Susitha Wanigaratne1, Donald C Cole2, Kate Bassil2, Ilene Hyman2, Rahim Moineddin3, Marcelo L Urquia4. 1. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 2. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 3. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants. METHODS: We conducted a retrospective population-based cohort study. Ontario immigration (2002-2010) and hospitalisation data (2002-2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22-31, 32-36, 37-41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration. RESULTS: Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants. CONCLUSIONS: Refugee status, jointly with secondary migration, influences PTB among migrants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants. METHODS: We conducted a retrospective population-based cohort study. Ontario immigration (2002-2010) and hospitalisation data (2002-2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22-31, 32-36, 37-41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration. RESULTS: Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants. CONCLUSIONS: Refugee status, jointly with secondary migration, influences PTB among migrants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Keywords:
MIGRATION; PERINATAL EPIDEMIOLOGY; PREGNANCY; SOCIAL EPIDEMIOLOGY
Authors: Susitha Wanigaratne; Donald C Cole; Kate Bassil; Ilene Hyman; Rahim Moineddin; Yogendra Shakya; Marcelo L Urquia Journal: Matern Child Health J Date: 2016-10
Authors: Susitha Wanigaratne; Yogendra Shakya; Anita J Gagnon; Donald C Cole; Meb Rashid; Jennifer Blake; Parisa Dastoori; Rahim Moineddin; Joel G Ray; Marcelo L Urquia Journal: BMJ Open Date: 2018-04-10 Impact factor: 2.692
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