Have We Left Some Behind? Trends in Socio-Economic Inequalities in Breastfeeding Initiation: A Population-Based Epidemiological Surveillance Study

Canadian Journal of Public Health, Vol. 105, 2014

7 Pages Posted: 16 Aug 2015

See all articles by Nathan Nickel

Nathan Nickel

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Patricia Martens

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Dan Chateau

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Joykrishna Sarkar

University of Manitoba - Manitoba Centre for Health Policy

Chun Yan Goh

University of Manitoba - Manitoba Centre for Health Policy

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy

Carole Taylor

University of Manitoba - Manitoba Centre for Health Policy

Alan Katz

University of Manitoba - Department of Community Health Sciences (CHS); University of Manitoba - Manitoba Centre for Health Policy

Date Written: 2014

Abstract

Objectives: Breastfeeding is associated with improved health. Surveillance data show that breastfeeding initiation rates have increased; however, imited 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.

Keywords: Health status disparities; social determinants of health; social class; breast feeding

Suggested Citation

Nickel, Nathan and Martens, Patricia and Chateau, Dan and Brownell, Marni D. and Sarkar, Joykrishna and Goh, Chun Yan and Burland, Elaine and Taylor, Carole and Katz, Alan, Have We Left Some Behind? Trends in Socio-Economic Inequalities in Breastfeeding Initiation: A Population-Based Epidemiological Surveillance Study (2014). Canadian Journal of Public Health, Vol. 105, 2014. Available at SSRN: https://ssrn.com/abstract=2611368

Nathan Nickel (Contact Author)

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Patricia Martens

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Dan Chateau

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Marni D. Brownell

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Joykrishna Sarkar

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Chun Yan Goh

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Elaine Burland

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Carole Taylor

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

Alan Katz

University of Manitoba - Department of Community Health Sciences (CHS) ( email )

750 Bannatyne Ave
Winnipeg, R3E 0W3
Canada

University of Manitoba - Manitoba Centre for Health Policy ( email )

University of Manitoba Bannatyne Campus
Winnipeg
Canada

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