BMJ Open
Volume 8, Issue 4, 2018

Refugee maternal and perinatal health in Ontario, Canada: A retrospective population-based study (Article) (Open Access)

Wanigaratne S.* , Shakya Y. , Gagnon A.J. , Cole D.C. , Rashid M. , Blake J. , Dastoori P. , Moineddin R. , Ray J.G. , Urquia M.L.
  • a Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
  • b Access Alliance Multicultural Health and Community Services, Toronto, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • c Ingram School of Nursing, McGill University, Montreal, QC, Canada
  • d Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • e Crossroads Medical Clinic, Women's College Hospital, Toronto, ON, Canada
  • f Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
  • g Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada, Access Alliance Multicultural Health and Community Services, Toronto, Canada
  • h Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
  • i Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Keenan Research Centre, St. Michael's Hospital, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, Canada, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
  • j Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada

Abstract

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. Primary outcomes Numerous adverse maternal and perinatal health outcomes. Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences. © 2018 Article author(s).

Author Keywords

perinatology maternal medicine social medicine Public health Epidemiology

Index Keywords

maternal care immigrant refugee maternal health health insurance human Refugees controlled study Human immunodeficiency virus infected patient premature labor groups by age Humans migrant Adolescent Infant, Newborn Canada Emigrants and Immigrants female newborn pregnancy population research Article Retrospective Studies Ontario pregnancy outcome adult health care quality cohort analysis Perinatal Care maternal welfare retrospective study cesarean section
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053322024&doi=10.1136%2fbmjopen-2017-018979&partnerID=40&md5=4366cb0d75d1b531cadc660709e666f2
DOI: 10.1136/bmjopen-2017-018979
ISSN: 20446055
Cited by: 2
Original Language: English