{
    "abstract": "Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas.\nTo compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada.\nThis population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414\u202f337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks' gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022.\nNonrefugee immigrant status vs nonimmigrant status.\nThe primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or \u22653 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity.\nThe cohort included 148\u202f085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266\u202f252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52\u202f447 [35.4%]) and the East Asia and Pacific (35\u202f280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148\u202f085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266\u202f252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).\nThis study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.",
    "authors": [
        {
            "affiliation": "Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.\nMAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.",
            "firstname": "Jennifer A",
            "initials": "JA",
            "lastname": "Jairam"
        },
        {
            "affiliation": "Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.\nInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.\nICES, Toronto, Ontario, Canada.\nDepartment of Psychiatry, Women's College Hospital, Toronto, Ontario, Canada.",
            "firstname": "Simone N",
            "initials": "SN",
            "lastname": "Vigod"
        },
        {
            "affiliation": "Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.\nGillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill.",
            "firstname": "Arjumand",
            "initials": "A",
            "lastname": "Siddiqi"
        },
        {
            "affiliation": "ICES, Toronto, Ontario, Canada.",
            "firstname": "Jun",
            "initials": "J",
            "lastname": "Guan"
        },
        {
            "affiliation": "ICES, Toronto, Ontario, Canada.",
            "firstname": "Alexa",
            "initials": "A",
            "lastname": "Boblitz"
        },
        {
            "affiliation": "ICES, Toronto, Ontario, Canada.",
            "firstname": "Xuesong",
            "initials": "X",
            "lastname": "Wang"
        },
        {
            "affiliation": "Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.\nMAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.",
            "firstname": "Patricia",
            "initials": "P",
            "lastname": "O'Campo"
        },
        {
            "affiliation": "Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.\nICES, Toronto, Ontario, Canada.\nKeenan Research Centre, St Michael's Hospital, Toronto, Ontario, Canada.\nDepartment of Obstetrics and Gynaecology, St Michael's Hospital, Toronto, Ontario, Canada.",
            "firstname": "Joel G",
            "initials": "JG",
            "lastname": "Ray"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1001/jamanetworkopen.2022.56203\n10.1186/s12978-018-0527-2\n10.1001/jamanetworkopen.2018.4571\n10.1001/jamanetworkopen.2020.34993\n10.25011/cim.v38i1.22410\n10.1001/jamanetworkopen.2020.30207\n10.1016/j.jogc.2017.05.012\n10.1016/j.ajog.2004.05.099\n10.1016/j.jogc.2018.07.021\n10.1136/bmjopen-2020-046174\n10.1186/s40748-020-00123-1\n10.1097/AOG.0000000000003762\n10.3390/children9030394\n10.1146/annurev-publhealth-032013-182419\n10.1111/ppe.12370\n10.1186/s12884-014-0393-z\n10.1503/cmaj.061680\n10.1016/S1701-2163(16)35215-X\n10.1111/j.1749-6632.2009.05333.x\n10.1111/j.1365-3016.2008.00959.x\n10.1111/j.1471-0528.2010.02523.x\n10.1136/bmjopen-2017-018979\n10.1016/j.amepre.2010.05.012\n10.1111/j.1365-3016.2011.01192.x\n10.1111/1471-0528.13058\n10.1136/bmjopen-2015-007903\n10.1093/eurpub/cku230\n10.2105/AJPH.2015.302886\n10.1111/1471-0528.12326\n10.1596/978-1-4648-0348-2_ch3\n10.1136/jech.2008.083535\n10.24095/hpcdp.29.3.01\n10.1186/s12911-016-0375-3\n10.1371/journal.pone.0102275\n10.1016/S1701-2163(16)34655-2\n10.1016/j.jogc.2019.02.014\n10.1080/03610910902859574\n10.1093/aje/kwh090\n10.1017/CBO9781139236065\n10.1093/aje/kwr183\n10.1097/EDE.0b013e3181caeb90\n10.1377/hlthaff.2019.00735\n10.1007/s10995-018-2682-z\n10.1111/j.1471-0528.2008.01713.x\n10.1093/eurpub/ckq046\n10.1186/s12884-016-0860-9\n10.1016/j.socscimed.2015.10.023\n10.1136/jech.2010.109405\n10.1007/s10995-014-1477-0\n10.1016/j.socscimed.2012.02.013\n10.1155/2017/8783294\n10.1186/2046-4053-4-13\n10.1111/hsc.12950\n10.1371/journal.pone.0250947\n10.1503/cmaj.121283\n10.1136/jech.2004.028092\n10.1186/1472-6963-11-20\n10.24095/hpcdp.31.S1.01",
    "journal": "JAMA network open",
    "keywords": [],
    "methods": null,
    "publication_date": "2023-02-17",
    "pubmed_id": "36795412\n29945657\n30646359\n33555330\n25662620\n33355674\n28733065\n15467568\n30385209\n34615673\n33407937\n32168209\n35327766\n25494053\n28590511\n25494970\n17485694\n22472334\n17913111\n20201871\n18782253\n20374596\n29643152\n20709259\n21470263\n25227712\n26307615\n25587005\n26469648\n23786308\n0\n19692737\n9375258\n19527567\n27769227\n25019202\n21050516\n31060985\n15033648\n21841157\n20220526\n32364858\n30712089\n18485162\n20522516\n27059448\n26492459\n21282138\n24756226\n22464222\n28210508\n26187687\n31997461\n33945565\n23091180\n16415256\n21281470\n22047772",
    "results": "The cohort included 148\u202f085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266\u202f252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52\u202f447 [35.4%]) and the East Asia and Pacific (35\u202f280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148\u202f085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266\u202f252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19).",
    "title": "Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada.",
    "xml": "<Element 'PubmedArticle' at 0x788504ffacf0>"
}