Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study

Evans, Andrea; Ray, Joel G.; Austin, Peter C.; Lü, H.; Gandhi, Sima; Guttmann, Astrid

doi:10.1503/cmaj.221207

Cited by 5 publications

(1 citation statement)

References 28 publications

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“…Studies have reported differences in access to and quality of prenatal care among immigrants in many countries including those with publicly funded health care. 50 , 51 A recent study in Canada also showed that adequate prenatal care differed by immigrant admission category (government-assisted v. privately sponsored) even among refugees; 52 thus, initiation and adequacy of prenatal care may differ between immigrants of the 3 categories evaluated in our study. Other important data unavailable in our study included use of tobacco, alcohol, and other substances that are associated with adverse birth outcomes.…”

Section: Discussionmentioning

confidence: 54%

Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study

Yang,

Shapiro,

et al. 2024

CMAJ

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Background: Most studies of disparities in birth and postnatal outcomes by parental birthplace combine all immigrants into a single group. We sought to evaluate heterogeneity among immigrants in Canada by comparing birth and postnatal outcomes across different immigration categories. Methods: We conducted a population-based retrospective study using Statistics Canada data on live births and stillbirths (1993–2017) and infant deaths (1993–2018), linked to parental immigration data (1960–2017). We classified birthing parents as born in Canada, economic-class immigrants, family-class immigrants, or refugees, and evaluated differences in preterm births, small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, stillbirths, and infant deaths among singleton births by group. Results: Among 7 980 650 births, 1 715 050 (21.5%) were to immigrants, including 632 760 (36.9%) in the economic class, 853 540 (49.8%) in the family class, and 228 740 (13.4%) refugees. Compared with infants of Canadian-born birthing parents, infants of each of the 3 immigrant groups had higher risk of preterm birth, SGA birth, and stillbirth, but lower risk of LGA birth and neonatal death. Compared with infants of economic-class immigrants, infants of refugees had higher risk of early preterm birth (0.9% v. 0.8%, adjusted risk ratio [RR] 1.08, 95% confidence interval [CI] 1.01–1.15) and LGA birth (9.2% v. 7.5%, adjusted RR 1.12, 95% CI 1.10–1.15), but lower risk of SGA birth (10.2% v. 11.0%, adjusted RR 0.92, 95% CI 0.90–0.94), while infants of family-class immigrants had higher risk of SGA birth (12.2% v. 11.0%, adjusted RR 1.01, 95% CI 1.00–1.02). Risk of stillbirth, neonatal death, and overall infant death did not differ significantly among immigrant groups. Interpretation: Heterogeneity exists in outcomes of infants born to immigrants to Canada across immigration categories. These results highlight the importance of disaggregating immigrant populations in studies of health disparities.

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Section: Discussionmentioning

confidence: 54%

Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study

Yang,

Shapiro,

et al. 2024

CMAJ

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Mortality Following Childbirth in Ontario: A 20-Year Analysis of Temporal Trends and Causes

Sprague,

Roberts,

Lavin Venegas

et al. 2024

Journal of Obstetrics and Gynaecology Canada

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Inequalities in access to prenatal care during the COVID‐19 pandemic: Analysis of a population‐based cohort

Hetherington,

Darling,

Harper

et al. 2024

Paediatric Perinatal Epid

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BackgroundBefore the COVID‐19 pandemic, access to prenatal care was lower among some socio‐demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities.ObjectivesTo investigate if the COVID‐19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio‐economic situation (SES) and are recent immigrants.MethodsWe used linked administrative datasets from ICES to identify a population‐based cohort of 455,245 deliveries in Ontario from January 2018 to December 2021. Our outcomes were first‐trimester prenatal visits, first‐trimester ultrasound and adequacy of prenatal care. We used joinpoint analysis to examine outcome time trends and identify trend change points. We stratified analyses by age, rural residence, SES and recent immigration, and examined risk differences (RD) with 95% confidence intervals (CI) between groups at the beginning and end of the study period.ResultsFor all outcomes, we noted disruptions to care beginning in March or April 2020 and returning to previous trends by November 2020. Inequalities were stable across groups, except recent immigrants. In July 2017, 65.0% and 69.8% of recent immigrants and non‐immigrants, respectively, received ultrasounds in the first trimester (RD −4.8%, 95% CI −8.0, −1.5). By October 2020, this had increased to 75.4%, with no difference with non‐immigrants (RD 0.4%, 95% CI −2.4, 3.2). Adequacy of prenatal care showed more intensive care as of November 2020, reflecting a higher number of visits.ConclusionsWe found no evidence that inequalities between socio‐economic groups that existed prior to the pandemic worsened after March 2020. The pandemic may be associated with increased access to care for recent immigrants. The introduction of virtual visits may have resulted in a higher number of prenatal care visits.

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Receipt of adequate prenatal care for privately sponsored versus government-assisted refugees in Ontario, Canada: a population-based cohort study

Cited by 5 publications

References 28 publications

Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study

Birth and postnatal outcomes among infants of immigrant parents of different admission categories and parents born in Canada: a population-based retrospective study

Mortality Following Childbirth in Ontario: A 20-Year Analysis of Temporal Trends and Causes

Inequalities in access to prenatal care during the COVID‐19 pandemic: Analysis of a population‐based cohort

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