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A new record linkage for assessing infant mortality rates in Ontario, Canada

Fell DB, Park AL, Sprague AE, Islam N, Ray JG. Can J Public Health. 2020; 111(2):278-85. Epub 2019 Dec 19. DOI:

Objective — Infant 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.

Methods — All 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.

Results — Of 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).

Conclusion — Use 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.

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