Abstract
ObjectiveInfant mortality statistics for Canada have routinely omitted Ontario—Canada’s most populous province—as a high proportion of Vital Statistics infant death registrations could not be linked with their corresponding Vital Statistics live birth registrations. We assessed the feasibility of linking an alternative source of live birth information with infant death registrations.MethodsAll infant deaths occurring before 365 days of age registered in Ontario’s Vital Statistics in 2010–2011 were linked with birth records in the Canadian Institute for Health Information’s hospitalization database. Crude birthweight-specific and gestational age-specific infant mortality rates were calculated, and rates examined according to maternal and infant characteristics.ResultsOf 1311 infant death registrations, only 47 (3.6%) could not be linked to a hospital birth record. The overall crude infant mortality rate was 4.7 deaths per 1000 live births (95% CI, 4.4 to 4.9), the same as previously reported for the rest of Canada in 2011. Infant mortality was higher in women < 20 years (5.8 per 1000 live births) and ≥ 40 years (5.9 per 1000 live births), and lowest among those aged 25–29 years (3.9 per 1000 live births). Infant mortality was notably higher in the lowest (5.1 per 1000 live births) residential income quintile than the highest (3.4 per 1000 live births).ConclusionUse of birth hospitalization records resulted in near-complete linkage of all Vital Statistics infant death registrations. This approach could enhance the conduct of representative surveillance and research on infant mortality when direct linkage of live birth and infant death registrations is not achievable.
Highlights
The infant mortality rate is an important population health indicator, reflecting the well-being of infants, children, pregnant women, and their families as well as the quality of health care (Public Health Agency of Canada 2008)
The infant mortality rate has been a key metric of global initiatives to improve child health such as the United Nations’ Millennium Development Goals (United Nations 2015) and Sustainable Development Goals (United Nations Economic and Social Council 2017; You et al 2015)
Data on infant mortality can be obtained from a variety of sources, the gold standard used by most high-income countries is a civil registration system that continuously records births and deaths, which are reported to a centralized authority (Setel et al 2007)
Summary
The infant mortality rate is an important population health indicator, reflecting the well-being of infants, children, pregnant women, and their families as well as the quality of health care (Public Health Agency of Canada 2008). ServiceOntario regularly transfers these Vital Statistics registration files to Statistics Canada, where they are combined with registrations from other provinces and territories to create the national-level Vital Statistics Birth and Death Databases. Statistics Canada regularly performs a national-level record linkage of live birth registrations with infant death registrations to create a linked live birth–infant death file. This linked file is used extensively for national research and surveillance by the Canadian Perinatal Surveillance System (CPSS) within the Public Health Agency of Canada (Ananth et al 2009; Deb-Rinker et al 2015; Gilbert et al 2013; Joseph et al 2002, 2012; Public Health Agency of Canada 2008, 2017). A similar linkage of birth and infant death registrations is performed annually in the United States and the resulting linked file is a cornerstone of maternal and child health surveillance (Buehler et al 2000)
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