1. Area deprivation and cultural inequalities in fetal growth: capturing trends over time Nathalie Auger, a,b,c Alison L Park, a,b Mark Daniel d a Institut national de santé publique du Québec, b Research Centre of the University of Montréal Hospital Centre, c Social and Preventive Medicine, University of Montréal, d Sansom Institute for Health Research, University of South Australia Key Conclusions Over time, inequalities in fetal growth related to local area deprivation in Montréal: 1)Narrowed for Francophones 2)Narrowed for Anglophones initially, but later reversed due to an increase in poor fetal growth in materially deprived and advantaged areas These trends co-occurred with an increase in the number of Francophone births and decrease in the number of Anglophone births in advantaged areas. Key Conclusions Over time, inequalities in fetal growth related to local area deprivation in Montréal: 1)Narrowed for Francophones 2)Narrowed for Anglophones initially, but later reversed due to an increase in poor fetal growth in materially deprived and advantaged areas These trends co-occurred with an increase in the number of Francophone births and decrease in the number of Anglophone births in advantaged areas. Background Fetal growth recently improved in Montréal, but more for Francophones than Anglophones, leading to a reversal in inequalities after year 2000. Objective: To determine how area deprivation is related to time trends in fetal growth for Anglophones and Francophones of Montréal. Background Fetal growth recently improved in Montréal, but more for Francophones than Anglophones, leading to a reversal in inequalities after year 2000. Objective: To determine how area deprivation is related to time trends in fetal growth for Anglophones and Francophones of Montréal. Findings Fetal growth inequalities related to area deprivation decreased for Francophones in Montréal from 1989-2008. Inequalities also decreased for Anglophones, but this trend masked recent increases in poor fetal growth in advantaged (and deprived) areas, as well as a greater number of births overall in deprived areas over time. Acknowledgements This project has been carried out thanks to funding from Health Canada, administered by the McGill Training and Retention of Health Professionals Project. Methods Data Singleton live births in metropolitan Montréal (N=602,618) Variables Mother tongue: Francophone, Anglophone Material deprivation quintile: Composite score of socioeconomic data for census enumeration (1991, 1996) and dissemination (2001, 2006) areas 1 Period: Four intervals from 1989-2008 Outcome: Small-for-gestational-age (SGA) birth, weight <10 th percentile for age and sex Analysis 1) Prevalence rate of SGA birth (%) 2) Prevalence difference (95% confidence interval, CI) for period and SGA, accounting for area clustering in generalized estimating equations* * Stratified by language and deprivation, and adjusted for maternal age, education, marital status, birthplace, previous deliveries Methods Data Singleton live births in metropolitan Montréal (N=602,618) Variables Mother tongue: Francophone, Anglophone Material deprivation quintile: Composite score of socioeconomic data for census enumeration (1991, 1996) and dissemination (2001, 2006) areas 1 Period: Four intervals from 1989-2008 Outcome: Small-for-gestational-age (SGA) birth, weight <10 th percentile for age and sex Analysis 1) Prevalence rate of SGA birth (%) 2) Prevalence difference (95% confidence interval, CI) for period and SGA, accounting for area clustering in generalized estimating equations* * Stratified by language and deprivation, and adjusted for maternal age, education, marital status, birthplace, previous deliveries Contact: nathalie.auger@inspq.qc.ca, Phone: 514-864-1600 x3717 1 Pampalon R, et al. A deprivation index for health planning in Canada. Chronic Dis Can 2009:29:178-91 SGA birth prevalence Results Recommendations Efforts to monitor perinatal health inequalities related to area deprivation can help identify population subgroups with emerging risk, but area-based measures should be used with caution as they may mask: 1) Underlying shifts in the distribution of births across deprivation levels over time 2) Underlying changes in rates of adverse births outcomes across deprivation levels over time FrancophonesAnglophones SGA birth for Anglophone vs Francophone Prevalence difference (95% CI) of SGA for period AdvantagedDeprived 1989-1993Ref 1994-1998-1.3 (-1.9, -0.7)-2.6 (-3.3, -2.0) 1999-2003-3.1 (-3.7, -2.6)-4.9 (-5.5, -4.2) 2004-2008-3.0 (-3.5, -2.4)-5.2 (-5.8, -4.5) Prevalence difference (95% CI) of SGA for period AdvantagedDeprived 1989-1993Ref 1994-1998-1.0 (-1.9, -0.1)-2.1 (-3.6, -0.5) 1999-2003-1.7 (-2.7, -0.8)-3.4 (-4.9, -1.9) 2004-2008-0.7 (-1.7, 0.2)-1.9 (-3.4, -0.4) % SGA Note: Only the most and least deprived quintiles are shown.