Language and infant mortality in a large Canadian province

Highlights

• Infant mortality in minority populations of Canada is poorly understood.

• We studied infant mortality in French, English, and foreign language groups.

• Infant mortality decreased over time for all but foreign languages.

• Poor Anglophones slowed the decrease in infant mortality over time.

• Research is needed to document the impact of language in other countries.

Abstract

Objectives

Infant mortality in minority populations of Canada is poorly understood, despite evidence of ethnic inequality in other countries. We studied infant mortality in different linguistic groups of Quebec, and assessed how language and deprivation impacted rates over time.

Study design

Population-level study of vital statistics data for 1,985,287 live births and 10,283 infant deaths reported in Quebec from 1989 through 2012.

Methods

We computed infant mortality rates for French, English, and foreign languages according to level of material deprivation. Using Kitagawa's method, we evaluated the impact of changes in mortality rates, and population distribution of language groups, on infant mortality in the province.

Results

Infant mortality declined from 6.05 to 4.61 per 1000 between 1989–1994 and 2007–2012. Most of the decline was driven by Francophones who contributed 1.39 fewer deaths per 1000 births over time, and Anglophones of wealthy and middle socio-economic status who contributed 0.13 fewer deaths per 1000 births. The foreign language population and poor Anglophones contributed more births over time, including 0.08 and 0.02 more deaths per 1000 births, respectively. Mortality decreased for Francophones and Anglophones in each level of deprivation. Rates were lower for foreign languages, but increased over time, especially for the poor.

Conclusions

Infant mortality rates decreased for Francophones and Anglophones in Quebec, but increased for foreign languages. Poor Anglophones and individuals of foreign languages contributed more births over time, and slowed the decrease in infant mortality. Language may be useful for identifying inequality in infant mortality in multicultural nations.

Introduction

Since the 1980s, infant mortality has fallen significantly in Canada, including Quebec,¹ but variation in rates across different cultural groups is poorly understood. Apart from Aboriginals,² very little is known on infant mortality among minorities in Canada. In many countries, ethnic minorities have higher infant mortality rates than the majority population. In the USA, for example, infant mortality rates among non-Hispanic blacks, Puerto Ricans, American Indian and Alaska natives range between 7.1 and 11.5 per 1000, while non-Hispanic whites have only 5.2 deaths per 1000.³ In Europe, immigrants from Asia, Africa and the West Indies have a higher risk of infant mortality than the majority population.4, 5, 6 Reasons for these disparities are not fully established, but minorities are often socio-economically disadvantaged,5, 6, 7 with some research suggesting that 18%–43% of inequality in infant mortality may be due to low socio-economic status.6, 8 Interestingly, some disadvantaged minorities have paradoxically low mortality, such as Hispanics in the USA,³ Lebanese and former Yugoslav immigrants in Denmark,⁵ and Finns in Sweden.⁹

A better understanding of how infant mortality varies between minority groups in Canada is needed. Minority groups are primarily defined by language in Quebec, one of the largest Canadian provinces. Quebec is highly multicultural, containing Francophones predominantly, but also Anglophone, foreign language, and Aboriginal minorities. Language in Quebec not only is a marker for cultural minorities, but also reflects ethnicity and social status.¹⁰ Several studies report that language in Quebec is linked to inequality in stillbirth,11, 12 foetal growth restriction,¹³ and mortality.¹⁴ Evidence of decreasing socio-economic status in Anglophones,¹⁵ and increasing immigration from countries with foreign languages,¹⁶ is added cause for concern. Rates of infant mortality are not known, yet merit further study.

In this study, we aim to determine which linguistic groups contributed to the decline in infant mortality in Quebec. Because socio-economic status is strongly linked with minority status, we also account for the contribution of material deprivation over time.