Wanigaratne Susitha, Cole Donald C, Bassil Kate, Hyman Ilene, Moineddin Rahim, Urquia Marcelo L
At the time of the study, Susitha Wanigaratne was a doctoral student at the Dalla Lana School of Public Health, University of Toronto, Ontario, Canada at the time of this study. Donald C. Cole and Ilene Hyman are with the Dalla Lana School of Public Health. Kate Bassil is with Toronto Public Health, Toronto, Ontario, Canada. Rahim Moineddin is with the Department of Family and Community Medicine, University of Toronto. Marcelo L. Urquia is with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
Am J Public Health. 2015 Dec;105(12):2449-56. doi: 10.2105/AJPH.2015.302886. Epub 2015 Oct 15.
We compared severe maternal morbidity (SMM) and SMM subtypes, including HIV, of refugee women with those of nonrefugee immigrant and nonimmigrant women.
We linked 1,154,421 Ontario hospital deliveries (2002-2011) to immigration records (1985-2010) to determine the incidence of an SMM composite indicator and its subtypes. We determined SMM incidence according to immigration periods, which were characterized by lifting restrictions for all HIV-positive immigrants (in 1991) and refugees who may place "excessive demand" on government services (in 2002).
Refugees had a higher risk of SMM (17.1 per 1000 deliveries) than did immigrants (12.1 per 1000) and nonimmigrants (12.4 per 1000). Among SMM subtypes, refugees had a much higher risk of HIV than did immigrants (risk ratio [RR] = 7.94; 95% confidence interval [CI] = 5.64, 11.18) and nonimmigrants (RR = 17.37; 95% CI = 12.83, 23.53). SMM disparities were greatest after the 2002 policy came into effect. After exclusion of HIV cases, SMM disparities disappeared.
An apparent higher risk of SMM among refugee women in Ontario, Canada is explained by their high prevalence of HIV, which increased over time parallel to admission policy changes favoring humanitarian protection.
我们比较了难民妇女与非难民移民妇女和非移民妇女的严重孕产妇发病率（SMM）及其亚型，包括感染艾滋病毒的情况。
我们将安大略省1154421例医院分娩病例（2002 - 2011年）与移民记录（1985 - 2010年）相联系，以确定SMM综合指标及其亚型的发病率。我们根据移民时期确定SMM发病率，这些时期的特点是对所有艾滋病毒呈阳性的移民（1991年）和可能对政府服务提出“过度需求”的难民（2002年）放宽限制。
难民的SMM风险（每1000例分娩中有17.1例）高于移民（每1000例中有12.1例）和非移民（每1000例中有12.4例）。在SMM亚型中，难民感染艾滋病毒的风险比移民（风险比[RR]=7.94；95%置信区间[CI]=5.64，11.18）和非移民（RR = 17.37；95% CI = 12.83，23.53）高得多。2002年政策生效后，SMM差异最大。排除艾滋病毒病例后，SMM差异消失。
加拿大安大略省难民妇女中明显较高的SMM风险是由她们较高的艾滋病毒感染率所解释的，随着时间的推移，这一感染率与有利于人道主义保护的准入政策变化同步上升。
