Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.
OBJECTIVE
To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries.


METHODS
Cross-country comparative study of linked population-based databases.


METHODS
Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden.


METHODS
All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010).


METHODS
Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI).


METHODS
Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries).


RESULTS
There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest.


CONCLUSIONS
Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.
St. Michael's Hospital, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
M L
ML
Urquia
R H
RH
Glazier
A J
AJ
Gagnon
L H
LH
Mortensen
A-M
AM
Nybo Andersen
T
T
Janevic
S
S
Guendelman
D
D
Thornton
F
F
Bolumar
I
I
Río Sánchez
R
R
Small
M-A
MA
Davey
A
A
Hjern
D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D017691:Caribbean Region / Q000208:ethnology; D016208:Databases, Factual; D019049:Developed Countries; D004461:Eclampsia / Q000208:ethnology*; D054242:Emigrants and Immigrants; D005060:Europe / Q000453:epidemiology; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007843:Latin America / Q000208:ethnology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000208:ethnology*; D011247:Pregnancy; D014481:United States / Q000453:epidemiology
Eclampsia; health disparities; immigration; industrialised countries; pre-eclampsia; pregnancy complications