title: Exploring the maternal and infant continuum - ethnic disparities in infant hospital admissions for respiratory disease.
abstract: OBJECTIVE
  To investigate maternal and birth-related risk factors associated with infant respiratory hospitalisations in New Zealand.
  
  
  METHODS
  A Kaupapa Māori-framed retrospective cohort analysis of public hospital maternal data linked to infant data (54,980 births 1995-2009). Primary outcome was rate of hospitalisation for respiratory disease in the first year of life. Risk variables examined included socioeconomic status (SES), age, smoking, parity, gestation, time to hospital discharge, breastfeeding and maternal ethnicity as a potential marker of differential exposure to risk factors.
  
  
  RESULTS
  Independent risk factors for hospitalisation included low maternal SES (rate ratio: 1.33 [95% CI 1.19-1.49]); smoking (1.3 [1.19-1.41]); parity (2.77 [2.37-3.24]); preterm birth (3.14 [2.58-3.83]; 30 compared with 40 weeks); but not breastfeeding (0.99 [0.87-1.11]). After adjustment for risk factors, respiratory hospitalisations remained highest among infants of young Māori women (rate ratio 1.93 [1.46-2.55] at age 22.5 years) and Pacific women across all maternal age groups (rate ratios 2.43 to 2.55), compared with infants of European women.
  
  
  CONCLUSIONS
  Maternal and birth factors are strongly associated with ethnic disparities in infant hospital admissions for respiratory disease.
  
  
  CONCLUSIONS
  Interventions that begin in pregnancy and address risk factors and social determinants of health are needed to address these disparities.
authors.affiliation: Women's Health Research Centre, Department of Primary Healthcare and General Practice, University of Otago, New Zealand. bev.lawton@otago.ac.nz.
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawton
authors.affiliation: Biostatistical Group, Dean's Department, University of Otago, New Zealand.
authors.forename: James
authors.initials: J
authors.lastname: Stanley
authors.affiliation: Women's Health Research Centre, Department of Primary Healthcare and General Practice, University of Otago, New Zealand.
authors.forename: Sara
authors.initials: S
authors.lastname: Filoche
authors.affiliation: Women's Health Research Centre, Department of Primary Healthcare and General Practice, University of Otago, New Zealand.
authors.forename: Sue
authors.initials: S
authors.lastname: Garrett
authors.affiliation: Department of Primary Healthcare and General Practice, University of Otago, New Zealand.
authors.forename: Sally B
authors.initials: SB
authors.lastname: Rose
authors.affiliation: Eru Pōmare Māori Health Research Centre, Department of Public Health, University of Otago, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Robson
authors.affiliation: Department of General Practice and Primary Healthcare, University of Auckland, New Zealand.
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001942:Breast Feeding / Q000706:statistics & numerical data; D015984:Causality; D002648:Child; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009035:Mothers; D009520:New Zealand / Q000453:epidemiology; D010298:Parity; D047928:Premature Birth / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Kaupapa Māori; New Zealand; ethnic groups; hospitalisation; infant; pregnancy; respiratory tract infections; risk factors