David Matthias, Borde Theda, Brenne Silke, Ramsauer Babett, Henrich Wolfgang, Breckenkamp Jürgen, Razum Oliver
Department of Gynecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Alice Salomon University of Applied Sciences, Berlin, Germany.
Arch Gynecol Obstet. 2017 Oct;296(4):745-762. doi: 10.1007/s00404-017-4450-5. Epub 2017 Jul 26.
In Germany, regular immigrants and their descendants have legal and financial access to health care equal to the general citizenry. Nonetheless, some of their health outcomes are comparatively unfavorable, and that is only partially explained by their lower socioeconomic status (SES). The aim of this study was to assess whether this disparity exists also for obstetric and perinatal outcomes.
We compared obstetric and perinatal outcomes between immigrant women (first or second generation) and non-immigrant women, delivering at three maternity hospitals in Berlin, Germany, 2011-2012. Multivariable logistic regression analysis was used to assess immigrant status and other possible risk factors for the baby being delivered preterm, small for gestational age (SGA), or transferred to neonatal care.
The final database retained 6702 women, of whom 53.1% were first- or second-generation immigrants. First-generation Turkish immigrant women had significantly lower odds of preterm birth (OR 0.37, P < 0.001), SGA (OR 0.60, P = 0.0079), and transfer of the newborn to neonatal care (OR 0.61, P = 0.0034). Second-generation immigrant women had significantly lower odds of preterm birth (OR 0.67, P = 0.0049) or transfer of the newborn to neonatal care (OR 0.76, P = 0.0312). Moreover, women with education below university level, age 35+, or smokers had higher odds for poor outcomes.
This study provides strong evidence that health disparities for obstetric and perinatal health outcomes do not exist in immigrants relative to native Germans, but exist instead in women without post-secondary-level education compared to women with such education, regardless of ethnicity or migration history.
在德国，合法移民及其后代在医疗保健方面享有与普通公民平等的法律和经济权利。尽管如此，他们的一些健康结果相对较差，而这只是部分地由其较低的社会经济地位（SES）所解释。本研究的目的是评估这种差异在产科和围产期结局方面是否也存在。
我们比较了2011 - 2012年在德国柏林的三家妇产医院分娩的移民妇女（第一代或第二代）和非移民妇女的产科和围产期结局。采用多变量逻辑回归分析来评估移民身份以及其他可能导致婴儿早产、小于胎龄（SGA）或转入新生儿护理的风险因素。
最终数据库保留了6702名妇女，其中53.1%为第一代或第二代移民。第一代土耳其移民妇女早产（OR 0.37，P < 0.001）、SGA（OR 0.60，P = 0.0079）以及新生儿转入新生儿护理（OR 0.61，P = 0.0034）的几率显著较低。第二代移民妇女早产（OR 0.67，P = 0.0049）或新生儿转入新生儿护理（OR 0.76，P = 0.0312）的几率也显著较低。此外，教育水平低于大学、年龄35岁及以上或吸烟的妇女出现不良结局的几率更高。
本研究提供了强有力的证据，表明相对于德国本土人，移民在产科和围产期健康结局方面不存在健康差异，相反，与受过高等教育的女性相比，未接受过高等教育的女性存在健康差异，无论其种族或移民史如何。
