Urquia Marcelo L, Wanigaratne Susitha, Ray Joel G, Joseph K S
Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON; Institute for Clinical Evaluative Sciences, Sunnybrook Hospital, Toronto, ON.
Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON; Institute for Clinical Evaluative Sciences, Sunnybrook Hospital, Toronto, ON.
J Obstet Gynaecol Can. 2017 Nov;39(11):978-987. doi: 10.1016/j.jogc.2017.05.012. Epub 2017 Jul 18.
This study sought to quantify the risk of severe maternal morbidity (SMM) according to maternal country of birth in Canada.
The study analyzed 1 252 543 in-hospital deliveries of Ontario residents discharged between April 1, 2002, and March 31, 2012. The main outcome measure was a composite indicator of SMM used for surveillance. The top 10 most common component conditions were also evaluated. Maternal country of birth and other immigration characteristics were obtained through linkage with official immigration records. We used modified Poisson regression with generalized estimating equations to assess associations according to maternal country of birth.
Overall, immigrant women (N = 335 544) did not differ from Canadian-born women (n = 916 999) in SMM rates (12.1 vs. 12.0 cases per 1000 deliveries, respectively). However, SMM varied substantially according to maternal region of birth, from 9.2 cases per 1000 deliveries among immigrants from Western countries to 23.0 cases per 1000 deliveries among immigrants from Sub-Saharan Africa. Even larger variations were found when immigrants were categorized by their specific countries of birth. The top 10 contributing conditions to SMM among Canadian-born women were also the main contributors among immigrant subgroups. The notable exception was HIV infection, the top contributor among immigrants from Sub-Saharan Africa, whose rate of HIV infection was 43 times that of Canadian-born women (95% CI 34.39-55.23). After excluding HIV cases, disparities in SMM were largely reduced among Sub-Saharan African women but did not disappear.
There is large heterogeneity in SMM and its component conditions among Canadian immigrants depending on country of origin.
本研究旨在根据加拿大产妇的出生国量化严重孕产妇发病（SMM）风险。
该研究分析了2002年4月1日至2012年3月31日期间安大略省居民出院的1252543例住院分娩病例。主要结局指标是用于监测的SMM综合指标。还评估了最常见的10种组成病症。通过与官方移民记录联动获取产妇的出生国及其他移民特征。我们使用修正泊松回归和广义估计方程来评估根据产妇出生国的关联情况。
总体而言，移民妇女（N = 335544）与加拿大出生的妇女（n = 916999）的SMM发生率无差异（分别为每1000例分娩12.1例和12.0例）。然而，SMM根据产妇出生地区差异很大，从西方国家移民的每1000例分娩9.2例到撒哈拉以南非洲移民的每1000例分娩23.0例。当按移民的具体出生国分类时，差异更大。加拿大出生妇女中导致SMM的前10种病症也是移民亚组中的主要因素。值得注意的例外是艾滋病毒感染，它是撒哈拉以南非洲移民中的首要因素，其艾滋病毒感染率是加拿大出生妇女的43倍（95%CI 34.39 - 55.23）。排除艾滋病毒病例后，撒哈拉以南非洲妇女中SMM的差异大幅降低但并未消失。
根据原籍国不同，加拿大移民中SMM及其组成病症存在很大异质性。
