ORCID Profile
0000-0002-2412-0459
Current Organisations
McGill University
,
Institut National de Santé Publique du Québec
,
Centre de recherche du CHUM
,
Université de Montréal
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Publisher: Elsevier BV
Date: 03-2009
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.ANNEPIDEM.2012.01.004
Abstract: Time trends in educational inequalities in small-for-gestational-age (SGA) birth are important to evaluate for policy, especially at preterm gestational ages when morbidity and mortality are typically greater. We evaluated educational inequalities in preterm and term SGA birth over time, accounting for potential bias at preterm gestational ages. Data included 2,204,056 singleton live births from 25 to 43 gestational weeks, 1981 to 2007. We estimated prevalence ratios (PR) and percent prevalence differences (PPD) of preterm and term SGA birth for a continuous education score, accounting for maternal characteristics. Sensitivity analyses included correction for misclassification of preterm SGA status, and use of fetuses-at-risk denominators in regression models. Although prevalence of SGA birth decreased over time, relative educational inequalities (PRs) persisted for preterm and term cases. PPDs decreased slightly, but more for term than preterm SGA birth. Sensitivity analyses indicated that PRs for education were stronger for preterm than term SGA birth. PPDs were larger for term SGA birth in the first period, but greater for preterm SGA birth in the last period. Relative educational inequalities in SGA birth persisted over time. The difference in prevalence between the least and most educated mothers is currently greater for preterm than for term SGA birth.
Publisher: Springer Science and Business Media LLC
Date: 15-01-2015
DOI: 10.1007/S00038-015-0650-6
Abstract: We assessed trends in stillbirth over time for Francophones and Anglophones of Quebec, a large Canadian province with publically funded health care and an English-speaking minority. We calculated stillbirth rates for Francophones and Anglophones, and estimated hazard ratios (HR) by decade from 1981 to 2010, adjusting for maternal characteristics. We analyzed temporal trends by gestational interval and cause of fetal death. Stillbirth rates decreased in Quebec during the three decades, due to improved rates in Francophones. Rates decreased for Anglophones in 1991-2000, but increased in 2001-2010 at term, during the second trimester, and for most causes of fetal death. In the 2000s, the hazard of stillbirth for Anglophones was nearly the same as the hazard for Francophones in the 1980s (HR 0.93, 95 % confidence interval 0.82, 1.05). Stillbirth rates declined in both Francophones and Anglophones before the turn of the century, but increased thereafter for Anglophones, suggesting that linguistic inequalities in stillbirth may be emerging in Quebec. Linguistic status may be a useful marker for surveillance of inequalities in stillbirth.
Publisher: Springer Science and Business Media LLC
Date: 08-04-2011
Publisher: Springer Science and Business Media LLC
Date: 07-09-2010
DOI: 10.1007/S10654-010-9499-4
Abstract: Most studies that link neighbourhoods to disease outcomes have represented neighbourhoods as area-level socioeconomic status. Where objective contextual attributes of urban environments have been measured, few studies of food availability have evaluated mortality as an outcome. We sought to estimate associations between the availability of fast-food restaurants (FFR), fruit and vegetable stores (FVS), and cardiovascular mortality in an urban area. Food business data were extracted from a validated commercial database containing all businesses and services in the Montréal Census Metropolitan Area (MCMA). Mortality data (1999-2003) were obtained for the MCMA (3.4 million residents). Directly standardised mortality rates for cardiovascular deaths (n = 30,388) and non-cardiovascular deaths (all causes - cardiovascular deaths) (n = 91,132) and FFR and FVS densities (n/km²) were analysed for 845 census tracts. Generalised additive models and generalised linear models were used to analyse food source-mortality relationships. FVS density was not associated with cardiovascular or non-cardiovascular mortality (relative risk (RR) = 1.02, 95% confidence interval (CI): 0.76, 1.36, and RR = 1.14, 95% CI: 0.87, 1.50, respectively). Higher FFR density was associated with mortality in bivariate and multivariable analyses. Relative risks of death (95% CI) per 10% increase in FFR density were similar for both cardiovascular and non-cardiovascular mortality: 1.39 (1.19, 1.63) and 1.36 (1.18, 1.57), respectively, accounting for socio-demographic covariates. FFR density is associated with cardiovascular mortality but this relationship is no different in magnitude than that for non-cardiovascular mortality. These results together with null associations between FVS density and mortality do not support a major role for food source availability in cardiovascular outcomes.
Publisher: BMJ
Date: 05-2008
Abstract: The unresolved "epidemiological paradox" concerns the association between low socioeconomic status and unexpectedly favourable birth outcomes in foreign born mothers. The "healthy migrant" effect concerns the association between foreign born status per se and birth outcomes. The epidemiological paradox and healthy migrant effect were analysed for newborns in a favourable sociopolitical environment. 98,330 live births to mothers in Montreal, Canada from 1997 to 2001 were analysed. Mothers were categorised as foreign born versus Canadian born. Outcomes were: small for gestational age (SGA) birth low birth weight (LBW) and preterm birth (PTB). Multilevel logistic regression was used to examine the interaction between maternal education and foreign born status, adjusting for covariates. Not having a high school diploma was associated with LBW in Canadian (odds ratio (OR) 3.20 95% CI 2.61 to 3.91) but not foreign born (OR 1.14 95% CI 0.99 to 2.10) mothers and was more strongly associated with SGA birth in Canadian (OR 2.03 95% CI 1.84 to 2.22) than in foreign born (OR 1.26 95% CI 1.07 to 1.49) mothers. Foreign born status was associated with SGA birth (OR 1.37 95% CI 1.28 to 1.47), LBW (OR 1.51 95% CI 1.27 to 1.79) and PTB (OR 1.12 95% CI 1.03 to 1.22) in university-educated mothers only. The epidemiological paradox associated with low educational attainment was present for SGA birth and LBW but not PTB. Foreign born status was associated with adverse birth outcomes in university-educated mothers, the opposite of the healthy migrant effect.
Publisher: Springer Science and Business Media LLC
Date: 14-07-2009
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.HEALTHPLACE.2013.03.003
Abstract: This study investigated temporal trends in heterogeneity of foetal growth restriction across neighbourhood deprivation levels for two culturally distinct communities (Anglophones and Francophones) in a North American metropolitan centre. Inequalities in foetal growth restriction related to deprivation fell from 1989 to 2008 for Francophones, but initial improvements for Anglophones later reversed with a rise in poor foetal growth in the most materially disadvantaged and, unexpectedly, advantaged areas as well. Inequalities in foetal growth restriction related to neighbourhood material deprivation may be emerging in this minority Anglophone population. Potential mechanisms underlying these trends are discussed, as well as implications for perinatal health policy.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2008
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.SOCSCIMED.2012.04.033
Abstract: Evidence suggests that in idual socioeconomic status is a better predictor of preterm birth (PTB) than other in idual social characteristics, but it is not clear if socioeconomic (material) area context is likewise more strongly related to PTB than social area characteristics. We compared material and social area deprivation to determine which was more strongly associated with PTB. Live singleton births from Québec, Canada were obtained for 1999-2006 (N = 581,898). PTB was defined as <37 completed gestational weeks. Two composite indices representing area-level material and social deprivation were used in Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for PTB, accounting for in idual-level characteristics including maternal education. Results indicated that PTB rates were higher for areas with high material (7.1%) and social (6.8%) deprivation than those with low material (5.5%) and social (5.9%) deprivation. Adjusted hazards of PTB were slightly greater for material deprivation than social deprivation. These findings indicate that material area deprivation is marginally more strongly associated with PTB than social deprivation, but it is not clear that interventions to prevent PTB should focus on material deprivation any more than on social area deprivation.
Publisher: Springer Science and Business Media LLC
Date: 25-12-2009
DOI: 10.1007/S10654-008-9307-6
Abstract: Elevated ratios of male to female births are emerging in Asian countries due to selective abortion of female foetuses. Little research has evaluated the possibility of sex selection among Asians in the West. We evaluated patterns in the secondary sex ratio (SSR, number of male per 100 female births) according to ethnicity in Québec, Canada. We performed a population-based retrospective analysis of live and still births in urban Québec, 1981-2004 (N = 1,612,614 live births). Outcomes included: (1) first and second order SSR over four consecutive 6-year intervals analysed according to parental mother tongue, parental birth region, and mothers still speaking her mother tongue at home, (2) adjusted relative risk (RR) of female birth by parental ethnicity, and (3) estimated number of unborn females. For the period 1987-1992, first order SSRs were elevated (range 118-121) for Indo-Pakistani parental mother tongue and mothers currently speaking Indo-Pakistani at home. Second order SSRs were not elevated. For Indo-Pakistani mother tongues, the RR of female birth was lower than French/English in the same period (adjusted RR 0.96, 95% CI 0.92-0.99). SSRs were not imbalanced in the late 1990s among Indo-Pakistani parents, or among Chinese ethnicity in any study period. The SSR in Québec was elevated in the 1980s and early 1990s among firstborn relative to subsequent born infants of Indo-Pakistani descent. The reason for this imbalance is unclear. Further research in other Western settings is necessary to evaluate the possibility of sex selection.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2012
DOI: 10.1007/S10903-011-9460-Y
Abstract: Perinatal health data for Haitians are scant. We evaluated adverse birth outcomes for Haitians in Québec, Canada. We analyzed 2,124,909 live births from 1981 to 2006. Haitian ethnicity was assessed using maternal birth country (Haiti, other Caribbean country, other foreign country, Canada) and home language (Creole, French/English but Creole mother tongue, French/English, other). Associations between ethnicity and preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth were calculated. Adverse birth outcomes were more common among mothers with Haitian ethnicity. Relative to Canadian-born mothers, odds for Haitian-born mothers were 4 times greater for extreme PTB (≤27 weeks), twice greater for very PTB (28-31 weeks), and 25% higher for moderate PTB (32-36 weeks). Patterns were similar for SGA birth and severe cases of LBW. Despite overall decreases LBW and SGA birth, relative and absolute inequalities increased over time. Perinatal health inequalities are increasing for Haitian-born mothers.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.JADOHEALTH.2014.12.006
Abstract: We assessed the potential for harmful messages in online advertisements targeted to youth, using the ex le of the Canadian "Light It Up" marketing c aign from a large sports corporation. We undertook a cluster randomized controlled trial of 20 secondary school classes in Montreal, Canada. Classes were randomly allocated to view a "Light It Up" advertisement (n = 205) or a neutral comparison advertisement (n = 192). The main outcome measures were self-reports of illicit drug messages in the advertisements. Of the students, 22.9% reported that the "Light It Up" advertisement contained illicit drug messages compared with 1.0% for the comparison advertisement (relative risk, 22.0 95% confidence interval, 6.5-74.9). Although meant to promote sports, youth in this study believed that the "Light It Up" advertisement was related to illicit drugs. The c aign illustrates how advertisements may inadvertently market unwanted behaviors to children.
Publisher: Wiley
Date: 04-08-2008
DOI: 10.1111/J.1365-3016.2008.00959.X
Abstract: Evidence points to an association between a mother's place of residence and her newborn's health, independent of in idual characteristics. Neighbourhood constructs such as immigrant density, deprivation and crime have all been separately associated with birth outcomes. Little research has considered the joint influence of variables representing a spectrum of neighbourhood constructs. Subjective vs. objective measures of neighbourhood constructs (e.g. reported vs. perceived crime) are often not considered. We sought to evaluate the relationship between neighbourhood measures of reported crime, neighbourhood perceived security, immigrant density, material/social deprivation, residential stability and the odds of small-for-gestational-age (SGA) birth in an urban setting in Canada. Neighbourhood was defined as police districts (n = 49). We linked Montreal livebirths 1997-2001 (n = 98 330) to police district crime measures, survey data on perceived security, and 2001 census data. We used multi-level analysis to calculate odds ratios (OR) for neighbourhood effects on SGA birth accounting for in idual characteristics. Mothers residing in neighbourhoods with the most favourable perception had a lower odds of SGA birth than neighbourhoods with the least favourable perception [OR 0.87, 95% CI 0.77, 0.97]. Mothers in neighbourhoods with lower proportions of immigrants had lower odds of SGA birth relative to neighbourhoods with the highest proportion of immigrants. Reported crime, residential stability and material/social deprivation (accounting for neighbourhood perception) were not associated with SGA birth. Immigrant density and subjective perceptions of neighbourhood security are associated with SGA birth. Public health strategies to improve fetal growth should target neighbourhoods with low perceived security and high immigrant density.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2013
DOI: 10.1007/S11356-013-1677-Y
Abstract: Preterm birth (PTB) is a growing public health problem potentially associated with ambient air pollution. Gasoline service stations can emit atmospheric pollutants, including volatile organic compounds potentially implicated in PTB. The objective of this study was to evaluate the relationship between residential proximity to gasoline service stations and PTB. Singleton live births on the Island of Montreal from 1994 to 2006 were obtained (n=267,478). Gasoline service station locations, presence of heavy-traffic roads, and neighborhood socioeconomic status (SES) were determined using a geographic information system. Multivariable logistic regression was used to analyze the association between PTB and residential proximity to gasoline service stations (50, 100, 150, 200, 250, and 500 m), accounting for maternal covariates, neighborhood SES, and heavy-traffic roads. For all distance categories beyond 50 m, presence of service stations was associated with a greater odds of PTB. Associations were robust to adjustment for maternal covariates for distance categories of 150 and 200 m but were nullified when adjusting for neighborhood SES. In analyses accounting for the number of service stations, the likelihood of PTB within 250 m was statistically significant in unadjusted models. Associations were, however, nullified in models accounting for maternal covariates or neighborhood SES. Our results suggest that there is no clear association between residential proximity to gasoline service stations in Montreal and PTB. Given the correlation between proximity of gasoline service stations and SES, it is difficult to delineate the role of these factors in PTB.
Publisher: Informa UK Limited
Date: 02-2009
DOI: 10.1080/13557850802071132
Abstract: Studies in the USA suggest that the association between maternal birthplace, socioeconomic status (SES), and low birth weight (LBW) can vary across different immigrant groups. Less is known outside the USA about these associations. Our study assesses the association of maternal birthplace and SES on the likelihood of LBW infants in Québec, Canada. Using 2000 Quebec birth registry data, logistic regression was used to examine differentials in LBW according to maternal birthplace and SES. Singleton infants born to Québec mothers (n=47,988) were grouped into nine regions based on maternal birthplace: (1) Canada (2) the USA and western Europe (3) eastern Europe (4) Latin America (5) the Caribbean (6) Sub-Saharan Africa (7) north Africa and Middle East (8) South Asia and (9) East Asia and Pacific. SES was classified into four categories according to maternal educational attainment: (1) low SES (<11 years) (2) medium-low SES (11-12 years) (3) medium-high SES (13-14 years) and (4) high SES (more than 14 years). Covariates included maternal age, gestational duration, and parity. LBW was defined as between 500 and 2499 g. Compared to a LBW prevalence of 4.5 for Canadian-born mothers, South Asian- and Caribbean-born mothers had prevalence percentages of 9.2 and 8.2, respectively. After adjusting for SES and other covariates, the likelihood (odds ratio (OR), 95% confidence intervals (CI)) of LBW outcomes remained greater for South Asian- (OR 2.84 95% CI, 1.90-4.24) and Caribbean-born mothers (OR 1.52 95% CI 1.11-2.10). After pooling these two groups and testing for moderation by SES, we found that high SES immigrant mothers (OR 3.82 95% CI 2.33-6.25) had a higher likelihood of LBW infants than low SES mothers (OR 2.00 95% CI 1.22-3.33) compared to high SES Canadian-born mothers. In Québec, the association between foreign-born status and LBW varies according to maternal birthplace.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.PUHE.2009.04.012
Abstract: Evidence of the association between income inequality and mortality for small rather than large areas is conflicting. This study evaluated community-level income inequality in relation to age- and cause-specific mortality. Ecological analysis. Mortality data were extracted from the Québec, Canada registry for 1999-2003. For Québec communities (n=143), directly standardized mortality rates were calculated for all-cause (overall, working-age and post-working-age), suicide, alcohol, tobacco and cardiovascular mortality. Using 2001 Canada Census data, the tertiles of income inequality measured as the decile ratio, coefficient of variation and median share were calculated. The relative risk (RR) of death was determined using Poisson regression, accounting for median community income, family structure and rural-urban area. Income inequality was most strongly associated with alcohol-related mortality (RR(CoefficientVariation) 0.85, 95% confidence interval 0.77-0.94), followed by statistically significant but weaker inverse associations with tobacco-related and age-specific all-cause mortality. Income inequality in Québec communities is inversely associated with mortality outcomes, particularly alcohol-related mortality. These associations contrast with positive or null associations observed in studies of larger US and Canadian metropolitan areas, respectively. Community-level studies accounting for in idual-level covariates are necessary to clarify the relationship between income inequality and mortality.
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1748-0361.2009.00242.X
Abstract: Rural relative to urban area and low socioeconomic status (SES) are associated with adverse birth outcomes. Whether a graded association of increasing magnitude is present across the urban-rural continuum, accounting for SES, is unclear. We examined the association between rural-urban continuum, SES and adverse birth outcomes. Singleton births from 1999 to 2003 (n = 356,147) were linked to Québec municipalities ranked on a continuum of 3 urban and 4 rural areas based on population and economic base. Maternal education was used to represent SES. Odds ratios (OR) were calculated for preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth, accounting for municipality and in idual-level covariates. We used stratified analyses to examine interaction between SES and rural-urban continuum. Relative to metropolitan area residence, living in small urban or rural areas was associated with adverse birth outcomes. Living in rural areas was associated with SGA birth (OR 1.11, 95% CI 1.05-1.17) and LBW (OR 1.15, 95% CI 1.05-1.26), and living in small urban areas was associated with PTB (OR 1.14, 95% CI 1.08-1.20). Upon stratification by education, living in remote rural relative to metropolitan areas was associated with adverse birth outcomes among university educated mothers only, and living in small urban areas was associated with adverse birth outcomes among mothers with lesser but not higher education. An SES gradient was present in all rural-urban areas, particularly for SGA birth. Differences in perinatal health exist across the rural-urban continuum, and maternal education has a modifying influence.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2011
DOI: 10.1007/S10995-010-0645-0
Abstract: To clarify the relationship between preterm birth (PTB) and extreme weather events, we evaluated PTB during a January 1998 ice storm that had led to a provincial emergency in the middle of winter in the province of Québec, Canada. Singleton live births for three periods (1993-1997, 1998, 1999-2003) were obtained (N = 855,320). PTB was defined as gestational age <37 completed weeks. Births in the Triangle of Darkness, the area most strongly affect by the storm, were geocoded. Multivariate logistic regression was used to calculate the likelihood of PTB for the Triangle relative to metropolitan Montréal, adjusting for maternal age, education, civil status, maternal birthplace, and previous deliveries. Associations for 1998 relative to other periods were evaluated. Short-term (January-February) and long-term (March-October) exposure periods were examined. The proportion PTB for 1998 January-February births in the Triangle (8.7%) was high compared with 1998 March-October births (6.0%) and with the corresponding proportions for 1993-1997 (6.2%) and 1999-2003 (6.9%). Covariate-adjusted odds of PTB for January-February 1998 were 27% higher for the Triangle relative to metropolitan Montréal, though precision was low. Furthermore, adjusted odds were 28% higher for 1998 relative to 1999-2003, despite increasing rates of PTB over time. Odds were not elevated over a long-term exposure period. This study suggests a weak association between PTB and exposure to extreme weather for the two months following an ice storm, but not for later periods after the storm.
Publisher: Springer Science and Business Media LLC
Date: 25-03-2010
Publisher: Springer Science and Business Media LLC
Date: 28-12-2012
DOI: 10.1007/S10654-011-9644-8
Abstract: Language is an important determinant of health, but analyses of linguistic inequalities in mortality are scant, especially for Canadian linguistic groups with European roots. We evaluated the life expectancy gap between the Francophone majority and Anglophone minority of Québec, Canada, both over time and across major provincial areas. Arriaga's method was used to estimate the age and cause of death groups contributing to changes in the life expectancy gap at birth between 1989-1993 and 2002-2006, and to evaluate patterns across major provincial areas (metropolitan Montréal, other metropolitan centres, and small cities/rural areas). Life expectancy at birth was greater for Anglophones, but the gap decreased over time by 1.3 years (52% decline) in men and 0.9 years (47% decline) in women, due to relatively sharper reductions in Francophone mortality from several causes, except lung cancer which countered reductions in women. The life expectancy gap in 2002-2006 was widest in other metropolitan centres (men 5.1 years, women 3.2 years), narrowest in small cities/rural areas (men 0.8 years, women 0.7 years), and tobacco-related causes were the main contributors. Only young Anglophones <40 years in small cities/rural areas had mortality higher than Francophones, resulting in a narrower gap in these areas. Differentials in life expectancy favouring Anglophones decreased over time, but varied across areas of Québec. Tobacco-related causes accounted for the majority of the current life expectancy gap.
Publisher: BMJ
Date: 08-2008
Abstract: Residential proximity to highways is a potential proxy for exposure to traffic-related pollution that has been linked to adverse birth outcomes. We evaluated whether proximity to highway interacts with in idual and neighbourhood socioeconomic status (SES) to influence birth outcomes. The study population consisted of all live singleton births in Montréal, Canada, from 1997 to 2001 (n = 99,819). Proximity was defined as residing within 200 m of a highway. Neighbourhood SES was measured for census tracts as the proportion of families below the low-income threshold. In idual SES was represented by maternal education. Using multilevel logistic regression, the odds of preterm birth (PTB), low birthweight (LBW) and small-for-gestational-age (SGA) birth were calculated for mothers residing in proximity to highways, accounting for in idual and neighbourhood SES. Effect modification between SES and proximity to highway was tested for each outcome. In wealthy neighbourhoods, proximity to highway was associated with an elevated odds of PTB (OR 1.58, 95% CI 1.23 to 2.04), LBW (OR 1.81, 95% CI 1.36 to 2.41) and SGA birth (OR 1.32, 95% CI 1.05 to 1.66). For highly educated mothers, proximity to highway was associated with PTB (OR 1.25, 95% CI 1.07 to 1.46) and LBW (OR 1.24, 95% CI 1.03 to 1.49), but the association was borderline for SGA birth (OR 1.15, 95% CI 1.00 to 1.32). Proximity to highway was not associated with birth outcomes in other maternal and neighbourhood SES categories. Counterintuitively, high SES mothers may be more likely than low SES mothers to experience adverse births associated with residential proximity to highway.
No related grants have been discovered for Nathalie Auger.