European Journal of Public Health
Volume 21, Issue 2, 2011, Pages 229-234

Ethnic disparity in severe acute maternal morbidity: A nationwide cohort study in the Netherlands (Article) (Open Access)

Zwart J.J. , Jonkers M.D. , Richters A. , Öry F. , Bloemenkamp K.W. , Duvekot J.J. , Van Roosmalen J.
  • a Department of Obstetrics, K6-P-35, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, Netherlands
  • b Department of Public Health, TNO Prevention and Health, Leiden, Netherlands
  • c Department of Public health and Primary care, Leiden University Medical Centre, Leiden, Netherlands
  • d Department of Public Health, TNO Prevention and Health, Leiden, Netherlands, Pacemaker in Global Health, Amsterdam, Netherlands
  • e Department of Obstetrics, K6-P-35, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, Netherlands
  • f Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynecology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, Netherlands
  • g Department of Obstetrics, K6-P-35, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, Netherlands, Section of Health care and Culture, VU University Medical Centre, Amsterdam, Netherlands

Abstract

Background: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium. Methods: All women experiencing SAMM were prospectively collected in a nationwide population-based design from August 2004 to August 2006. Women delivering in the same period served as reference cohort. Population-based risks were calculated by ethnicity and by type of morbidity. Additionally, non-Western and Western women having experienced SAMM were compared in multivariable logistic regression analysis. Results: All 98 Dutch maternity units participated. There were 371 021 deliveries during the study period. A total of 2506 women with SAMM were included, 21.1% of whom were non-Western immigrants. Non-Western immigrants showed a 1.3-fold [95% confidence interval (CI) 1.2-1.5] increased risk to develop SAMM. Large differences were observed among different ethnic minority groups, ranging from a non-increased risk for Moroccan and Turkish women to a 3.5-fold (95% CI 2.8-4.3) increased risk for sub-Saharan African women. Low socio-economic status, unemployment, single household, high parity and prior caesarean were independent explanatory factors for SAMM, although they did not fully explain the differences. Immigration-related characteristics differed by ethnic background. Conclusions: Non-Western immigrants have an increased risk of developing SAMM as compared to Western women. Risks varied largely by ethnic origin. Immigration-related characteristics might partly explain the increased risk. The results suggest that there are opportunities for quality improvement by targeting specific disadvantaged groups. © The Author 2010.

Author Keywords

community health planning risk factors Ethnic groups severe maternal morbidity Immigration obstetrics

Index Keywords

Netherlands prospective study multicenter study clinical trial pregnancy complication Pregnancy Complications Prospective Studies human Cohort Studies statistics Ethnic Groups ethnic group comparative study morbidity ethnology Young Adult Humans female risk factor Risk Factors pregnancy Incidence Article adult obstetrical nursing maternal mortality cohort analysis Healthcare Disparities health care disparity mortality
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-79953232350&doi=10.1093%2feurpub%2fckq046&partnerID=40&md5=75d477fc5491455afa30307e1f161d63
DOI: 10.1093/eurpub/ckq046
ISSN: 11011262
Cited by: 48
Original Language: English