Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada

Jairam, Jennifer A.; Vigod, Simone N.; Siddiqi, Arjumand; Guan, Jun; Boblitz, Alexa; Wang, Xuesong; O’Campo, Patricia; Ray, Joel G.

doi:10.1001/jamanetworkopen.2022.56203

Cited by 6 publications

(9 citation statements)

References 69 publications

(151 reference statements)

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“…44,45 The current study complements our previous research on neighbourhood income level and risk of concomitant preterm birth and small-for-gestational-age birth weight, by identifying at tributes of mother-infant pairs who are at higher risk of adverse neonatal outcomes within lowest-income neighbourhoods. 35 Collectively, the findings from this current study and recent data about SMMM among females residing in low-income neighbourhoods 47 suggest that immigrant females and their newborns each have an overall lower risk of adverse birth outcomes than their Canadian-born counterparts. This study highlights the importance of evaluating health outcomes like SNMM within area-level, constrained income groups, particularly when there is a known gradient effect across income levels.…”

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confidence: 99%

“…35 Furthermore, immigrant females had a slightly lower overall risk of severe maternal morbidity or mortality (SMMM) than nonimmigrant females, all of whom were residing within low-income areas. 47 In this study, we sought to compare the risk of SNMM between newborns of immigrant and nonimmigrant females residing in low-income urban neighbourhoods. We further sought to evaluate risk of SNMM by maternal world region of birth and country of birth, and by duration of residence among immigrant females.…”

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Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Jairam

Vigod

Siddiqi

et al. 2023

CMAJ

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Neonatal morbidity and mortality are important public health indicators used to monitor and evaluate neonatal health and quality of perinatal care. 1,2 The neonatal period, ranging from birth to 27 days thereafter, is the most vulnerable time for infant survival. 1 Around 75% of infant deaths occur during this period, largely from prematurity and other conditions that can often be prevented by timely obstetrical and neonatal care. 3,4 In high-income countries, improvements in health care have resulted in a decline in neonatal mortality, 5,6 including in Canada, where the rate is 3.6 deaths per 1000 live births. 7 Accordingly, research and public health surveillance has increasingly focused on severe neonatal morbidity (SNM), which refers to a newborn who has survived a severe complication during birth or the neonatal period. 1,8,9 Identifying newborns at high risk of SNM is crucial as it has serious implications for the surviving child and their family. 10,11 Limited research has examined SNM in high-income countries. 2,6,8,[12][13][14][15][16][17] Studies have primarily focused on deriving and validating the criteria to define SNM, 1,3,10 quantifying the prevalence of SNM and identifying risk factors in African, Asian and Latin American regions. 11,[18][19][20][21][22][23][24][25][26][27] Research is also lacking on a range of upstream social determinants of health inequity and their influence on SNM. 28,29 Living in a low-income area 12,[30][31][32][33][34][35] and being an

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Section: Discussionsupporting

confidence: 50%

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confidence: 99%

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confidence: 99%

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Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Jairam

Vigod

Siddiqi

et al. 2023

CMAJ

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“…Immigrants may have a different health trajectory and pregnancy outcomes than nonimmigrants . Accordingly, an additional analysis was completed for the corresponding main model of any upward income mobility and SMM-M or SNM-M.…”

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Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity

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ImportanceResiding in a low-income neighborhood is generally associated with worse pregnancy outcomes. It is not known if moving from a low- to higher-income area between 2 pregnancies alters the risk of adverse birth outcomes in the subsequent birth compared with women who remain in low-income areas for both births.ObjectiveTo compare the risk of adverse maternal and newborn outcomes among women who achieved upward area-level income mobility vs those who did not.Design, Setting, and ParticipantsThis population-based cohort study was completed in Ontario, Canada, from 2002 to 2019, where there is universal health care. Included were all nulliparous women with a first-time singleton birth at 20 to 42 weeks’ gestation, each residing in a low-income urban neighborhood at the time of the first birth. All women were then assessed at their second birth. Statistical analysis was conducted from August 2022 to April 2023.ExposureMovement from a lowest-income quintile (Q1) neighborhood to any higher-income quintile neighborhood (Q2-Q5) between the first and second birth.Main Outcomes and MeasuresThe maternal outcome was severe maternal morbidity or mortality (SMM-M) at the second birth hospitalization or up to 42 days post partum. The primary perinatal outcome was severe neonatal morbidity or mortality (SNM-M) within 27 days of the second birth. Relative risks (aRR) and absolute risk differences (aARD) were estimated by adjusting for maternal and infant characteristics.ResultsA total of 42 208 (44.1%) women (mean [SD] age at second birth, 30.0 [5.2] years) experienced upward area-level income mobility, and 53 409 (55.9%) women (age at second birth, 29.0 [5.4] years) remained in income Q1 between births. Relative to women who remained in income Q1 between births, those with upward mobility had a lower associated risk of SMM-M (12.0 vs 13.3 per 1000 births), with an aRR of 0.86 (95% CI, 0.78 to 0.93) and aARD of −2.09 per 1000 (95% CI, −3.1 to −0.9 per 1000 ). Likewise, their newborns experienced lower respective rates of SNM-M (48.0 vs 50.9 per 1000 live births), with an aRR of 0.91 (95% CI, 0.87 to 0.95) and aARD of −4.7 per 1000 (95% CI, −6.8 to −2.6 per 1000).Conclusions and RelevanceIn this cohort study of nulliparous women living in low-income areas, those who moved to a higher-income area between births experienced less morbidity and death in their second pregnancy, as did their newborns, compared with those who remained in low-income areas between births. Research is needed to determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes.

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“…In the Original Investigation titled “Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity,” published May 23, 2023, neighborhood income quintile was incorrectly referred to as neighborhood income quartile in the Methods and Discussion sections. In addition, the Supplement cited reference 42 in eTable 4, eTable 5, eTable 6, and eTable 7, when it should have cited reference 41.…”

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Errors in Methods, Discussion, and Supplement

2023

JAMA Netw Open

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In the Original Investigation titled "Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity," 1 published May 23, 2023, neighborhood income quintile was incorrectly referred to as neighborhood income quartile in the Methods and Discussion sections. In addition, the Supplement cited reference 42 in eTable 4, eTable 5, eTable 6, and eTable 7, when it should have cited reference 41. This article has been corrected. 1

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Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada

Cited by 6 publications

References 69 publications

Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods

Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity

Errors in Methods, Discussion, and Supplement

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