was also positively associated with Hb, via vitamin C intake and SF (0.004 [0.001, 0.010]; 0.008 [0.003, 0.017]). CONCLUSIONS Interventions fostering healthier food environments as well as higher consumption of traditional meats and foods naturally rich in vitamin C, which is known to enhance iron absorption, and fighting inflammation could contribute to decrease the high prevalence of anemia and ID in this young Indigenous population.
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Affiliation(s)
- Emad Tahir
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Pierre Ayotte
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Centre de toxicologie du Québec, INSPQ, Quebec City, Canada
| | - Matthew Little
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard E Bélanger
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Département de pédiatrie, Université Laval, Quebec City, QC, Canada
| | - Michel Lucas
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Donna Mergler
- CINBIOSE, Université du Québec à Montréal, Montreal, QC, Canada
| | - Elhadji A Laouan Sidi
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Québec and Labrador Health and Social Services Commission, Wendake, QC, Canada
| | - Mélanie Lemire
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada.
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada.
- Centre de Recherche du CHU de Québec, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.
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Caron-Beaudoin É, Ayotte P, Laouan Sidi EA, Gros-Louis McHugh N, Lemire M. Exposure to perfluoroalkyl substances (PFAS) and associations with thyroid parameters in First Nation children and youth from Quebec. Environ Int 2019; 128:13-23. [PMID: 31029975 DOI: 10.1016/j.envint.2019.04.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are found in several consumer goods. Exposure to PFASs in children has been associated with alteration in thyroid hormones, which have critical roles in brain function. OBJECTIVE In 2015, 198 children and youth (3-19 y) were recruited as part of the pilot project Jeunes, Environnement et Santé/Youth, Environment and Health (JES!-YEH!), realized in collaboration with four First Nation communities in Quebec. We aimed to evaluate serum concentrations of PFASs in relation to concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4) and thyroglobulin while adjusting for relevant confounders. METHODS PFASs (PFOS, PFOA, PFHxS, PFNA), 2,2',4,4'-Tetrabromodiphenyl ether (PBDE-47) thyroid parameters (TSH, free T4, and thyroglobulin) were measured in serum samples of 186 participants. Iodine, creatinine, and cotinine were measured in urine samples. Serum levels of PFASs were compared to those measured in the general Canadian population and elsewhere. Multivariate regression analyses were performed to determine associations between PFASs and TSH, free T4 and thyroglobulin. RESULTS PFOS, PFOA and PFHxS serum concentrations were low. However, PFNA concentrations among participants aged 12 to 19 years old from Anishinabe communities were three times higher than those measured in the Canadian Health Measures Survey (2009-2011) for the same age group (Geometric Means: 3.01 μg/L and 0.71 μg/L, respectively) and were particularly higher in the Anishinabe participants aged 6 to 11 years old (GM: 9.44 μg/L). Few participants had levels of TSH, free T4, and thyroglobulin outside age-specific paediatric ranges. When adjusted for relevant covariates and other contaminants, PFNA serum concentrations were positively associated with free T4 levels (Adjusted β = 0.36; p = 0.0014), but not with TSH and thyroglobulin levels. No association was observed between the other PFAS and thyroid hormones parameters. CONCLUSION This pilot project reveals among the highest exposure to PFNA in children reported until today, and suggests effects of PFNA as an endocrine disruptor, highlighting the importance of investigating the sources and effects of disproportionate exposure to emerging contaminants in some indigenous communities and ban all PFAS at the international scale.
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Affiliation(s)
- Élyse Caron-Beaudoin
- Université de Montreal School of Public Health, Department of Environmental and Occupational Health, QC, Montreal, Canada.
| | - Pierre Ayotte
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada; Institut national de santé publique du Québec, QC, Québec, Canada
| | - Elhadji Anassour Laouan Sidi
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Quebec and Labrador Health and Social Services Commission, Wendake, QC, Canada
| | - Mélanie Lemire
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec - Université Laval, Canada; Département de médecine sociale et préventive, Université Laval, Québec, Canada
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Chen L, Wang WJ, Auger N, Xiao L, Torrie J, McHugh NGL, Luo ZC. Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study. BMJ Open 2019; 9:e025084. [PMID: 30992290 PMCID: PMC6500205 DOI: 10.1136/bmjopen-2018-025084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Both pregestational and gestational diabetes mellitus (PGDM, GDM) occur more frequently in First Nations (North American Indians) pregnant women than their non-Indigenous counterparts in Canada. We assessed whether the impacts of PGDM and GDM on perinatal and postneonatal mortality may differ in First Nations versus non-Indigenous populations. DESIGN A population-based linked birth cohort study. SETTING AND PARTICIPANTS 17 090 First Nations and 217 760 non-Indigenous singleton births in 1996-2010, Quebec, Canada. MAIN OUTCOME MEASURES Relative risks (RR) of perinatal and postneonatal death. Perinatal deaths included stillbirths and neonatal (0-27 days of postnatal life) deaths; postneonatal deaths included infant deaths during 28-364 days of life. RESULTS PGDM and GDM occurred much more frequently in First Nations (3.9% and 10.7%, respectively) versus non-Indigenous (1.1% and 4.8%, respectively) pregnant women. PGDM was associated with an increased risk of perinatal death to a much greater extent in First Nations (RR=5.08[95% CI 2.99 to 8.62], p<0.001; absolute risk (AR)=21.6 [8.6-34.6] per 1000) than in non-Indigenous populations (RR=1.76[1.17, 2.66], p=0.003; AR=4.2[0.2, 8.1] per 1000). PGDM was associated with an increased risk of postneonatal death in non-Indigenous (RR=3.46[1.71, 6.99], p<0.001; AR=2.4[0.1, 4.8] per 1000) but not First Nations (RR=1.16[0.28, 4.77], p=0.35) infants. Adjusting for maternal and pregnancy characteristics, the associations were similar. GDM was not associated with perinatal or postneonatal death in both groups. CONCLUSIONS The study is the first to reveal that PGDM may increase the risk of perinatal death to a much greater extent in First Nations versus non-Indigenous populations, but may substantially increase the risk of postneonatal death in non-Indigenous infants only. The underlying causes are unclear and deserve further studies. We speculate that population differences in the quality of glycaemic control in diabetic pregnancies and/or genetic vulnerability to hyperglycaemia's fetal toxicity may be contributing factors.
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Affiliation(s)
- Lu Chen
- Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Québec, Canada
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiaotong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Wen-Juan Wang
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiaotong University School of Medicine, Xinhua Hospital, Shanghai, China
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Nathalie Auger
- Epidemiology, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Lin Xiao
- Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Jill Torrie
- Public Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, Canada
| | - Nancy Gros-Louis McHugh
- Research Sector, First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, Canada
| | - Zhong-Cheng Luo
- Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, Québec, Canada
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He H, Xiao L, Torrie JE, Auger N, McHugh NGL, Zoungrana H, Luo ZC. Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada. CMAJ 2017; 189:E739-E746. [PMID: 28554947 DOI: 10.1503/cmaj.160900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Infant mortality is higher in Indigenous than non-Indigenous populations, but comparable data on infant morbidity are lacking in Canada. We evaluated disparities in infant morbidities experienced by Indigenous populations in Canada. METHODS We used linked population-based birth and health administrative data from Quebec, Canada, to compare hospitalization rates, an indicator of severe morbidity, in First Nations, Inuit and non-Indigenous singleton infants (< 1 year) born between 1996 and 2010. RESULTS Our cohort included 19 770 First Nations, 3930 Inuit and 225 380 non-Indigenous infants. Compared with non-Indigenous infants, all-cause hospitalization rates were higher in First Nations infants (unadjusted risk ratio [RR] 2.05, 95% confidence interval [CI] 1.99-2.11; fully adjusted RR 1.43, 95% CI 1.37-1.50) and in Inuit infants (unadjusted RR 1.96, 95% CI 1.87-2.05; fully adjusted RR 1.37, 95% CI 1.24-1.52). Higher risks of hospitalization (accounting for multiple comparisons) were observed for First Nations infants in 12 of 16 disease categories and for Inuit infants in 7 of 16 disease categories. Maternal characteristics (age, education, marital status, parity, rural residence and Northern residence) partly explained the risk elevations, but maternal chronic illnesses and gestational complications had negligible influence overall. Acute bronchiolitis (risk difference v. non-Indigenous infants, First Nations 37.0 per 1000, Inuit 39.6 per 1000) and pneumonia (risk difference v. non-Indigenous infants, First Nations 41.2 per 1000, Inuit 61.3 per 1000) were the 2 leading causes of excess hospitalizations in Indigenous infants. INTERPRETATION First Nations and Inuit infants had substantially elevated burdens of hospitalizations as a result of diseases of multiple systems. The findings identify substantial unmet needs in disease prevention and medical care for Indigenous infants.
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Affiliation(s)
- Hua He
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Lin Xiao
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Jill Elaine Torrie
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Nathalie Auger
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Nancy Gros-Louis McHugh
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Hamado Zoungrana
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que
| | - Zhong-Cheng Luo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health (He, Luo), Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Department of Obstetrics and Gynecology (He, Xiao, Luo), Sainte-Justine Hospital, University of Montreal, Montréal, Que.; Public Health Department (Xiao, Torrie), Cree Board of Health and Social Services of James Bay, Mistissini, Que.; University of Montreal Hospital Research Centre (Auger), University of Montreal, Montréal, Que.; Research Division, First Nations of Quebec and Labrador Health and Social Service Commission (Gros-Louis McHugh), Wendake, Que.; Nunavik Regional Board of Health and Social Services (Zoungrana), Kuujjuaq, Que.
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Xiao L, Zhang DL, Torrie J, Auger N, McHugh NGL, Luo ZC. Macrosomia, Perinatal and Infant Mortality in Cree Communities in Quebec, 1996-2010. PLoS One 2016; 11:e0160766. [PMID: 27517613 PMCID: PMC4982632 DOI: 10.1371/journal.pone.0160766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cree births in Quebec are characterized by the highest reported prevalence of macrosomia (~35%) in the world. It is unclear whether Cree births are at greater elevated risk of perinatal and infant mortality than other First Nations relative to non-Aboriginal births in Quebec, and if macrosomia may be related. METHODS This was a population-based retrospective birth cohort study using the linked birth-infant death database for singleton births to mothers from Cree (n = 5,340), other First Nations (n = 10,810) and non-Aboriginal (n = 229,960) communities in Quebec, 1996-2010. Community type was ascertained by residential postal code and municipality name. The primary outcomes were perinatal and infant mortality. RESULTS Macrosomia (birth weight for gestational age >90th percentile) was substantially more frequent in Cree (38.0%) and other First Nations (21.9%) vs non-Aboriginal (9.4%) communities. Comparing Cree and other First Nations vs non-Aboriginal communities, perinatal mortality rates were 1.52 (95% confidence intervals 1.17, 1.98) and 1.34 (1.10, 1.64) times higher, and infant mortality rates 2.27 (1.71, 3.02) and 1.49 (1.16, 1.91) times higher, respectively. The risk elevations in perinatal and infant death in Cree communities attenuated after adjusting for maternal characteristics (age, education, marital status, parity), but became greater after further adjustment for birth weight (small, appropriate, or large for gestational age). CONCLUSIONS Cree communities had greater risk elevations in perinatal and infant mortality than other First Nations relative to non-Aboriginal communities in Quebec. High prevalence of macrosomia did not explain the elevated risk of perinatal and infant mortality in Cree communities.
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Affiliation(s)
- Lin Xiao
- Public Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, H3T 1C5, Canada
| | - Dan-Li Zhang
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, H3T 1C5, Canada
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
| | - Jill Torrie
- Public Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada
- * E-mail: (ZCL); (JT)
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Quebec, H2X 0A9, Canada
| | - Nancy Gros-Louis McHugh
- Research Division, First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, G0A 4V0, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Montreal, Quebec, H3T 1C5, Canada
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
- * E-mail: (ZCL); (JT)
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Chen L, Xiao L, Auger N, Torrie J, McHugh NGL, Zoungrana H, Luo ZC. Disparities and Trends in Birth Outcomes, Perinatal and Infant Mortality in Aboriginal vs. Non-Aboriginal Populations: A Population-Based Study in Quebec, Canada 1996-2010. PLoS One 2015; 10:e0138562. [PMID: 26397838 PMCID: PMC4580319 DOI: 10.1371/journal.pone.0138562] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Aboriginal populations are at substantially higher risks of adverse birth outcomes, perinatal and infant mortality than their non-Aboriginal counterparts even in developed countries including Australia, U.S. and Canada. There is a lack of data on recent trends in Canada. METHODS We conducted a population-based retrospective cohort study (n = 254,410) using the linked vital events registry databases for singleton births in Quebec 1996-2010. Aboriginal (First Nations, Inuit) births were identified by mother tongue, place of residence and Indian Registration System membership. Outcomes included preterm birth, small-for-gestational-age, large-for-gestational-age, low birth weight, high birth weight, stillbirth, neonatal death, postneonatal death, perinatal death and infant death. RESULTS Perinatal and infant mortality rates were 1.47 and 1.80 times higher in First Nations (10.1 and 7.3 per 1000, respectively), and 2.37 and 4.46 times higher in Inuit (16.3 and 18.1 per 1000, respectively) relative to non-Aboriginal (6.9 and 4.1 per 1000, respectively) births (all p<0.001). Compared to non-Aboriginal births, preterm birth rates were persistently (1.7-1.8 times) higher in Inuit, large-for-gestational-age birth rates were persistently (2.7-3.0 times) higher in First Nations births over the study period. Between 1996-2000 and 2006-2010, as compared to non-Aboriginal infants, the relative risk disparities increased for infant mortality (from 4.10 to 5.19 times) in Inuit, and for postneonatal mortality in Inuit (from 6.97 to 12.33 times) or First Nations (from 3.76 to 4.25 times) infants. Adjusting for maternal characteristics (age, marital status, parity, education and rural vs. urban residence) attenuated the risk differences, but significantly elevated risks remained in both Inuit and First Nations births for the risks of perinatal mortality (1.70 and 1.28 times, respectively), infant mortality (3.66 and 1.47 times, respectively) and postneonatal mortality (6.01 and 2.28 times, respectively) in Inuit and First Nations infants (all p<0.001). CONCLUSIONS Aboriginal vs. non-Aboriginal disparities in adverse birth outcomes, perinatal and infant mortality are persistent or worsening over the recent decade in Quebec, strongly suggesting the needs for interventions to improve perinatal and infant health in Aboriginal populations, and for monitoring the trends in other regions in Canada.
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Affiliation(s)
- Lu Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Lin Xiao
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
- Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut National de Santé Publique du Québec, Montreal, Quebec, H2P 1E2, Canada
| | - Jill Torrie
- Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, G0W 1C0, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, G0A 4V0, Canada
| | - Hamado Zoungrana
- Nunavik Regional Board of Health and Social Services, Kuujjuaq, Quebec, J0M1C0, Canada
| | - Zhong-Cheng Luo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, 200092, China
- Department of Obstetrics and Gynecology, Sainte-Justine Hospital Research Center, University of Montreal, 3175 Cote-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
- * E-mail:
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Masching R, Dell CA, Egan JP, McHugh NGL, Lee D, Prentice T, Storm L, Thomas C, McGee A, Dale-Harris H. The Complexities of Accessing Care and Treatment: Understanding Alcohol Use by Aboriginal Persons Living with HIV and AIDS. Canadi J Aborig Community Based HIV/AIDS Res 2014; 6:70-94. [PMID: 27867443 PMCID: PMC5112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The role of alcohol in the transmission of HIV and access to health services for persons living with HIV/AIDS is relatively unexamined across the globe. Our team's community-based, mixed methods study examined both of these questions from the perspectives of Aboriginal persons living in Canada with HIV/AIDS (APHA) and service providers (SP). A bilingual national survey was undertaken with APHAs and SPs and the findings were followed up on in peer interviews. A complex relationship was identified between alcohol use, perceptions of alcohol use and access to services. Nearly half of APHAs surveyed reported that alcohol played a role in their becoming HIV positive. APHAs and SPs differed in their assessment of the impact of alcohol in the lives of Aboriginal persons once diagnosed, with a far greater proportion of SPs identifying it as problematic. Both SPs and APHAs associated the misuse of alcohol with diminished health. Nearly half of the APHAs surveyed shared they had been told they were drinking by a SP when they were not, while over one-third reported ever being denied services because of drinking when in fact they were not. Both SPs and APHAs identified physical health and discrimination as key reasons. Notwithstanding these results that point to shortcomings in service provision, the data also reveal that most APHAs are recieving care in which their choices are respected and from providers they trust. The findings point to the need for a nuanced strategy to solidify the strengths and address the shortcomings in APHA's service provision.
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Affiliation(s)
- Renée Masching
- Renée Masching (MA) is First Nations from Southern Ontario and is the Director of Research and Policy with the Canadian Aboriginal AIDS Network
| | - Colleen A. Dell
- Colleen Anne Dell (PhD) is a Professor and Research Chair in Substance Abuse at the University of Saskatchewan in the Department of Sociology and School of Public Health. She is also a Senior Research Associate with the Canadian Centre on Substance Abuse
| | - John P. Egan
- John P Egan (PhD) is a Canadian community-based researcher based at the University of Auckland in Auckland, New Zealand
| | - Nancy Gros-Louis McHugh
- Nancy Gros-Louis McHugh (BA) is Huronne-Wendat from Wendake, and works as the research coordinator for the First Nations of Quebec and Labrador Health and Social Services Commission
| | - David Lee
- David Lee (1962-2013) was a Sekani Person living with HIV/AIDS from McLeod Lake First Nations in northern BC and spent more than 15 years working on the front lines in the Downtown Eastside of Vancouver
| | - Tracey Prentice
- Tracey Prentice is a PhD Candidate in Population Health at the University of Ottawa
| | - Lyanna Storm
- Lyanna Storm is a Service Provider with the Vancouver Native Health Society, and a community facilitator at the Positive Women’s Network and Dr. Peter Centre
| | - Cliff Thomas
- Cliff Thomas (Elder) is originally from Pegwis First Nations, Manitoba and now lives in Ottawa, Ontario. He is a past National Research Advisory Committee member and an Elder for the Aboriginal HIV & AIDS Community-Based Research Collaborative Centre (AHA Centre)
| | - Amy McGee
- Amy McGee (PhD) is a community-based researcher and midwife living in Ottawa and owner of Drawing Insight
| | - Hugh Dale-Harris
- Hugh Dale-Harris (BEd) is a teacher, researcher, adventurer and father and also co-owner of Drawing Insight
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Auger N, Park AL, Zoungrana H, McHugh NGL, Luo ZC. Rates of stillbirth by gestational age and cause in Inuit and First Nations populations in Quebec. CMAJ 2013; 185:E256-62. [PMID: 23422443 DOI: 10.1503/cmaj.120945] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Inuit and First Nations populations have higher rates of stillbirth than non-Aboriginal populations in Canada do, but little is known about the timing and cause of stillbirth in Aboriginal populations. We compared gestational age- and cause-specific stillbirth rates in Inuit and First Nations populations with the rates in the non-Aboriginal population in Quebec. METHODS Data included singleton stillbirths and live births at 24 or more gestational weeks among Quebec residents from 1981 to 2009. We calculated odds ratios (ORs), rate differences and 95% confidence intervals (CIs) for the retrospective cohort of Inuit and First Nations births relative to non-Aboriginal births using fetuses at risk (i.e., ongoing pregnancies) as denominators and adjusting for maternal characteristics. The main outcomes were stillbirth by gestational age (24-27, 28-36, ≥ 37 wk) and cause of death. RESULTS Rates of stillbirth per 1000 births were greater among Inuit (6.8) and First Nations (5.7) than among non-Aboriginal (3.6) residents. Relative to the non-Aboriginal population, the risk of stillbirth was greater at term (≥ 37 wk) than before term for both Inuit (OR 3.1, 95% CI 1.9 to 4.8) and First Nations (OR 2.6, 95% CI 2.1 to 3.3) populations. Causes most strongly associated with stillbirth were poor fetal growth, placental disorders and congenital anomalies among the Inuit, and hypertension and diabetes among the First Nations residents. INTERPRETATION Stillbirth rates in Aboriginal populations were particularly high at term gestation. Poor fetal growth, placental disorders and congenital anomalies were important causes of stillbirth among the Inuit, and diabetic and hypertensive complications were important causes in the First Nations population. Prevention may require improvements in pregnancy and obstetric care.
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Affiliation(s)
- Nathalie Auger
- Institut national de santé publique du Québec, Montréal, Que.
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