area deprivation and cultural inequalities in fetal growth: capturing trends over time nathalie...
TRANSCRIPT
Area deprivation and cultural inequalities in fetal growth:
capturing trends over timeNathalie Auger,a,b,c Alison L Park,a,b Mark Danield
a Institut national de santé publique du Québec, bResearch Centre of the University of Montréal Hospital Centre,cSocial and Preventive Medicine, University of Montréal, dSansom Institute for Health Research, University of South Australia
Key Conclusions
Over time, inequalities in fetal growth related to local area deprivation in Montréal: 1) Narrowed for Francophones2) Narrowed for Anglophones initially, but later reversed due to an increase in poor
fetal growth in materially deprived and advantaged areas
These trends co-occurred with an increase in the number of Francophone births and decrease in the number of Anglophone births in advantaged areas.
Background
Fetal growth recently improved in Montréal, but more for Francophones than Anglophones, leading to a reversal in inequalities after year 2000.
Objective: To determine how area deprivation is related to time trends in fetal growth for Anglophones and Francophones of Montréal.
Findings
Fetal growth inequalities related to area deprivation decreased for Francophones in Montréal from 1989-2008.
Inequalities also decreased for Anglophones, but this trend masked recent increases in poor fetal growth in advantaged (and deprived) areas, as well as a greater number of births overall in deprived areas over time.
Acknowledgements
This project has been carried out thanks to funding from Health Canada, administered by the McGill Training and Retention of Health Professionals Project.
MethodsData
Singleton live births in metropolitan Montréal (N=602,618)
Variables
Mother tongue: Francophone, Anglophone
Material deprivation quintile: Composite score of socioeconomic data for census enumeration (1991, 1996) and dissemination (2001, 2006) areas1
Period: Four intervals from 1989-2008
Outcome: Small-for-gestational-age (SGA) birth, weight <10th percentile for age and sex
Analysis
1) Prevalence rate of SGA birth (%)2) Prevalence difference (95% confidence interval, CI) for period and SGA, accounting for area clustering in generalized estimating equations* * Stratified by language and deprivation, and adjusted for maternal age, education, marital status, birthplace, previous deliveries
Contact: [email protected], Phone: 514-864-1600 x3717 1Pampalon R, et al. A deprivation index for health planning in Canada. Chronic Dis Can 2009:29:178-91
SGA birth prevalence
Results
Recommendations
Efforts to monitor perinatal health inequalities related to area deprivation can help identify population subgroups with emerging risk, but area-based measures should be used with caution as they may mask:
1) Underlying shifts in the distribution of births across deprivation levels over time
2) Underlying changes in rates of adverse births outcomes across deprivation levels over time
Francophones Anglophones
SGA birth for Anglophone vs Francophone
1989-1993
1994-1998
1999-2003
2004-2008
2,000
6,000
10,000 Advantaged Deprived
1989-1993
1994-1998
1999-2003
2004-2008
15,000
20,000
25,000 Advantaged Deprived
1989-1993
1994-1998
1999-2003
2004-2008
4
8
12
16
% S
GA
1989-1993
1994-1998
1999-2003
2004-2008
4
8
12
16
% S
GA
1989-1993
1994-1998
1999-2003
2004-2008
0.8
1.0
1.2
Pre
vale
nce ra
tio
(95
% C
I)
Prevalence difference (95% CI) of SGA for period
Advantaged Deprived
1989-1993 Ref Ref
1994-1998 -1.3 (-1.9, -0.7) -2.6 (-3.3, -2.0)
1999-2003 -3.1 (-3.7, -2.6) -4.9 (-5.5, -4.2)
2004-2008 -3.0 (-3.5, -2.4) -5.2 (-5.8, -4.5)
Prevalence difference (95% CI) of SGA for period
Advantaged Deprived
1989-1993 Ref Ref
1994-1998 -1.0 (-1.9, -0.1) -2.1 (-3.6, -0.5)
1999-2003 -1.7 (-2.7, -0.8) -3.4 (-4.9, -1.9)
2004-2008 -0.7 (-1.7, 0.2) -1.9 (-3.4, -0.4)
1989-1993
1994-1998
1999-2003
2004-2008
7
8
9
10
11
12
% S
GA
Note: Only the most and least deprived quintiles are shown.