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

CMAJ : Canadian Medical Association Journal Pub Date : 2024-04-01 DOI:10.1503/cmaj.230878

Seungmi Yang, Gabriel D. Shapiro, Edward Ng, B. Vissandjée, Zoua M. Vang

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Abstract

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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不同入境类别的移民父母和在加拿大出生的父母所生婴儿的出生和产后结果：一项基于人口的回顾性研究

背景：大多数关于父母出生地的出生和产后结果差异的研究将所有移民合并为一个群体。我们试图通过比较不同移民类别的出生和产后结果来评估加拿大移民之间的异质性。方法：我们利用加拿大统计局的活产和死产数据（1993-2017 年）以及婴儿死亡数据（1993-2018 年），并将其与父母的移民数据（1960-2017 年）联系起来，开展了一项基于人口的回顾性研究。我们将生育父母分为在加拿大出生的父母、经济类移民、家庭类移民或难民，并评估了不同群体的早产、小胎龄（SGA）和大胎龄（LGA）新生儿、死胎和单胎婴儿死亡的差异。结果：在 7 980 650 例新生儿中，有 1 715 050 例（21.5%）是移民所生，包括 632 760 例（36.9%）经济类新生儿、853 540 例（49.8%）家庭类新生儿和 228 740 例（13.4%）难民新生儿。与加拿大出生的父母所生的婴儿相比，3 个移民群体中每个群体的婴儿早产、SGA 出生和死产的风险都较高，但 LGA 出生和新生儿死亡的风险较低。与经济阶层移民的婴儿相比，难民的婴儿早产（0.9% 对 0.8%，调整后风险比 [RR] 1.08，95% 置信区间 [CI] 1.01-1.15）和 LGA 出生（9.2% 对 7.5%，调整后风险比 1.12，95% 置信区间 [CI] 1.01-1.15）的风险较高。12，95% CI 1.10-1.15），但 SGA 出生风险较低（10.2% v. 11.0%，调整 RR 0.92，95% CI 0.90-0.94），而家庭类移民的婴儿 SGA 出生风险较高（12.2% v. 11.0%，调整 RR 1.01，95% CI 1.00-1.02）。死胎、新生儿死亡和婴儿总体死亡的风险在不同移民群体之间没有显著差异。释义：不同移民类别的加拿大移民所生婴儿的结局存在异质性。这些结果凸显了在健康差异研究中对移民人口进行分类的重要性。

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CMAJ : Canadian Medical Association Journal

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