Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis

Adane, Akilew Awoke; Bailey, Helen D.; Marriott, Rhonda; Farrant, Brad M.; White, Scott W.; Shepherd, Carrington

doi:10.1136/jech-2020-214507

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…Previous studies have evaluated immigrant status 6 , 16 , 17 , 46 or area-level income 12 , 15 as independent risk factors for SNM, including some that used race and ethnicity as predictors of SNM. 11 , 12 One Australian study found no association between immigrant status and SNM, but used an SNM composite with 3 indicators and no procedures.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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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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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: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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“…One in eleven Australians is born too early and among Aboriginal and/or Torres Strait Islander women (hereafter respectfully referred to as Aboriginal) the rate is almost double [3]. Perinatal outcomes are considerably worse for Australian Aboriginal infants, who experience higher rates of PTB, low birthweight and infant mortality both nationally [3], and in Western Australia (WA) [4][5][6]. The causes of these inequalities are complex and risk factors for poor perinatal outcomes are not necessarily the same in Aboriginal women as in the broader WA obstetric population.…”

Section: Introductionmentioning

confidence: 99%

The Western Australian preterm birth prevention initiative: a whole of state singleton pregnancy cohort study showing the need to embrace alternative models of care for Aboriginal women

Berman

Newnham

White

et al. 2023

BMC Pregnancy Childbirth

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Background Preterm birth (PTB) is the greatest cause of mortality and morbidity in children up to five years of age globally. The Western Australian (WA) PTB Prevention Initiative, the world’s first whole-of-population whole-of-state program aimed at PTB prevention, was implemented across WA in 2014. Methods We conducted a prospective population-based cohort study using pregnancy data for singleton births in WA from 2009 to 2019. Logistic regression using the last full year before the Initiative (2013) as the reference, and run charts were used to examine changes in PTB rates compared to pre-Initiative levels, by gestational age group, hospital type, low and high risk of PTB in mid-pregnancy, and onset of labour (spontaneous/medically initiated). Analyses were stratified by Aboriginal and non-Aboriginal maternal ethnicity. Results Amongst non-Aboriginal women, there was initially a reduction in the PTB rate across the state, and in recent years it returned to pre-Initiative levels. Amongst Aboriginal women there was a small, non- significant reduction in the state-wide PTB rate in the first three years of the Initiative, followed by a rise in recent years. For non-Aboriginal women, the reduction in the rate of PTB at the tertiary centre was sustained and improved further for women of all risk levels and onsets of labour. This reduction was not observed for Aboriginal women giving birth at the tertiary centre, amongst whom there was an increase in the PTB rate overall and in all subgroups, with the exception of medically initiated PTB. Amongst Aboriginal women the PTB rate has also increased across the state. At non-tertiary hospitals there was a large increase in PTB amongst both Aboriginal and non-Aboriginal women, largely driven by medically initiated late PTB. Maternal risk factors cannot account for this increase. Conclusions The reduction in PTB rates amongst non-Aboriginal women at the state’s tertiary hospital demonstrates that with the right strategies, PTB can be reduced. A sustained collaborative model is required to realise this success in non-tertiary hospitals. The series of interventions was of limited use in Aboriginal women, and future efforts will need to be directed at strategies more likely to be successful, such as midwifery continuity of care models, with Aboriginal representation in the healthcare workforce.

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“…Social risk factors associated with inequalities in maternal and neonatal outcomes include Black and minority ethnicity, poverty, young motherhood, homelessness, difficulty speaking or understanding English, migrant or refugee status, domestic violence, mental illness and substance abuse [1][2][3][4][5][6][7][8][9][10][11][12]. It is hypothesised that the current fragmented service women experience when accessing maternity care is directly linked to these health inequalities [1,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

et al. 2023

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Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis

Cited by 4 publications

References 33 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

The Western Australian preterm birth prevention initiative: a whole of state singleton pregnancy cohort study showing the need to embrace alternative models of care for Aboriginal women

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

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