American Journal of Public Health
Volume 105, Issue 12, 2015, Pages 2449-2456

Contribution of HIV to maternal morbidity among refugee women in Canada (Article)

Wanigaratne S.* , Cole D.C. , Bassil K. , Hyman I. , Moineddin R. , Urquia M.L.
  • a Dalla Lana School of Public Health, University of TorontoON, Canada, Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
  • b Dalla Lana School of Public Health, University of TorontoON, Canada
  • c Toronto Public Health, Toronto, ON, Canada
  • d Dalla Lana School of Public Health, University of TorontoON, Canada
  • e Department of Family and Community Medicine, University of Toronto, Canada
  • f Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada

Abstract

Objectives. We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of non refugee immigrant and nonimmigrant women. Methods. We linked 1 154 421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002). Results. Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared. Conclusions. An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.

Author Keywords

[No Keywords available]

Index Keywords

HIV Infections refugee Pregnancy Complications, Infectious health disparity complication Health Status Disparities human Refugees statistics and numerical data Young Adult Humans migrant Adolescent Emigrants and Immigrants female risk factor Risk Factors pregnancy Ontario adult parity
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84946730646&doi=10.2105%2fAJPH.2015.302886&partnerID=40&md5=41dbe26b608cbd281451eac86a2d181e
DOI: 10.2105/AJPH.2015.302886
ISSN: 00900036
Cited by: 6
Original Language: English