Abstract
BackgroundThe northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. Nunavut has rates of infant mortality, postneonatal mortality and hospitalisation of infants for respiratory infections that greatly exceed those for the rest of Canada. The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. Nunavut has the largest Inuit population in Canada, a population which has been identified as having high rates of Sudden Infant Death Syndrome (SIDS) and infant deaths due to infections.MethodsTo determine the causes and potential risk factors of infant mortality in Nunavut, we reviewed all infant deaths (<1yr) documented by the Nunavut Chief Coroner’s Office and the Nunavut Bureau of Statistics (n=117; 1999–2011). Rates were compared to published data for Canada.ResultsSudden death in infancy (SIDS/SUDI; 48%) and infection (21%) were the leading causes of infant death, with rates significantly higher than for Canada (2003–2007). Of SIDS/SUDI cases with information on sleep position (n=42) and bed-sharing (n=47), 29 (69%) were sleeping non-supine and 33 (70%) were bed-sharing. Of those bed-sharing, 23 (70%) had two or more additional risk factors present, usually non-supine sleep position. CPT1A P479L homozygosity, which has been previously associated with infant mortality in Alaska Native and British Columbia First Nations populations, was associated with unexpected infant death (SIDS/SUDI, infection) throughout Nunavut (OR:3.43, 95% CI:1.30-11.47).ConclusionUnexpected infant deaths comprise the majority of infant deaths in Nunavut. Although the CPT1A P479L variant was associated with unexpected infant death in Nunavut as a whole, the association was less apparent when population stratification was considered. Strategies to promote safe sleep practices and further understand other potential risk factors for infant mortality (P479L variant, respiratory illness) are underway with local partners.
Highlights
The northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit
An additional 27 cases were reported to the Nunavut Bureau of Statistics, 7 of which occurred in the territory during the perinatal period; the remaining 20 occurred out of territory (Edmonton, Winnipeg and Ottawa)
Cause-specific infant mortality rates for Sudden Infant Death Syndrome (SIDS)/Sudden Unexpected Death in Infancy (SUDI) and infections were 6.08 and 2.71/1,000 live births, respectively, and these rates were significantly increased compared to national rates (ORs:11.97; 95%confidence intervals (CI): 8.9-15.8 and 8.79; 95%CI: 5.6-13.2; Table 1)
Summary
The northern territory Nunavut has Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit. Nunavut has rates of infant mortality, postneonatal mortality and hospitalisation of infants for respiratory infections that greatly exceed those for the rest of Canada. The infant mortality rate in Nunavut is 3 times the national average, and twice that of the neighbouring territory, the Northwest Territories. Nunavut has the largest Inuit population in Canada, a population which has been identified as having high rates of Sudden Infant Death Syndrome (SIDS) and infant deaths due to infections. A northern Canadian territory covering the most northern and eastern area of Canada, is Canada’s largest jurisdictional land mass with 33,322 inhabitants, of which 85% self-identify as Inuit [1,2]. There are 25 communities in the three regions of Nunavut: Qikiqtani, Kivalliq and Kitikmeot. 45% of births to Nunavut residents occur out of territory [9]
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