Abstract
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.