Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study

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dc.contributor.authorNickel, Nathan C
dc.contributor.authorMartens, Patricia J
dc.contributor.authorChateau, Dan
dc.contributor.authorBrownell, Marni D
dc.contributor.authorSarkar, Joykrishna
dc.contributor.authorGoh, Chun Yan
dc.contributor.authorBurland, Elaine
dc.contributor.authorTaylor, Carole
dc.contributor.authorKatz, Alan
dc.contributor.authorthe PATHS Equity Team
dc.date.accessioned2015-10-26T15:21:33Z
dc.date.available2015-10-26T15:21:33Z
dc.date.issued2014
dc.descriptionhttp://journal.cpha.ca/index.php/cjph/article/view/4499en_US
dc.description.abstractOBJECTIVES: Breastfeeding is associated with improved health. Surveillance data show that breastfeeding initiation rates have increased; however, limited work has examined trends in socio-economic inequalities in initiation. The study’s research question was whether socio-economic inequalities in breastfeeding initiation have changed over the past 20 years. METHODS: This population-based study is a project within PATHS Equity for Children. Analyses used hospital discharge data for Manitoba mother–infant dyads with live births, 1988-2011 (n=316,027). Income quintiles were created, each with ~20% of dyads. Three-year, overall and byquintile breastfeeding initiation rates were estimated for Manitoba and two hospitals. Age-adjusted rates were estimated for Manitoba. Rates were modelled using generalized linear models. Three measures, rate ratios (RRs), rate differences (RDs) and concentration indices, assessed inequality at each time point. We also compared concentration indices with Gini coefficients to assess breastfeeding inequality vis-à-vis income inequality. Trend analyses tested for changes over time. RESULTS: Manitoba and Hospital A initiation rates increased; Hospital B rates did not change. Significant inequalities existed in nearly every period, across all three measures: RRs, RDs and concentration indices. RRs and concentration indices suggested little to no change in inequality from 1988 to 2011. RDs for Manitoba (comparing initiation in the highest to lowest income quintiles) did not change significantly over time. RDs decreased for Hospital A, suggesting decreasing socio-economic inequalities in breastfeeding; RDs increased for Hospital B. Income inequality increased significantly in Manitoba during the study period. CONCLUSIONS: Overall breastfeeding initiation rates can improve while inequality persists or worsens.en_US
dc.description.sponsorshipCanadian Institutes of Health Research (CIHR) and the Heart & Stroke Foundation of Canadaen_US
dc.identifier.citationNickel NC, Martens PJ, Chateau D, Brownell MD, Sarkar J, Goh CY, Burland E, Taylor C, Katz A, The PATHS Equity Team. Have we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance study. Canadian Journal of Public Health 2014; 105(5):e362-e368.en_US
dc.identifier.urihttp://hdl.handle.net/1993/30910
dc.language.isoengen_US
dc.publisherCanadian Public Health Associationen_US
dc.rightsopen accessen_US
dc.subjecthealth status disparitiesen_US
dc.subjectsocial determinants of healthen_US
dc.subjectsocial classen_US
dc.subjectbreastfeedingen_US
dc.titleHave we left some behind? Trends in socio-economic inequalities in breastfeeding initiation: A population-based epidemiological surveillance studyen_US
dc.typeArticleen_US
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