Maternal and Child Health Journal
Volume 20, Issue 10, 2016, Pages 2189-2198

Severe Neonatal Morbidity Among Births to Refugee Women (Article)

Wanigaratne S.* , Cole D.C. , Bassil K. , Hyman I. , Moineddin R. , Shakya Y. , Urquia M.L.
  • a Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5W 1W8, Canada, Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
  • b Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
  • c Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada, Toronto Public Health, Toronto, M5B 1W2, Canada
  • d Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
  • e Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, M5G 1V7, Canada
  • f Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada, Access Alliance Multicultural Health and Community Services, 340 College Street, Toronto, ON M5T 3A9, Canada
  • g Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5W 1W8, Canada, Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada

Abstract

Background Despite being considered high risk, little is known about the perinatal health of refugees in developed countries. Our objectives were to examine whether: (1) the healthy migrant effect applies to infants born to refugee women with respect to severe neonatal morbidity (SNM); (2) refugee status was a risk factor for SNM among immigrants; (3) refugee sponsorship status was a risk factor for SNM by comparing asylum-seekers to sponsored refugees; and (4) refugees were at greater risk of specific SNM subtypes. Methods Immigration records (1985–2010) linked to Ontario hospital data (2002–2010) were used to examine SNM. We calculated adjusted risk ratios (ARR) with 95 % confidence intervals (95 % CI) for SNM and unadjusted risk ratios with 99 % CI for SNM subtypes using log-binomial regression. Results There were borderline differences in SNM among refugees (N = 29,755) compared to both non-immigrants (N = 860,314) (ARR = 0.94, 95 % CI 0.89, 0.99) and other immigrants (N = 230,847) (ARR = 1.10, 95 % CI 1.04, 1.18) with a larger difference comparing other immigrants to non-immigrants (ARR = 0.83, 95 % CI 0.81, 0.85). Asylum-seekers did not differ from sponsored refugees (ARR = 1.07, 95 % CI 0.90, 1.27). Though rare, several SNM subtypes were significant with large effect sizes. Conclusion With respect to SNM risk, the healthy migrant effect clearly applies to non-refugee immigrants, but is weaker for refugees and may not apply. Among immigrants, refugee status was a weak risk factor for SNM and may not be clinically important. Sponsorship status was not associated with greater risk of SNM. Further investigation of several SNM subtypes is warranted. © 2016, Springer Science+Business Media New York.

Author Keywords

Healthy migrant effect Administrative data Refugees Severe neonatal morbidity

Index Keywords

birth refugee health care survey Health Care Surveys health disparity Health Status Disparities human Refugees Premature Birth statistics and numerical data morbidity Infant, Premature ethnology Humans migrant Infant, Newborn Emigrants and Immigrants female Socioeconomic Factors Infant newborn socioeconomics pregnancy Mothers Ontario mother adult prematurity Parturition
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84978173670&doi=10.1007%2fs10995-016-2047-4&partnerID=40&md5=d8c51043dfce38654e64e740af0ca003
DOI: 10.1007/s10995-016-2047-4
ISSN: 10927875
Cited by: 4
Original Language: English