Journal of Epidemiology and Community Health
Volume 70, Issue 6, 2016, Pages 622-628

The influence of refugee status and secondary migration on preterm birth (Article)

Wanigaratne S. , Cole D.C. , Bassil K. , Hyman I. , Moineddin R. , Urquia M.L.*
  • a Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • b Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • c Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • d Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • e Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
  • f Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Abstract

Background It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants. Methods We conducted a retrospective populationbased cohort study. Ontario immigration (2002-2010) and hospitalisation data (2002-2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22-31, 32-36, 37-41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration. Results Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants. Conclusions Refugee status, jointly with secondary migration, influences PTB among migrants.

Author Keywords

[No Keywords available]

Index Keywords

refugee health risk health disparity Health Status Disparities Population Dynamics Population Surveillance human Refugees Cohort Studies Premature Birth statistics and numerical data Young Adult Humans Adolescent Canada immigration policy female Socioeconomic Factors socioeconomics pregnancy Retrospective Studies Ontario adult migration international migration prematurity cohort analysis Emigration and Immigration birth date Transients and Migrants retrospective study Ontario [Canada] health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84962200777&doi=10.1136%2fjech-2015-206529&partnerID=40&md5=82eacbff03f19165715f0dbfe308fa42
DOI: 10.1136/jech-2015-206529
ISSN: 0143005X
Cited by: 10
Original Language: English