Mortality among children and youth in high-percentage First Nations identity areas, 2000-2002 and 2005-2007.

INTRODUCTION Many First Nations children live in communities that face diverse social and health challenges compared with their non-Aboriginal peers, including some of the most socio-economically challenging situations in Canada. These differences can be seen in broad indicators of the social determinants of health. Studies of mortality in Aboriginal populations across Canada are often restricted by the lack of Aboriginal identifiers on national death records. While some studies have utilised a record-linkage approach, this is often not possible for the entire country or for recent data. Some researchers have adopted a geographic approach and examined mortality and morbidity in areas that have a high percentage of Aboriginal identity residents, and have uniformly reported elevated rates of mortality and morbidity compared with other areas. The purpose of this article was to examine child and youth mortality (aged 1 to 19 years) in areas where a high percentage of the population identified as First Nations in comparison with areas where there is a low percentage of Aboriginal identity residents. METHODS Using a geographic threshold table approach, areas with a high percentage of Aboriginal identity peoples were classified as either First Nations, Métis, or Inuit communities based on the predominant identity group. The upper one-third of the total Aboriginal population distribution was used as a cut-off for high percentage First Nations areas, where 97.7% of the population aged 1-19 were of First Nations identity in 2006 (N=140 779). Mortality rates were then calculated for high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas, excluding high-percentage Métis or Inuit identity areas. Deaths were aggregated for the 3 years surrounding the 2001 and 2006 census periods, and a total of 473 deaths were recorded for 2000-2002 and 493 deaths for 2005-2007. Analysis was facilitated via the correspondence of six-digit residential postal codes on vital statistics records to census geographical areas using automated geo-coding software (Statistics Canada; PCCF+). RESULTS Age-standardized mortality rates for children and youth in high-percentage First Nations identity areas were significantly higher than in low-percentage Aboriginal identity areas. The rate ratio for all-cause mortality for boys was 3.2 (CI: 2.9-3.6) for 2005-2007 and 3.6 (CI: 3.2-4.2) for girls. Mortality rates for injuries had the largest difference, with rate ratios of 4.7 (CI: 4.0-5.5) and 5.3 (CI:4.5-6.3) for boys in 2000-2002 and 2005-2007 and 5.5 (CI: 4.4-6.8) and 8.3 (CI: 6.8-10.1) for girls in the same period. CONCLUSION A strength of this study is that it is the first to use national-level vital statistics registration data across two time periods to report mortality by cause for children and youth living in high-percentage First Nations areas. Vital events were geographically coded to high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas at the Dissemination Areas level. This area-based methodology allows for mortality to be calculated for children and youth by sex and by detailed cause of death for multiple time periods. The results provide key evidence for the persistent differences in the causes of death for children and youth living in high-percentage First Nations identity areas.