Perinatal health among foreign versus native-born mothers in Canada: variations across outcomes and cohorts.

BACKGROUND: To examine perinatal health differences between foreign-born and native-born mothers in Canada across multiple outcomes and two cohorts 10 years apart. METHODS: Using 94 896 and 131 271 births in the 1996 and 2006 Canadian Census-Birth Cohort, respectively, we estimated risk ratios and risk differences of preterm birth (PTB), small-for-gestational age (SGA), large-for-gestational age (LGA), stillbirth and infant mortality between foreign-born and Canadian-born mothers. RESULTS: In the 1996 cohort, we observed no important differences in adverse outcomes between foreign-born and native-born mothers. In the 2006 cohort, however, foreign-born mothers had lower risks of PTB, LGA, stillbirth, and infant mortality and a higher risk of SGA on both the relative and absolute scales. Lowered risk of PTB among foreign-born mothers in the 2006 cohort was also observed within Caucasian, East Asian, Southeast Asian and South Asian mothers. Favourable outcomes associated with foreign-born status in the 2006 cohort were negatively graded by duration of residence in Canada among immigrant mothers. CONCLUSIONS: Differences in perinatal health by maternal foreign-born status varied across cohorts and a more pronounced 'healthy migrant' effect was observed among more recent migrants. The native-born mothers' perinatal health over time and a more restrictive/selective immigration policy in recent years would explain our results.

Adverse birth outcomes in relation to maternal marital and cohabitation status in Canada.

PURPOSE: An increasing percentage of children are born to couples who cohabit but are not legally married. Using data from a nationally representative Canadian sample, we estimated associations of maternal marital and cohabitation status with stillbirth, infant mortality, preterm birth (PTB), and small- and large-for-gestational-age (SGA and LGA) birth. METHODS: The 2006 Canadian Birth-Census Cohort was created by linking birth registration data with the 2006 long-form census. We used log-binomial regression to estimate risk ratios (RRs) for adverse birth outcomes associated with being single or living with a common-law partner. Analyses were adjusted for maternal age and education. RESULTS: Data were analyzed for 130,931 singleton births. Adjusted RRs (95% confidence intervals) for single mothers compared with married mothers were 1.92 (1.51-2.42) for stillbirth, 2.08 (1.55-2.81) for infant mortality, 1.36 (1.27-1.46) for PTB, 1.31 (1.22-1.39) for SGA birth, and 0.95 (0.90-1.01) for LGA birth. Adjusted RRs for cohabiting mothers compared with married mothers were 0.93 (0.74-1.16) for stillbirth, 1.05 (0.81-1.35) for infant mortality, 1.09 (1.03-1.15) for PTB, 1.05 (0.99-1.10) for SGA birth, and 0.96 (0.92-1.00) for LGA birth. CONCLUSIONS: In a nationally representative Canadian birth cohort, cohabiting and legally married women experienced similar birth outcomes, but most outcomes for single women were substantially worse.

Positional accuracy of geocoding from residential postal codes versus full street addresses.

BACKGROUND: Postal codes are often the only geographic identifier available for assigning contextual or environmental information to a study population. This analysis assesses the influence of three factors-delivery mode type (mode of postal delivery), representative point type (source of latitude-longitude coordinates), and community size-on the accuracy of postal code spatial assignment. DATA AND METHODS: PCCF+ (Postal Code Conversion File Plus) was used to assign delivery mode type, representative point type and community size to each individual in the 2011 Census of Canada. A sample (n = 1,004) was randomly selected with a minimum of 90 observations for each category of those three factors. Based on the address information of individuals in the sample, measures of positional accuracy for geocoding from residential postal codes (PCCF+) versus reference locations as determined by full street addresses (Google Maps) were calculated using a geographic information system. Accuracy was measured as the distance that the geocoded position differed from the full street address. RESULTS: Positional accuracy was related primarily to mode of postal delivery. Rural and mixed (partly urban, partly rural) modes had much higher geocoding error than did urban modes. Rural and small-town Canada and latitude and longitude based on dissemination area centroids had low accuracy, largely because of their close relationship to rural and mixed modes of delivery. DISCUSSION: The accuracy of geocoding from postal codes can vary. Geocoding imprecision may result in misclassification, depending on the spatial resolution of the environmental or contextual measures. The spatial resolution required for a study helps to identify subpopulations that should be excluded because of inadequate positional accuracy.

Socioeconomic disparities in small-for-gestational-age birth and preterm birth.

BACKGROUND: Maternal socioeconomic disadvantage has been associated with increased risk of small-for-gestational-age birth and preterm birth. Few studies, however, have considered maternal education and income simultaneously to better understand the mechanisms underlying perinatal health disparities. This analysis examines both maternal education and income and their association with the risk of small-for-gestational-age birth and preterm birth. DATA AND METHODS: The study is based on 127,694 singleton live births from the 2006 Canadian Birth-Census Cohort, a national cohort of births registered from May 2004 to May 2006 that were linked to the 2006 long-form Census. Unadjusted rates of small-for-gestational-age birth (sex-specific birth weight below the 10th percentile for gestational age) and preterm birth (before 37 completed weeks of gestation) were estimated across selected maternal characteristics. Logistic regression was used to estimate crude and covariate-adjusted risk ratios of both outcomes according to maternal education and income adequacy quintiles. RESULTS: Small-for-gestational-age birth was associated with both maternal education and income adequacy, while preterm birth was associated with maternal education only. These findings persisted after taking factors including maternal age, ethnicity, and marital status into account. The results suggest that the mechanism by which maternal education is associated with these outcomes is likely not through income, nor does income replace education as a potentially meaningful measure of socioeconomic position. INTERPRETATION: The mechanisms underlying associations between socioeconomic position and perinatal health disparities are complex. The results of this study indicate that more than one socioeconomic factor may play a role.

Birth outcomes among First Nations, Inuit and Métis populations.

BACKGROUND: First Nations, Inuit, and Métis are at higher risk of adverse birth outcomes than are non-Indigenous people. However, relatively little perinatal information is available at the national level for Indigenous people overall or for specific identity groups. DATA AND METHODS: This analysis describes and compares rates of preterm birth, small-for-gestational-age birth, large-for-gestational-age birth, stillbirth, and infant mortality (neonatal, postneonatal, and cause-specific) in a nationally representative sample of First Nations, Inuit, Métis, and non-Indigenous births. The study cohort consisted of 17,547 births to Indigenous mothers and 112,112 births to non-Indigenous mothers from 2004 through 2006. The cohort was created by linking the Canadian Live Birth, Infant Death and Stillbirth Database to the long form of the 2006 Census, which contains a self-reported Indigenous identifier. RESULTS: With the exception of small-for-gestational-age birth, adverse birth outcomes occurred more frequently among First Nations, Inuit, and Métis women than among non-Indigenous women. Inuit had the highest preterm birth rate (11.4 per 100 births; 95% CI: 9.7 to 13.1) among the three Indigenous groups. The large-for-gestational-age rate was highest for First Nations births (20.9 per 100 births; 95% CI: 19.9 to 21.8). Infant mortality rates were more than twice as high for each Indigenous group compared with the non-Indigenous population, and rates of sudden infant death syndrome were more than seven times higher among First Nations and Inuit. DISCUSSION: The results confirm disparities in birth outcomes between Indigenous and non-Indigenous populations, and demonstrate differences among First Nations, Métis and Inuit.

The 2006 Canadian Birth-Census Cohort.

BACKGROUND: Evidence on socioeconomic and ethnocultural disparities in perinatal health in Canada tends to be limited to analyses by neighbourhood or for selected provinces. In 2010, the Canadian Institutes of Health Research awarded funding for a project on perinatal outcomes. This article describes the resulting 2006 Canadian Birth-Census Cohort Database. DATA AND METHODS: From the Canadian Live Birth, Infant Death and Stillbirth Database, 687,340 records of children born in Canada from May 16, 2004 through May 15, 2006 to mothers whose usual place of residence was Canada were selected as in-scope births. Deterministic rules were applied to link each person on the birth record-child, mother, father-to 2006 Census data.The cohort was restricted to records linked to a long-form questionnaire, and a cohort weight was developed. Cohort rates (unweighted and weighted) for five birth outcomes-preterm birth, small-for-gestational age, large-for-gestational age, stillbirth, and infant mortality-were compared with rates for all in-scope births across birth characteristics. Cohort rates for these birth outcomes were examined across selected census characteristics. RESULTS: Linkage rates were 91% for births surviving to age 1, 76% for stillbirths, and 80% for infant deaths matched to a birth registration. The cohort estimates were similar to those for all in-scope births, particularly after the cohort weight was applied. The cohort data produced plausible estimates of selected birth outcomes across maternal ethnocultural categories and levels of education. INTERPRETATION: The 2006 Canadian Birth-Census Cohort data can help inform perinatal surveillance and research in Canada.

Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study.

BACKGROUND: People with lower incomes tend to have less favourable health outcomes than do people with higher incomes. Because death registrations in Canada do not contain information about the income of the deceased, vital statistics cannot be used to examine mortality by income at the individual level. However, through record linkage, information on the individual or family income of people followed for mortality can be obtained. Recently, a large, population-based sample of Canadian adults was linked to almost 16 years of mortality data. METHODS: This study examines cause-specific mortality rates by income adequacy among Canadian adults. It is based on data from the 1991 to 2006 Canadian census mortality and cancer follow-up study, which followed 2.7 million people aged 25 or older at baseline, 426,979 of whom died during the 16-year period. Age-standardized mortality rates (ASMRs), rate ratios, rate differences and excess mortality were calculated by income adequacy quintile for various causes of death. RESULTS: For most causes examined, ASMRs were clearly graded by income: highest among people in the in the lowest income quintile, and lowest among people in the highest income quintile. Inter-quintile rate ratios (quintile 1/quintile 5) were greater than 2.00 for HIV/AIDS, diabetes mellitus, suicide, cancer of the cervix, and causes of death closely associated with smoking and alcohol. INTERPRETATION: These individually based results provide cause-specific information by income adequacy quintile that was not previously available for Canada.

Data resource profile: 1991 Canadian Census Cohort.

The 1991 Canadian Census Cohort is the largest population-based cohort in Canada (N=2,734,835). Prior to the creation of this Cohort, no national population-based Canadian cohort was available to examine mortality by socioeconomic indicators. The 1991 Canadian Census Cohort was created via the linkage of a sub-sample of respondents from the mandatory 1991 Canadian Census long-form to historical tax summary files, Canadian Mortality Database, Canadian Cancer Database, 1991 Health and Activity Limitation Survey and a sub-sample of the Longitudinal Worker File. Overall ascertainment of mortality and cancer is anticipated to be nearly complete and the Cohort is broadly representative of most groups in the Canadian population. The Cohort has been used to examine mortality outcomes by different indicators of socioeconomic status, occupational categories, ethnic groups, educational attainment, and for exposure to ambient air pollution. Results have shown that the estimated remaining years of life at age 25 differed substantially by income adequacy quintile, educational attainment, housing type and Aboriginal ancestry.

Neighbourhood income and neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality in Canada, 1991-2005.

BACKGROUND: Rates of infant mortality declined in Canada in the 1990s and 2000s, but the extent to which all socio-economic levels benefitted from this progress is unknown. OBJECTIVES: This study investigated differences and time trends in neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality across neighbourhood income quintiles among live births in Canada from 1991 through 2005. METHODS: The Canadian linked live birth and infant death file was used, excluding births from Ontario, Yukon, Northwest Territories and Nunavut. Mortality rates for neonatal, postneonatal and sudden infant death syndrome (SIDS) were calculated by neighbourhood income quintile and period (1991-1995, 1996-2000, 2001-2005). Hazard ratios (HR) for neighbourhood income quintile and period were computed, adjusting for province of residence, maternal age, parity, infant sex and multiple birth. RESULTS: In urban areas, for the entire study period (1991-2005), the poorest neighbourhood income quintile had a higher hazard of neonatal death (adjusted HR 1.24, 95% CI 1.15-1.34), postneonatal death (adjusted HR 1.58, 95% CI 1.41-1.76) and SIDS (adjusted HR 1.83, 95% CI 1.49-2.26) compared to the richest quintile. Postneonatal and SIDS mortality rates declined by 37% and 57%, respectively, between 1991-1995 and 2001-2005 whereas no significant change was observed in neonatal mortality. The decrease in postneonatal and SIDS mortality rates occurred across all income quintiles. CONCLUSION: This study shows that despite a decrease in infant mortality and SIDS across all neighbourhood income quintiles over time in Canada, socio-economic inequalities persist. This finding highlights the need for effective infant health promotion strategies in vulnerable populations.

Mortality following unemployment in Canada, 1991-2001.

BACKGROUND: This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians. METHODS: We conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30-69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women. RESULTS: For persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991-1996 and 1997-2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age. CONCLUSIONS: Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

Socio-economic inequalities in cause-specific mortality: a 16-year follow-up study.

OBJECTIVES: To examine socio-economic inequalities in cause-specific mortality by examining the independent effects of education, occupation and income in a population-based study of working-age Canadian adults. METHODS: This is a secondary analysis of data from the 1991-2006 Canadian Census mortality and cancer follow-up study (n=2.7 million persons). For this analysis, the cohort was restricted to 2.3 million persons aged 25 to 64 at cohort inception, of whom 164,332 died during the follow-up period. Hazard ratios were calculated by educational attainment (4 levels), occupational skill (6 categories) and income adequacy (5 quintiles) for all-cause mortality and major causes of death. Models were run separately for men and women, controlled for multiple variables simultaneously, and some were stratified by 10-year age cohorts. RESULTS: The magnitude of socio-economic inequalities in mortality differed by indicator of socio-economic position (education, occupation, or income), age group, sex, and cause of death. Compared to age-adjusted models, hazard ratios were attenuated but remained significant in models that adjusted for both age and all three indicators of socio-economic position simultaneously. Socio-economic inequalities in mortality were evident for most of the major causes of death examined. CONCLUSION: This study demonstrates that education, occupation and income were each independently associated with mortality and were not simply proxies for each other. When evaluating socio-economic inequalities in mortality, it is important to use different indicators of socio-economic position to provide a more complete picture.

Cause-specific mortality by education in Canada: a 16-year follow-up study.

BACKGROUND: People with lower levels of education tend to have higher rates of disease and death, compared with people who have higher levels of education. However, because death registrations in Canada do not contain information on the education of the deceased, unlinked vital statistics cannot be used to examine mortality differentials by education. METHODS: This study examines cause-specific mortality rates by education in a broadly representative sample of Canadians aged 25 or older. The data are from the 1991 to 2006 Canadian census mortality follow-up study, which included about 2.7 million people and 426,979 deaths. Age-standardized mortality rates (ASMRs) were calculated by education for different causes of death. Rate ratios, rate differences and excess mortality were also calculated. RESULTS: All-cause ASMRs were highest among people with less than secondary graduation and lowest for university degree-holders. If all cohort members had the mortality rates of those with a university degree, the overall ASMRs would have been 27% lower for men and 22% lower for women. The causes contributing most to that "excess" mortality were ischemic heart disease, lung cancer, chronic obstructive pulmonary disease, stroke, diabetes, injuries (men), and respiratory infections (women). Causes associated with smoking and alcohol abuse had the steepest gradients. INTERPRETATION: A mortality gradient by education was evident for many causes of death.

Temporal trends in Inuit, First Nations and non-Aboriginal birth outcomes in rural and northern Quebec.

OBJECTIVES: The objective was to assess trends in Inuit, First Nations and non-Aboriginal birth outcomes in the rural and northern regions of Quebec. STUDY DESIGN AND METHODS: In a birth cohort-based study of all births to residents of rural and northern Quebec from 1991 through 2000 (n = 177,193), we analyzed birth outcomes and infant mortality for births classified by maternal mother tongue (Inuit, First Nations or non-Aboriginal) and by community type (predominantly First Nations, Inuit or non-Aboriginal). RESULTS: From 1991-1995 to 1996-2000, there was a trend of increasing rates of preterm birth for all 6 study groups. In all rural and northern areas, low birth weight rates increased significantly only for the Inuit mother tongue group [RR1.45 (95% CI 1.05-2.01)]. Stillbirth rates showed a non-significant increase for the Inuit mother tongue group [RR1.76 (0.64-4.83)]. Neonatal mortality rates decreased significantly in the predominantly non-Aboriginal communities and in the non-Aboriginal mother tongue group [RR0.78 (0.66-0.92)], and increased non-significantly for the First Nations mother tongue group [RR2.17 (0.71-6.62)]. Perinatal death rates increased for the First Nations mother tongue grouping in northern areas [RR2.19 (0.99-4.85)]. CONCLUSION: There was a disconcerting rise of some mortality outcomes for births to First Nations and Inuit mother tongue women and to women in predominantly First Nations and Inuit communities, in contrast to some improvements for births to non-Aboriginal mother tongue women and to women in predominantly non-Aboriginal communities in rural or northern Quebec, indicating a need for improving perinatal and neonatal health for Aboriginal populations in rural and northern regions.

Birth outcomes and infant mortality among First Nations Inuit, and non-Indigenous women by northern versus southern residence, Quebec.

BACKGROUND: In circumpolar countries such as Canada, northern regions represent a unique geographical entity climatically, socioeconomically and environmentally. There is a lack of comparative data on birth outcomes among Indigenous and non-Indigenous subpopulations within northern regions and compared with southern regions. METHODS: A cohort study of all births by maternal mother tongue to residents of northern (2616 First Nations (North American Indians), 2388 Inuit and 5006 non-Indigenous) and southern (2563 First Nations, 810,643 non-Indigenous) Quebec, 1991-2000. RESULTS: Compared with births to southern non-Indigenous mother tongue women, births to northern women of all three mother tongue groups were at substantially elevated risks of infant death (adjusted OR (aOR) 1.7-2.9), especially postneonatal death (aOR 2.2-4.4) after controlling for maternal education, age, marital status and parity. The risk elevation in perinatal death was greater for southern First Nations (aOR 1.6) than for northern First Nations (aOR 1.2). Infant macrosomia was highly prevalent among First Nations in Quebec, especially in the north (31% vs 24% in the south). Within northern regions, Inuit births were at highest risk of preterm delivery (aOR 1.4) and infant death (aOR 1.6). CONCLUSION: All northern infants (First Nations, Inuit or non-Indigenous) were at substantially elevated risk of infant death in Quebec, despite a universal health insurance system. Southern First Nations newborns have not benefited from the more advanced perinatal care facilities in southern regions. Environmental influences may partly account for the very high prevalence of macrosomia among First Nations in northern Quebec.

Breast cancer incidence and neighbourhood income.

BACKGROUND: In developed countries, women of higher socioeconomic status often have higher breast cancer incidence rates, compared with women of lower socioeconomic status. DATA AND METHODS: Data were extracted from the Canadian Cancer Registry for the 229,955 cases of adult female invasive breast cancer diagnosed from 1992 through 2004. Postal code at diagnosis was used to determine neighbourhood income quintile. Breast cancer incidence was examined by year, region, age and neighbourhood income quintile. Census data for 1991 on children ever born and British Columbia data for 2006 on first-time attendance at mammography screening were analyzed by neighbourhood income quintile. RESULTS: Residence in the lowest as opposed to the highest neighbourhood income quintile was associated with a 15% lower risk of being diagnosed with breast cancer. Higher income levels were associated with lower parity in 1991 and a higher prevalence of first-time screening mammography in British Columbia in 2006. INTERPRETATION: Canadian data support an association between the diagnosis of invasive breast cancer and neighbourhood income quintile. Parity and mammography screening may account for some differences in incidence.

Potential years of life lost at ages 25 to 74 among Status Indians, 1991 to 2001.

BACKGROUND: Compared with other Canadians, First Nations peoples experience a disproportionate burden of illness and disease. Potential years of life lost (PYLL) before age 75 highlights the impact of youthful or early deaths. DATA AND METHODS: The 1991 to 2001 Canadian census mortality follow-up study tracked a 15% sample of adults aged 25 or older over more than a decade. This study examined mortality among people aged 25 to 74-55,600 Status Indians (39,200 on reserve and 16,500 off reserve) and 2,475,700 non-Aboriginal adults-all of whom were enumerated by the 1991 census long-form questionnaire. Age-standardized PYLL rates were calculated, based on the number of person-years at risk before age 75. RESULTS: Status Indian adults had 2.5 times the risk of dying before age 75, compared with non-Aboriginal adults. Results did not differ greatly by residence on or off reserve. Relative and absolute inequalities were greatest for unintentional and intentional injuries. Socio-economic factors such as income, education, housing and employment explained a substantial share of the disparities in premature death. INTERPRETATION: Status Indian adults had higher rates of premature mortality. Socio-economic factors played an important role in those disparities. Injuries were important contributors to both relative and absolute inequalities.

Potential years of life lost at ages 25 to 74 among Métis and non-Status Indians, 1991 to 2001.

BACKGROUND: Aboriginal peoples experience a disproportionate burden of disease, compared with other Canadians. However, relatively little information is available about mortality among Métis and non-Status Indians. METHODS: This study calculates potential years of life lost before age 75 (PYLL) for people aged 25 to 74 by all-cause and cause-specific mortality, and examines the effect of socio-economic factors on premature mortality. Age-specific and age-standardized PYLL rates were calculated for 11,600 Métis, 5,400 non-Status Indians, and 2,475,700 non-Aboriginal adults based on the number of person-years at risk up to age 75. RESULTS: Métis and non-Status Indian adults had about twice the risk of dying before age 75, compared with non-Aboriginal adults. While the largest percentage of PYLL was due to non-communicable diseases such as cardiovascular disease and cancer, relative and absolute inequalities were greatest for injuries. Socioeconomic indicators such as income, education and employment explained a large share of the disparities in premature mortality. INTERPRETATION: The results highlight the losses of potential years of life due to chronic diseases, as well as the possible importance of injury prevention programs for Métis and non-Status Indians.

Association of macrosomia with perinatal and postneonatal mortality among First Nations people in Quebec.

BACKGROUND: High prevalence of infant macrosomia (up to 36%, the highest in the world) has been reported in some First Nations communities in the Canadian province of Quebec and the eastern area of the province of Ontario. We aimed to assess whether infant macrosomia was associated with elevated risks of perinatal and postneonatal mortality among First Nations people in Quebec. METHODS: We calculated risk ratios (RRs) of perinatal and postneonatal mortality by birthweight for gestational age, comparing births to First Nations women (n = 5193) versus women whose mother tongue is French (n = 653 424, the majority reference group) in Quebec 1991-2000. RESULTS: The prevalence of infant macrosomia (birthweight for gestational age > 90th percentile) was 27.5% among births to First Nations women, which was 3.3 times (confidence interval [CI] 3.2-3.5) higher than the prevalence (8.3%) among births to women whose mother tongue is French. Risk ratios for perinatal mortality among births to First Nations women were 1.8 (95% CI 1.3-2.5) for births with weight appropriate for gestational age, 4.1 (95% CI 2.4-7.0) for small-for-gestational-age (< 10th percentile) births and < 1 (not significant) for macrosomic births compared to births among women whose mother tongue is French. The RRs for postneonatal mortality were 4.3 (95% CI 2.7-6.7) for infants with appropriate-for-gestational-age birthweight and 8.3 (95% CI 4.0-17.0) for infants with macrosomia. INTERPRETATION: Macrosomia was associated with a generally protective effect against perinatal death, but substantially greater risks of postneonatal death among births to First Nations women in Quebec versus women whose mother tongue is French.

Remaining life expectancy at age 25 and probability of survival to age 75, by socio-economic status and Aboriginal ancestry.

Previously, little information has been available about life expectancy and the probability of survival by socio-economic status or for Aboriginal groups. However, data from the 1991 to 2001 Canadian census mortality follow-up study made it possible to construct life tables for the non-institutional population aged 25 or older by a range of census variables. Those life tables have now been updated to include deaths through to the end of 2006. This report summarizes the updated findings. Life expectancy at age 25 and the probability of survival to age 75 tended to be low for people with low income and education, for residents of shelters, rooming houses and hotels, and for Registered Indians, non-Status Indians and Métis. In general, socio-economic disparities in mortality were greater for men than for women.

Suicide mortality by occupation in Canada, 1991-2001.

OBJECTIVE: To describe the association between occupation and risk of suicide among working-age men and women in Canada. METHOD: This study of suicide mortality over an 11-year period is based on a broadly representative 15% sample of the noninstitutionalized population of Canada aged 30 to 69 years at cohort inception. Age-standardized mortality rates (ASMRs) and rate ratios were calculated for men and women in 5 categories of skill level and 80 specific occupational groups, as well as for people not occupationally active. RESULTS: The suicide mortality rate was 20.1/100 000 person years for occupationally active men (during 9 600 000 person years of follow-up) and 5.3/100 000 person years for occupationally active women (during 8 100 000 person years of follow-up). Among occupationally active men, elevated rates of suicide mortality were observed for 9 occupational groups and protective effects were observed for 6 occupational groups. Among women, elevated rates of suicide were observed in 4 occupational groups and no protective effects were observed. For men and women, ASMRs for suicide were inversely related to skill level. CONCLUSIONS: The limited number of associations between occupational groups and suicide risk observed in this study suggests that, with few exceptions, the characteristics of specific occupations do not substantially influence the risk for suicide. There was a moderate gradient in suicide mortality risk relative to occupational skill level. Suicide prevention strategies in occupational settings should continue to emphasize efforts to restrict and limit access to lethal means, one of the few suicide prevention policies with proven effectiveness.