title: Severe Neonatal Morbidity Among Births to Refugee Women.
abstract: Background Despite being considered high risk, little is known about the perinatal health of refugees in developed countries. Our objectives were to examine whether: (1) the healthy migrant effect applies to infants born to refugee women with respect to severe neonatal morbidity (SNM); (2) refugee status was a risk factor for SNM among immigrants; (3) refugee sponsorship status was a risk factor for SNM by comparing asylum-seekers to sponsored refugees; and (4) refugees were at greater risk of specific SNM subtypes. Methods Immigration records (1985-2010) linked to Ontario hospital data (2002-2010) were used to examine SNM. We calculated adjusted risk ratios (ARR) with 95 % confidence intervals (95 % CI) for SNM and unadjusted risk ratios with 99 % CI for SNM subtypes using log-binomial regression. Results There were borderline differences in SNM among refugees (N = 29,755) compared to both non-immigrants (N = 860,314) (ARR = 0.94, 95 % CI 0.89, 0.99) and other immigrants (N = 230,847) (ARR = 1.10, 95 % CI 1.04, 1.18) with a larger difference comparing other immigrants to non-immigrants (ARR = 0.83, 95 % CI 0.81, 0.85). Asylum-seekers did not differ from sponsored refugees (ARR = 1.07, 95 % CI 0.90, 1.27). Though rare, several SNM subtypes were significant with large effect sizes. Conclusion With respect to SNM risk, the healthy migrant effect clearly applies to non-refugee immigrants, but is weaker for refugees and may not apply. Among immigrants, refugee status was a weak risk factor for SNM and may not be clinically important. Sponsorship status was not associated with greater risk of SNM. Further investigation of several SNM subtypes is warranted.
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5W 1W8, Canada. susitha.wanigaratne@mail.utoronto.ca.|Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. susitha.wanigaratne@mail.utoronto.ca.
authors.forename: Susitha
authors.initials: S
authors.lastname: Wanigaratne
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.|Toronto Public Health, Toronto, M5B 1W2, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Bassil
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
authors.forename: Ilene
authors.initials: I
authors.lastname: Hyman
authors.affiliation: Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Department of Family and Community Medicine, University of Toronto, Toronto, M5G 1V7, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.|Access Alliance Multicultural Health and Community Services, 340 College Street, Toronto, ON, M5T 3A9, Canada.
authors.forename: Yogendra
authors.initials: Y
authors.lastname: Shakya
authors.affiliation: Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5W 1W8, Canada.|Institute for Clinical and Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.|Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Urquia
mesh_terms: D000328:Adult; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D009017:Morbidity; D009035:Mothers; D009864:Ontario; D036801:Parturition; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000208:ethnology*; D012036:Refugees; D012959:Socioeconomic Factors
keywords: Administrative data; Healthy migrant effect; Refugees; Severe neonatal morbidity