Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity.

We evaluated the contribution of place of birth to ethnocultural inequality in pregnancy outcomes. We analyzed a cohort of 1,487,723 births between 1998 and 2019 among minority Anglophones and majority Francophones in Quebec, Canada. We estimated the association (adjusted risk ratio, RR; 95% confidence interval, CI) of language with preterm birth and stillbirth, and incorporated interaction terms to determine the contribution of place of birth and distance traveled. Compared with Francophones, minority Anglophones had a greater risk of preterm birth (RR 1.03; 95% CI 1.01-1.06) and were less likely to deliver farther from home (RR 0.95; 95% CI 0.94-0.95). Anglophones who delivered close to home had a higher risk of preterm birth (RR 1.07; 95% CI 1.04-1.11), whereas Anglophones who delivered farther had a lower risk (RR 0.69; 95% CI 0.64-0.75). Patterns were similar for stillbirth. Ethnocultural inequality in adverse birth outcomes may be influenced by place of birth.

Ethnicity, Child Sex, and the Likelihood of Marriage in Pregnancy: A Novel Analysis of Gender Inequity.

Objective: We assessed the association between fetal sex and the likelihood of marriage during pregnancy. Methods: We analyzed a cohort of 1,334,911 women who were unmarried at conception and had a live birth between 1990 and 2018 in Quebec, Canada. The exposure was fetal sex, determined by ultrasound. The outcome was marriage during pregnancy. We estimated hazard ratios and 95% confidence intervals (CI) for the association of child sex with the likelihood of marriage during pregnancy according to region of origin. Results: Among women who were unmarried at conception, 13.1% of foreign-born women got married during pregnancy compared with 2.6% of Canadian-born women. Women from the Middle East and North Africa who were pregnant with boys were 1.13 times more likely to marry during pregnancy compared with women who were pregnant with girls (95% CI 1.02-1.26). There was no association among Canadian-born women. Conclusion: Women from some cultural minorities who are pregnant with boys may be more likely to marry during pregnancy in Western settings. Gender inequality may manifest as a preference for sons that influences the likelihood of marriage.

Infant mortality among Arabic-speakers in Quebec, Canada, 1989-2017.

BACKGROUND: We assessed trends in infant mortality for Arabic-speakers in Quebec, Canada between 1981 and 2017. METHODS: We computed infant mortality rates for Arabic versus French and English-speakers in Quebec over time. We used adjusted risk ratios (aRR) and 95% confidence intervals (CI) to investigate trends among Arabic-speakers according to socioeconomic status, age, and cause of death. RESULTS: Infant mortality rates were 3.0 for Arabic-speakers and 5.1 for French and English-speakers per 1,000 live births. Infant mortality increased for Arabic-speakers between 1989-1995 and 2010-2017 (aRR 2.07; 95% CI, 1.04-4.12), but decreased for French and English-speakers (aRR 0.77; 95% CI, 0.73-0.81). The increase in infant mortality was greater for socioeconomically advantaged Arabic-speakers (aRR 2.52; 95% CI, 1.20-5.28) and early neonatal mortality (aRR 1.64; 95% CI, 0.98-2.76). DISCUSSION: Arabic-speakers in Quebec have a lower risk of infant mortality than French and English-speakers, but increasing infant mortality among Arabic-speakers is narrowing the gap.

Emerging Lingo-Cultural Inequality in Infant Autopsy in Quebec, Canada.

We investigated trends in infant autopsy for Francophones and Anglophones in Quebec, Canada. Using death certificates, we extracted 8214 infant deaths between 1989 and 2013. We computed rates of non-autopsy by language, socioeconomic disadvantage, age at death, and period. Using Kitagawa's method, we decomposed non-autopsy rates over time for both language groups. Infant non-autopsy rates increased from 38.6 to 56.2 per 100 for Francophones, and from 41.2 to 57.2 per 100 for Anglophones, between 1989-1995 and 2008-2013. Trends in English-speakers were driven by socioeconomically disadvantaged Anglophones, and were accelerated by a larger proportion of deaths in this group over time. For French-speakers, rates increased in all socioeconomic groups. The increase in non-autopsy rates was larger at early neonatal ages for both languages. These findings suggest that disadvantaged Anglophones are less likely to use infant autopsy over time, and that rates can be improved by targeting early neonatal deaths.

Quantile regression analysis of language and interpregnancy interval in Quebec, Canada. / Analyse de régression quantile de la relation entre la langue et l'intervalle entre les grossesses au Québec (Canada).

INTRODUCTION: Short and long interpregnancy intervals are associated with adverse perinatal outcomes such as miscarriage and preterm delivery, but cultural differences in interpregnancy intervals are understudied. Identifying cultural inequality in interpregnancy intervals is necessary to improve maternal-child outcomes. We assessed interpregnancy intervals for Anglophones and Francophones in Quebec. METHODS: We obtained birth records for all infants born in Quebec, 1989-2011. We identified 571 461 women with at least two births, and determined the interpregnancy interval. We defined short interpregnancy intervals (< 18 months) as the 20th percentile of the distribution, and long intervals (≥ 60 months) as the 80th percentile. Using quantile regression, we evaluated the association of language with short and long intervals, adjusted for maternal characteristics. We assessed differences over time and by maternal age for disadvantaged groups defined as no high school diploma, rural residence, and material deprivation. RESULTS: In adjusted regression models, Anglophones who had no high school diploma had intervals that were 1.0 month (95% CI: -1.5 to -0.4) shorter than Francophones at the 20th percentile of the distribution, and 1.9 months (-0.5 to 4.3) longer at the 80th percentile. Results were similar for Anglophones in rural and materially deprived areas. The trends persisted over time, but were stronger for women < 30 years. There were no differences between advantaged Anglophones and Francophones. CONCLUSION: Disadvantaged Anglophones are more likely to have short and long interpregnancy intervals relative to Francophones in Quebec. Public health interventions to improve perinatal health should target suboptimal intervals among disadvantaged Anglophones.

INTRODUCTION: On sait que les intervalles courts comme les intervalles longs entre les grossesses sont associés à des issues périnatales défavorables, comme des fausses couches et des accouchements prématurés, mais les différences culturelles à ce sujet sont mal connues. Repérer les inégalités culturelles dans les intervalles entre les grossesses est nécessaire afin d'améliorer les résultats relatifs à la santé de la mère et de l'enfant. Nous avons ainsi évalué les intervalles entre les grossesses chez les anglophones et les francophones du Québec. MÉTHODOLOGIE: Nous avons obtenu les dossiers de naissance de tous les enfants nés au Québec entre 1989 et 2011. Nous avons recensé 571 461 femmes ayant eu au moins deux naissances et déterminé l'intervalle entre leurs grossesses. Les intervalles courts entre les grossesses (moins de 18 mois) ont été définis comme étant le 20e percentile de la distribution, et les intervalles longs (60 mois ou plus), comme le 80e percentile. À l'aide de régressions quantiles, nous avons évalué l'association entre la langue et les intervalles courts et longs, ajustés en fonction des caractéristiques de la mère. Nous avons évalué les différences au fil du temps et selon l'âge de la mère pour les groupes défavorisés, qui ont été définis par l'absence de diplôme d'études secondaires, la résidence en milieu rural et le fait de vivre dans un quartier défavorisé matériellement. RÉSULTATS: Dans les modèles de régression ajustés, les anglophones sans diplôme d'études secondaires avaient des intervalles plus courts de 1,0 mois (intervalle de confiance [IC] à 95 % : −1,5 à −0,4) par rapport à leurs homologues francophones au 20e percentile de la distribution et plus longs de 1,9 mois (−0,5 à 4,3) au 80e percentile. Les résultats étaient similaires pour les anglophones des régions rurales et des quartiers matériellement défavorisés. Les tendances se sont maintenues au fil du temps, et se sont révélées plus fortes chez les femmes de moins de 30 ans. Aucune différence n'a été relevée entre les francophones favorisées et les anglophones favorisées. CONCLUSION: Au Québec, les anglophones défavorisées étaient plus susceptibles d'avoir des intervalles courts ou des longs entre leurs grossesses que les francophones défavorisées. Les interventions de santé publique visant à améliorer la santé périnatale devraient donc cibler les intervalles sous-optimaux chez les anglophones défavorisées de la province.

Identifying emerging reproductive vulnerability: an approach to decompose differences in total fertility.

PURPOSE: We introduce a method to partition the difference in total fertility between two groups. METHODS: We computed the total fertility rate for Francophones and Anglophones of Quebec, Canada, between 1989-1993 and 2004-2008. We partitioned the difference in excess fertility for one group relative to the other into the number of children contributed by maternal age, origin, material deprivation, education, and offspring birth order. We calculated the change in total fertility over time and the factors that contributed. RESULTS: The total fertility rate was higher by 0.18 children for Francophones in 1989-1993, but the gap reversed in 2004-2008, with total fertility higher for Anglophones by 0.12 children. Francophones had higher fertility in 1989-1993 due mainly to women who were Canadian born, aged 15-29 years, without secondary diploma, or living in socioeconomic deprivation. The reversal in 2004-2008 was caused by a reduction in fertility for Francophones aged 15-29 years and an increase in the contribution of Anglophones who were foreign born, aged 30-49 years or socioeconomically disadvantaged. CONCLUSIONS: Through decomposition of differences in total fertility, we identified populations with emerging reproductive vulnerability in a large Canadian province. Socioeconomically disadvantaged Anglophones in Quebec have increasing fertility, a potential sign of increasing reproductive risk.