Self-Rated Health in Migrant and Non-Migrant Women before, during and after Pregnancy: A Population-Based Study of 0.5 Million Pregnancies from the Swedish Pregnancy Register.

Pontus Henriksson,Paulina Nowicka,Kerstin Petersson,Emmie Söderström,Marie Blomberg,Kristin Thomas,Fernando Estévez-López,Marcus Bendtsen,Marie Löf

doi:10.3390/jcm9061764

Abstract

Self-rated health is a strong health marker. Migrants have been suggested to have poorer self-rated health than non-migrants (i.e., native-born). However, little is known about whether there are disparities in self-reported health in relation to pregnancy. Therefore, the aim of the current study was to examine the odds of poor self-rated health before, during and after pregnancy in migrant women as compared to women born in Sweden. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women between 2010 and 2018. Self-rated health was reported on a 5-point scale (from very poor to very good). Very poor and poor health were categorized as poor self-rated health. Logistic regression was utilized to calculate odds ratios (ORs) that were unadjusted and adjusted for covariates (age, parity, educational attainment and body mass index). The results demonstrate disparities in self-rated health across birth regions. In comparison to women born in Sweden, women born in Latin America and the Caribbean, South Asia as well as North Africa and the Middle East had consistently higher odds of poor self-rated health before, during and after pregnancy (ORs ranging from 1.14 to 1.96 in both unadjusted and adjusted models). Although women born in Sub-Saharan Africa did have comparable self-rated health as to women born in Sweden before pregnancy, after accounting for covariates, they had lower odds of poor self-rated health during and after pregnancy (ORs: 0.71 and 0.80 respectively). Therefore, additional measures and support may be needed to tackle disparities in health between migrant and non-migrant women before, during and after pregnancy.

Highlights

Self-rated health refers to the overall perception an individual has about their health and it is often measured by a one-item question, e.g., ‘How would you rate your general state of health?’ [1]
Women born in Latin America and the Caribbean (OR, 1.68 [95% confidence intervals (CIs), 1.43 to 1.96]), North Africa and the Middle East (OR, 1.96 [95% CI, 1.87 to 2.05]) and South Asia (OR, 1.34 [95% CI, 1.16 to 1.56]) had considerably higher odds of having poor self-rated health before pregnancy as compared to women born in Sweden
The estimates generally were attenuated in the adjusted model, women born in Latin America and the Caribbean, North Africa and the Middle East and South Asia still had higher odds of poor self-rated health than women born in Sweden

Summary

Introduction

Self-rated health refers to the overall perception an individual has about their health and it is often measured by a one-item question, e.g., ‘How would you rate your general state of health?’ [1]. Poor self-rated health has been associated with higher risk of mortality [1,2,3,4], cardiovascular disease [3,5], mental illness [4,6] and pregnancy complications [7]. Pregnancy and the postpartum period are sensitive periods in time in which women may experience poor self-rated health [14], mental illness [15] as well as pregnancy complications [16,17]. Only a few studies have examined self-rated health in migrant and non-migrant women in relation to pregnancy [8,10]. To the best of our knowledge, no previous study has examined differences in self-reported health among migrant and non-migrant women at multiple time points before, during and after pregnancy in a large nationwide sample. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women born in all seven so called super-regions [18]: (1) Central Europe, Eastern Europe and Central Asia; (2) high income countries (Sweden not included); (3) Latin America and the Caribbean; (4) North Africa and the Middle East; (5) South Asia; (6) Southeast Asia and East Asia; and (7) Sub-Saharan Africa

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Discussion

Conclusion