Maternal and Perinatal Health of Refugees in Ontario: A Population-based Perspective
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".