Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective
Notice bibliographique
Résumé
Refugee women and their newborns are suspected to experience greater risk of adverse maternal and perinatal health outcomes. However, little systematic refugee-specific research has been done. This dissertation poses the research question - "are refugee immigrant women and their newborns at higher risk of adverse maternal and perinatal outcomes compared to 1) non-refugee immigrant and 2) non-immigrant women?" Large population-based immigration (1985-2010) and hospitalizations databases (2002-2010) from Ontario, Canada were used (all women eligible for health insurance). The first manuscript examined severe maternal morbidity (SMM) and SMM subtypes among refugee immigrants compared to both non-refugee immigrants and non-immigrants. The rate of any SMM was elevated among refugees (n=30,420) compared to non-refugee immigrants (n=235,540) (adjusted rate ratios (ARR)=1.22, 95% confidence interval: 1.09-1.36) and non-immigrants (n=878,709) (ARR=1.34 (1.23-1.47)). HIV (SMM subtype) among refugees was 8 and 17 times that of non-refugee immigrants and non-immigrants, respectively. The SMM rate among refugees was no longer elevated when deliveries with HIV were excluded. The second manuscript examined the risk of severe neonatal morbidity (SNM) among neonates born to refugees compared to those of non-refugee immigrants and non-immigrants. SNM risk among non-sponsored refugees (i.e., asylum seekers) was also compared to that of sponsored refugees (i.e., government, privately sponsored). The risk of severe neonatal morbidity was significantly higher among newborns of refugee compared to non-refugee immigrants (ARR=1.10 (1.03-1.17)) but lower in comparison to non-immigrants (ARR=0.94 (0.89-0.99)). There was no difference by sponsorship status. The objective of the third manuscript was to determine if the relationship between refugee status and risk of preterm birth (PTB) was modified by secondary (migration to another country prior to Canada) or primary (direct to Canada) migration. A secondary objective was to examine whether this relationship varied by maternal region of birth. Secondary refugees and primary refugees experienced a significantly higher cumulative probability of PTB (22-31, 32-36, ≥37 weeks) compared to their secondary and primary non-refugee counterparts (adjusted cumulative odds ratio (ACOR) =1.59 (1.25-2.01) and ACOR=1.12 (1.02-1.23)), respectively. These associations were also significant for Asian immigrants. This dissertation makes a substantial contribution towards understanding the health and the determinants of health of refugee immigrant mothers and their infants in Canada.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».