Regional disparities in infant mortality in Canada: a reversal of egalitarian trends

<p>Abstract</p> <p>Background</p> <p>Although national health insurance plans and social programs introduced in the 1960s led to reductions in regional disparities in infant mortality in Canada, it is unclear if such patterns prevailed in the 1990s when the health care and related systems were under fiscal duress. This study examined regional patterns of change in infant mortality in Canada in recent decades.</p> <p>Methods</p> <p>We analysed regional changes in crude infant mortality rates and in infant mortality rates among live births with a birth weight ≥ 500 g and ≥ 1,000 g in Canada from 1945 to 2002. Associations between baseline infant mortality rates in the provinces and territories (e.g., in 1985–89) and the change observed in infant mortality rates over the subsequent period (e.g., between 1985–89 and 1995–99) were assessed using Spearman's rank correlation coefficient. Trends in regional disparities were also assessed by calculating period-specific rate ratios between provinces/territories with the highest versus the lowest infant mortality.</p> <p>Results</p> <p>Provincial/territorial infant mortality rates in 1945–49 were not correlated with changes in infant mortality over the next 10 years (rho = 0.01, P = 0.99). However, there was a strong negative correlation between infant mortality rates in 1965–69 and the subsequent decline in infant mortality (rho = - 0.85, P = 0.002). Provinces/territories with higher infant mortality rates in 1965–69 (Northwest Territories 64.7 vs British Columbia 20.7 per 1,000 live births) experienced relatively larger reductions in infant mortality between 1965–69 and 1975–79 (53.7% decline in the Northwest Territories vs a 36.6% decline in British Columbia). This pattern was reversed in the more recent decades. Provinces/territories with higher infant mortality rates ≥ 500 g in 1985–89 experience relatively smaller reductions in infant mortality between 1985–89 and 2000–02 (rho = 0.82, P = 0.004). The infant mortality ≥ 500 g rate ratio (contrasting the province/territory with the highest versus lowest infant mortality) was 3.2 in 1965–69, 2.4 in 1975–79, 2.2 in 1985–89, 3.1 in 1995–99 and 4.1 in 2000–02.</p> <p>Conclusion</p> <p>Fiscal constraints in the 1990s led to a reversal of provincial/territorial patterns of change in infant mortality in Canada and to an increase in regional health disparities.</p

Mortality in general practice--an analysis of 841 deaths during a two-year period in 17 Dutch practices

PURPOSE: To gain insight into how general practitioners (GPs) determine the cause of death and record it on the death certificate for patients who die at home. METHOD: During 1998 and 1999, the number of patient deaths, as well as the cause and place of death, were registered for 17 general practices. RESULTS: A total of 841 patients died during the two-year study period: an average of 25 patients per practice, per year. 53.8% at home, 34.6% in hospital, 8.7% in a nursing home, and 2.8% elsewhere. When compared with national figures, the number of deaths due to neoplasms were similar, whereas there were clear differences when causes for sudden death were compared with the information obtained from the National Central Bureau of Statistics (CBS). Heart disease (19%) was registered less often, and cerebrovascular accidents (45%) more frequently. There were 57 (6.7%) deaths due to unnatural causes, 23 (2.6%) of which were due to euthanasia, which were all reported according to the law, requiring no further action. Autopsies were obtained in 3% of all deaths. CONCLUSION: Especially in cases of sudden death, determining the cause of death is guesswork. During medical school and continuing education, attention should be given to the completion of registration information. The Central Bureau of Statistics would be able to give more and better feedback to the physicians. A case is made for maintaining a death registry in each general practice. A death register is a means of reflection and for improving quality of care