Perinatal health inequalities between Canadian-born and foreign-born women in Canada: a decomposition analysis
Bibliographic record
Abstract
Background: Foreign-born mothers are generally believed to experience better perinatal outcomes than Canadian-born mothers, despite relatively lower socioeconomic status. However, the magnitude and direction of inequalities by nativity status vary across outcomes. Little is known about factors contributing to the health inequalities by nativity status across different perinatal outcomes. Thus, we aim to examine the direction and magnitude of inequalities by nativity status across perinatal outcomes and estimate the contributions of select individual-level characteristics to the inequalities in Canada. Methods: Using 132 639 singleton births from the 2016 Canadian Birth-Census Cohort, we estimated the risk of preterm birth (PTB), small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth, stillbirth, and infant and neonatal death by maternal nativity status. We estimated the contribution of maternal race, maternal and paternal education, paternal nativity status and employment, family income and homeownership, as well as maternal age, marital status, activity limitations and parity to inequalities specific to each outcome, using Kitagawa's decomposition method. Results: Compared with Canadian-born mothers, foreign-born mothers experienced higher rates of all outcomes examined (eg, 627 (95% CI 608, 646) PTBs per 10 000 live births among foreign-born mothers vs 580 (568, 592) among Canadian-born mothers), except for LGA births (677 (648, 706) per 10 000 for foreign-born vs 1006 (959, 1054) for Canadian-born mothers). Non-White maternal race explained the largest proportion of the observed differences for non-fatal outcomes, while the highest income quartile explained the most for the differences in fatal outcomes. Conclusion: Foreign-born women fared worse than Canadian-born women for all adverse perinatal outcomes examined apart from LGA births. Our results highlight differential contributions of determinants to perinatal health inequalities by maternal nativity status across outcomes.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".