Linguistic mortality gradients in Quebec and the role of migrant composition.

OBJECTIVE: Anglophones and Allophones in Quebec (Canada) have lower mortality than Francophones, despite being linguistic minorities. This study assesses whether (1) language is a risk factor for mortality after accounting for migrant composition and (2) interprovincial migrants differ in mortality with respect to Quebec-born individuals. METHODS: We analyzed death records between 2004 and 2008 from Quebec (all-cause and main causes) and population data from the 2006 census to estimate age-adjusted mortality rates according to language and migrant status. Risk ratios by language and migrant status, adjusted for age, sex, and socioeconomic status, were estimated using Poisson generalized estimating equations. RESULTS: Francophone Quebec-borns had the highest mortality. Among Quebec-borns, Anglophones [RR= 0.85, 95% CI (0.79-0.91)] and Allophones [RR = 0.16, 95 %CI (0.12-0.22)] had lower mortality relative to Francophones. Interprovincial migrants had lower mortality (Anglophones [RR = 0.58, 95% CI (0.53-0.63)], Francophones [RR = 0.55, 95% CI (0.50-0.60)]) relative to Francophone Quebec-borns (Allophones were excluded due to small sample size). Among immigrants, mortality was lower for Francophones [RR = 0.62, 95% CI (0.57-0.67] and Allophones [RR = 0.35, 95% CI (0.31-0.38], but not Anglophones [RR = 0.92, 95% CI (0.84-1.01)], relative to Francophone Quebec-borns. CONCLUSION: In Quebec, linguistic disparities in mortality remained after accounting for migrant status, and both Francophone and Anglophone interprovincial migrants in Quebec had lower mortality than Quebec-born Francophones. Public health initiatives to reduce linguistic disparities in health should account for migrant status.

Preterm birth in the Inuit and First Nations populations of Québec, Canada, 1981-2008.

OBJECTIVES: To evaluate preterm birth (PTB) for Inuit and First Nations vs. non-Indigenous populations in the province of Québec, Canada. STUDY DESIGN: Retrospective cohort study. METHODS: We evaluated singleton live births for Québec residents, 1981-2008 (n = 2,310,466). Municipality of residence (Inuit-inhabited, First Nations-inhabited, rest of Québec) and language (Inuit, First Nations, French/English) were used to identify Inuit and First Nations births. The outcome was PTB (<37 completed weeks). Cox proportional hazards regression was employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) of PTB, adjusting for maternal age, education, marital status, parity and birth year. RESULTS: PTB rates were higher for Inuit language speakers in Inuit-inhabited areas and the rest of Québec compared with French/English speakers in the rest of Québec, and disparities persisted over time. Relative to French/English speakers in the rest of Québec, Inuit language speakers in the rest of Québec had the highest risk of PTB (HR 1.98, 95% CI: 1.62-2.41). The risk was also elevated for Inuit language speakers in Inuit-inhabited areas, though to a lesser extent (HR 1.29, 95% CI: 1.18-1.41). In contrast, First Nations language speakers in First Nations-inhabited areas and the rest of Québec had similar or lower risks of PTB relative to French/English speakers in the rest of Québec. CONCLUSIONS: Inuit populations, especially those outside Inuit-inhabited areas, have persistently elevated risks of PTB, indicating a need for strategies to prevent PTB in this population.

Life expectancy gap between the Francophone majority and Anglophone minority of a Canadian population.

Language is an important determinant of health, but analyses of linguistic inequalities in mortality are scant, especially for Canadian linguistic groups with European roots. We evaluated the life expectancy gap between the Francophone majority and Anglophone minority of Québec, Canada, both over time and across major provincial areas. Arriaga's method was used to estimate the age and cause of death groups contributing to changes in the life expectancy gap at birth between 1989-1993 and 2002-2006, and to evaluate patterns across major provincial areas (metropolitan Montréal, other metropolitan centres, and small cities/rural areas). Life expectancy at birth was greater for Anglophones, but the gap decreased over time by 1.3 years (52% decline) in men and 0.9 years (47% decline) in women, due to relatively sharper reductions in Francophone mortality from several causes, except lung cancer which countered reductions in women. The life expectancy gap in 2002-2006 was widest in other metropolitan centres (men 5.1 years, women 3.2 years), narrowest in small cities/rural areas (men 0.8 years, women 0.7 years), and tobacco-related causes were the main contributors. Only young Anglophones <40 years in small cities/rural areas had mortality higher than Francophones, resulting in a narrower gap in these areas. Differentials in life expectancy favouring Anglophones decreased over time, but varied across areas of Québec. Tobacco-related causes accounted for the majority of the current life expectancy gap.