World Region Of Origin Research Articles

Differences in maternal-newborn ABO blood groups and risk of serious infant infection.

During pregnancy, various maternal IgG antibodies are transferred to the developing fetus, some of which may protect the newborn against infection. If a mother and her fetus have different A, B or O (ABO) blood groups, then transferred maternal antibodies may plausibly protect the infant against infection. To determine if maternal-newborn ABO blood group incongruence vs. congruence is associated with a lower risk of serious infection in the infant. Retrospective population-based cohort. We used linked patient-level datasets for all singleton hospital livebirths from 2008 to 2022 in Ontario, Canada, with known maternal and newborn ABO blood groups. We used a dichotomous exposure state, either ABO blood group congruent (N = 114 507) or incongruent (N = 43 074). The main outcome of interest was the risk of serious infant infection within 27 days, and from 28 to 365 days, after birth. Cox proportional hazard models generated hazard ratios and 95% confidence intervals, and were adjusted for maternal age, world region of origin, residential income quintile and gestational age at birth. Relative to maternal-newborn congruency, incongruent ABO blood group was associated with an adjusted hazard ratio of 0.88 (95% CI: 0.80-0.97) for serious neonatal infection within 27 days of birth, and 0.93 (95% CI: 0.90-0.96) for serious infection between 28 and 365 days after birth. Maternal-newborn ABO incongruence may be associated with a lower relative risk of a serious infant infection within 27 days, and from 28 to 365 days, after birth.

Mental health and neurocognitive disorder–related hospitalization rates in immigrants and Canadian-born population: a linkage study

ObjectivesMental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada.MethodsHospital records from the Discharge Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada’s 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health–related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available.ResultsOverall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently.ConclusionDifferences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.

Health care utilisation for treatment of injuries among immigrants in Norway: a nationwide register linkage study

BackgroundPrevious research has generally found lower rates of injury incidence in immigrant populations than in native-born populations. Most of this literature relies on mortality statistics or hospital data, and we know less about injuries treated in primary health care. The aim of the present study was to assess use of primary and secondary care for treatment of injuries among immigrants in Norway according to geographic origin and type of injury.MethodsWe conducted a nationwide register-based cohort study of all individuals aged 25–64 years who resided in Norway as of January 1st 2008. This cohort was followed through 2014 by linking sociodemographic information and injury data from primary and secondary care. We grouped immigrants into six world regions of origin and identified immigrants from the ten most frequently represented countries of origin. Six categories of injury were defined: fractures, superficial injuries, open wounds, dislocations/sprains/strains, burns and poisoning. Poisson regression models were fitted to estimate incidence rate ratios separately for injuries treated in primary and secondary care according to immigrant status, geographic origin and type of injury, with adjustment for sex, age, county of residence, marital status and socioeconomic status.ResultsImmigrants had a 16% lower incidence of injury in primary care than non-immigrants (adjusted IRR = 0.84, 95% CI 0.83–0.84), and a 10% lower incidence of injury in secondary care (adjusted IRR = 0.90, 95% CI 0.90–0.91). Immigrants from Asia, Africa and European countries outside EU/EEA had lower rates than non-immigrants for injuries treated in both primary and secondary care. Rates were lower in immigrants for most injury types, and in particular for fractures and poisoning. For a subset of injuries treated in secondary care, we found that immigrants had lower rates than non-immigrants for treatment of self-harm, falls, sports injuries and home injuries, but higher rates for treatment of assault, traffic injuries and occupational injuries.ConclusionsHealth care utilisation for treatment of injuries in primary and secondary care in Norway was lower for immigrants compared to non-immigrants. Incidence rates were especially low for immigrants originating from Asia, Africa and European countries outside EU/EEA, and for treatment of fractures, poisoning, self-harm and sports injuries.

Severe Maternal Morbidity and Infant Mortality in Canada.

Severe maternal morbidity (SMM) comprises an array of conditions and procedures denoting an acutely life-threatening pregnancy-related condition. SMM may further compromise fetal well-being. Empirical data are lacking about the relation between SMM and infant mortality. This population-based cohort study included 1 892 857 singleton births between 2002 and 2017 in Ontario, Canada, within a universal health care system. The exposure was SMM as an overall construct arising from 23 weeks' gestation up to 42 days after the index delivery. The primary outcome was infant mortality from birth to 365 days. Multivariable modified Poisson regression generated relative risks and 95% confidence intervals (CIs), adjusted for maternal age, income, rurality, world region of origin, diabetes mellitus, and chronic hypertension. Infant mortality occurred among 174 of 19 587 live births with SMM (8.9 per 1000) vs 5289 of 1 865 791 live births without SMM (2.8 per 1000) (an adjusted relative risk of 2.93 [95% CI 2.51-3.41]). Of 19 587 pregnancies with SMM, 4523 (23.1%) had sepsis. Relative to births without SMM, the adjusted odds ratio for infant death from sepsis was 1.95 (95% CI 1.10-3.45) if SMM occurred without maternal sepsis and 6.36 (95% CI 3.50-11.55) if SMM included sepsis. SMM confers a higher risk of infant death. There is also coupling tendency (concurrent event of interest) between SMM with sepsis and infant death from sepsis. Identification of preventable SMM indicators, as well as the development of strategies to limit their onset or progression, may reduce infant mortality.

Risk of severe maternal morbidity or death in relation to elevated hemoglobin A1c preconception, and in early pregnancy: Apopulation-based cohort study.

BackgroundThe relation between prepregnancy average glucose concentration and a woman’s risk of severe maternal morbidity (SMM) is unknown. The current study evaluated whether an elevated preconception hemoglobin A1c (A1c) is associated with SMM or maternal death among women with and without known prepregnancy diabetes mellitus (DM).Methods and findingsA population-based cohort study was completed in Ontario, Canada, where there is universal healthcare. The main cohort included 31,225 women aged 16–50 years with a hospital live birth or stillbirth from 2007 to 2015, and who had an A1c measured within 90 days before conception, including 28,075 women (90%) without known prepregnancy DM. The main outcome was SMM or maternal mortality from 23 weeks’ gestation up to 42 days postpartum. Relative risks (RRs) were generated using modified Poisson regression, adjusting for the main covariates of maternal age, multifetal pregnancy, world region of origin, and tobacco/drug dependence. The mean maternal age was 31.1 years. Overall, SMM or death arose among 682 births (2.2%). The RR of SMM or death was 1.16 (95% CI 1.14–1.19; p < 0.001) per 0.5% increase in A1c and 1.16 (95% CI 1.13–1.18; p < 0.001) after adjusting for the main covariates. The adjusted relative risk (aRR) was increased among those with (1.11, 95% CI 1.07–1.14; p < 0.001) and without (1.15, 95% CI 1.02–1.29; p < 0.001) known prepregnancy diabetes, and upon further adjusting for body mass index (BMI) (1.15, 95% CI 1.11–1.20; p < 0.001), or chronic hypertension and prepregnancy serum creatinine (1.11, 95% CI 1.04–1.18; p = 0.002). The aRR of SMM or death was 1.31 (95% CI 1.06–1.62; p = 0.01) in those with a preconception A1c of 5.8%–6.4%, and 2.84 (95% CI 2.31–3.49; p < 0.001) at an A1c > 6.4%, each relative to an A1c < 5.8%. Among those without previously recognized prepregnancy diabetes and whose A1c was >6.4%, the aRR of SMM or death was 3.25 (95% CI 1.76–6.00; p < 0.001). Study limitations include that selection bias may have incorporated less healthy women tested for A1c, and BMI was unknown for many women.ConclusionsOur findings indicate that women with an elevated A1c preconception may be at higher risk of SMM or death in pregnancy or postpartum, including those without known prepregnancy DM.

Refugee Children's Participation in the Women, Infants, and Children Supplemental Nutrition (WIC) Program in Massachusetts, 1998-2010.

To (1) describe prevalence of growth abnormalities and anemia in refugee children; (2) describe the proportion of age-eligible refugee children enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and (3) identify risk factors for lack of enrollment in WIC. Data were collected from 1731 health screenings for refugee children younger than 5 years in Massachusetts in 1998-2010 and matched to WIC program records. Risk factors for lack of WIC enrollment were analyzed in SAS using multivariate logistic regression. Massachusetts. Refugee children under age 5 years. (1) prevalence of growth abnormalities and anemia in refugee children, (2) proportion of age-eligible refugee children enrolled in WIC, and (3) association of risk factors with lack of WIC enrollment. Overall, 33% of refugee children under age 5 in Massachusetts had at least 1 growth and nutrition problem, including anemia (31%), stunting (10%), wasting (8%), and low weight for age (10%). WIC enrollment among refugee children under 5 years of age was only 62%, lower than that of all eligible children under 5 in Massachusetts (86%). Risk factors for lack of WIC enrollment among refugee children included age, world region of origin, and arrival cohort. Although many refugee children under age 5 experience growth or nutrition problems, one-third of refugee children in Massachusetts were not enrolled in WIC for nutrition assistance, representing a failure of the system. Agencies providing services at the local level should be supported to facilitate enrollment and participation for shared clients.

Intergenerational teen pregnancy: a population-based cohort study.

To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth. Population-based cohort study. Ontario, Canada. A total of 15 097 mothers and their 16 177 daughters. Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate. Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP. The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome. There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends. Strong intergenerational association for teenage pregnancy between mother and daughter.

Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada

A woman's risk of venous thromboembolism during pregnancy is estimated to be two-to-six times higher than her risk when she is not pregnant. Such risk estimates are largely based on pregnancies that result in delivery of a newborn baby; no estimates exist for the risk of venous thromboembolism after induced abortion, another common pregnancy outcome. To fill this knowledge gap, we aimed to assess the risk of venous thromboembolism in women whose first pregnancy ended with induced abortion. We did this propensity score-matched cohort study using data from the universal health-care system of Ontario, Canada. We included primigravid women who had an induced abortion between Jan 1, 2003, and Dec 31, 2015, and used a propensity score to match them to primigravid women who had a livebirth (1:1) or nulligravid women who were not pregnant on the procedure date of their matched counterpart and who did not conceive within 1 year afterwards (5:1). We excluded from our analysis women younger than 15 years or older than 49 years and individuals who had missing or invalid information about their sex, area of residence, residential income, or world region of origin. The primary outcome was risk of any venous thromboembolism within 42 days of the index date (defined as the date of an induced abortion, delivery date for livebirth, or for non-pregnant women the induced abortion date of their matched counterpart). We compared the rate of venous thromboembolism in primigravid women who had an induced abortion with the rate of venous thromboembolism in propensity-score-matched non-pregnant women and propensity-score-matched primigravid women whose pregnancy ended with a livebirth. We generated hazard ratios (HRs) of 42-day risk of venous thromboembolism after induced abortion using Cox proportional hazard models. We identified 194 086 eligible women whose first pregnancy ended with induced abortion, of whom 176 001 (90·7%) could be matched with women whose first pregnancy ended in delivery of a newborn. These 176 001 women were also matched to 880 005 non-pregnant women. The rate of venous thromboembolism within 42 days of an induced abortion was 30·1 (95% CI 22·0-38·2) per 100 000 women compared with 13·5 (11·1-16·0) per 100 000 women in the non-pregnant group (HR 2·23, 95% CI 1·61-3·08). The HR was 0·16 (95% CI 0·12-0·22) when compared with the women in the livebirth cohort, whose venous thromboembolism rate within 42 days postpartum was 184·7 (95% CI 164·6-204·7) per 100 000 women. The 42-day risk of venous thromboembolism after an induced abortion is double that of a matched non-pregnant woman, and is significantly lower than after a livebirth. This novel information can inform estimates of peri-procedural risk of venous thromboembolism after induced abortion. Clinicians could consider a lower threshold for ordering a diagnostic test to rule out venous thromboembolism after induced abortion than they would in a non-pregnant woman. Institute for Clinical Evaluative Sciences.

Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study.

A teenage woman's sexual health practices may be influenced by her mother's experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters. We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters' data for induced abortions between age 12 years and their 20th birthday. We assessed each mother's history of induced abortion for the period from 4 years before her daughter's birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter's risk of having an induced abortion in relation to the mother's history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother- daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile. A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%-10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%-4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86-2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69-1.85) with 1 maternal abortion, 2.04 (95% CI 1.91-2.18) with 2 maternal abortions, 2.39 (95% CI 2.19-2.62) with 3 maternal abortions and 2.54 (95% CI 2.33-2.77) with 4 or more maternal abortions, relative to none. We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion.

Region of origin diversity in immigrant health: Moving beyond the Mexican case

Research suggests that Mexican immigrants arrive in the United States with equivalent or better health than native-born whites but lose their advantage over time. We seek to examine systematically how well the patterns of initial advantage and deteriorating health apply to immigrants originating from other regions of the world – regions that represent a growing proportion of U.S. immigrants. We begin by identifying which of the groups in our study have a health advantage compared to U.S.-born whites and to Mexican immigrants. We then we assess changes in health over time, controlling for variation in the health profiles of cohorts upon arrival. We use logistic regression of self-rated health and heart conditions with data from the 2004–2013 National Health Interview Survey. The results reveal diversity and similarity in health outcomes across world regions of origin, both on arrival and over time. By comparing and contrasting cases previously examined in isolation, we clarify and qualify theories of the immigrant health paradox and health deterioration.

Breast cancer screening disparities among immigrant women by world region of origin: a population-based study in Ontario, Canada.

Rates of mammography screening for breast cancer are disproportionately low in certain subgroups including low‐income and immigrant women. The purpose of the study was to examine differences in rates of appropriate breast cancer screening (i.e., screening mammography every 2 years) among Ontario immigrant women by world region of origin and explore the association between appropriate breast cancer screening among these women groups and individual and structural factors. A cohort of 183,332 screening‐eligible immigrant women living in Ontario between 2010 and 2012 was created from linked databases and classified into eight world regions of origin. Appropriate screening rates were calculated for each region by age group and selected sociodemographic, immigration, and healthcare‐related characteristics. The association between appropriate screening across the eight regions of origin and selected sociodemographic, immigration, and health‐related characteristics was explored using multivariate Poisson regression. Screening varied by region of origin, with South Asian women (48.5%) having the lowest and Caribbean and Latin American women (63.7%) the highest cancer screening rates. Factors significantly associated with lower screening across the world regions of origin included living in the lowest income neighborhoods, having a refugee status, being a new immigrant, not having a regular physical examination, not being enrolled in a primary care patient enrollment model, having a male physician, and having an internationally trained physician. Multiple interventions entailing cross‐sector collaboration, promotion of patient enrollment models, community engagement, comprehensive and intensive outreach to women, and knowledge translation and transfer to physicians should be considered to address screening disparities among immigrant population. Consideration should be given to design and delivery of culturally appropriate and easily accessible cancer screening programs targeted at high‐ risk immigrant subgroups, such as women of South Asian origin, refugees, and new immigrants.

Highly-Skilled Migration, Migrant Networks and the Prestige of Academic Institutions

This research analyzed the connection between highly skilled migration and several determining factors such as the migration networks, the prestige of academic institutions and the Gross Domestic Product per capita. We used linear regression method to analyze a sample of 207 countries, 25 receiving countries and 182 sending countries, from 6 different world regions (Africa, Asia, Europe, North America, Central &amp; South America and Oceania). We performed a global analysis including all the countries of the sample and also a partial analysis by each world region of origin. The results at global level showed that migration networks and the prestige of academic institution explained very well the number of highly skilled immigrants. In this sense, the prestigious academic institutions of the receiving countries imply economic incentives and benefits for skilled migrants. Further, relationships and linkages are an important help for highly skilled migrants. Thus both would act like external and internal networks attracting highly skilled migrants. Regarding to the partial analysis these factors were also relevant to explain the highly skilled migration, but the results varied depending on each region. In the case of Africa and Central &amp; South America the relevant factor explaining the highly-skilled migration was the prestige of academic institutions of the receiving countries. However in the regions of Europe, North America, and Oceania results were similar to the global analysis. In Asia all factors were significant.DOI: http://dx.doi.org/10.5755/j01.ee.26.5.12463

Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study.

BackgroundGiven that immigration has been linked to a variety of mental health stressors, understanding use of mental health services by immigrant groups is particularly important. However, very little research on immigrants’ use of mental health service in the host country considers source country. Newcomers from different source countries may have distinct experiences that influence service need and use after arrival. This population study examined rates of use of primary care and of specialty services for non-psychotic mental health disorders by immigrants to Ontario Canada during their first five years after arrival. Service use by recent immigrants in broad source region groups representing all world regions was compared to use by age-matched Canadian-born or long term immigrants (called long term residents).MethodThis matched population-based cross-sectional study assessed likelihood of any use and counts of visits for each of primary care, psychiatric care and hospital care (emergency department visits or inpatient admissions) for non-psychotic mental health disorders from 1993–2012. Adult immigrants living in urban Ontario (n = 912,114) were categorized based on their nine world regions of origin. Sex-stratified conditional logistic regression models and negative binomial models were used to compare service use by immigrant region groups to their age-matched long term residents.ResultsImmigrant were more or less likely to access primary mental health care compared to age-matched long term residents, depending on their world region of origin. Regarding specialty mental health care (psychiatry and hospital care), immigrants from all regions used less than long term residents. Across the three mental health services, estimates of use by immigrant region groups compared to long term residents were among the lowest for newcomers from East Asian and Pacific (range: 0.16–0.82) and among the highest for persons from Middle East and North Africa (range: 0.56–1.23).ConclusionThis population-based study showed lower use of mental health services by recent immigrants than long-term immigrants or native born individuals, with variation in immigrants’ use linked to world region of origin and type of mental health care. Variation across source region groups underscores the importance of identifying underlying individual characteristics that affect service use to make services more responsive to newcomers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0995-9) contains supplementary material, which is available to authorized users.

HIV Disparities in a US and Foreign-Born Cohort in Urban United States

Background: As we strive to reduce disparities in the implementation of the US National HIV/AIDS Strategy, we must understand HIV disparities as they exist in all US populations, including the foreign-born. We evaluate disparities in HIV prevalence in a US and foreign-born cohort in Philadelphia. Methods: Comparative analyses were conducted using data from questionnaires paired with HIV test results for individuals undergoing HIV testing in Philadelphia between 2007 and 2011. Descriptive analyses were conducted by gender and world region of origin. Results: Of 14,216 participants, 76.2% were US-born and 59% female. Caribbean men, 3.6% of the cohort, constituted 11.4% of the HIV- positive. Among women, Africans, 3.0% of the cohort constituted 4.5% of the HIVpositive. No disparities by race/ethnicity were found in the US-born cohort. Conclusions: In this global population in Philadelphia, HIV disparities were found to occur by world region of birth and gender. The foreign-born must be included in analyses of the domestic epidemic that drive prevention strategies, policy and resource allocation

Risk of cerebral palsy among the offspring of immigrants.

BackgroundCerebral palsy (CP) has a multifactorial etiology, and placental vascular disease may be one major risk factor. The risk of placental vascular disease may be lower among some immigrant groups. We studied the association between immigrant status and the risk of CP.MethodsWe conducted a population-based retrospective cohort study of all singleton and twin livebirths in Ontario between 2002–2008, and who survived ≥28 days after birth. Each child was assessed for CP up to age 4 years, based on either a single inpatient or ≥2 outpatient pediatric diagnoses of CP. Relative to non-immigrants (n = 566,668), the risk of CP was assessed for all immigrants (n = 177,390), and further evaluated by World region of origin. Cox proportional hazard ratios (aHR) were adjusted for maternal age, income, diabetes mellitus, obesity, tobacco use, Caesarean delivery, year of delivery, physician visits, twin pregnancy, preterm delivery, as well as small- and large-for-gestational age birthweight.ResultsThere were 1346 cases of CP, with a lower rate among immigrants (1.45 per 1000) than non-immigrants (1.92 per 1000) (aHR 0.77, 95% confidence interval [CI] 0.67 to 0.88). Mothers from East Asia and the Pacific (aHR 0.54, 95% CI 0.39 to 0.77) and the Caribbean (aHR 0.58, 95% CI 0.37 to 0.93) were at a significantly lower risk of having a child with CP. Whether further adjusting for preeclampsia, gestational hypertension, placental abruption or placental infraction, or upon using a competing risk analysis that further accounted for stillbirth and neonatal death, these results did not change.ConclusionsImmigration and ethnicity appear to attenuate the risk of CP, and this effect is not fully explained by known risk factors.

Serious Preeclampsia Among Different Immigrant Groups

ObjectiveResearch conducted outside Canada suggests that preeclampsia (PET) may be more common among certain ethnic groups. A limitation to prior studies is that they did not distinguish between immigrant and non-immigrant women; they also included women with mild PET arising near term, the clinical importance of which is debatable. We created the term “serious PET” to describe a diagnosis of severe PET, eclampsia, or any degree of PET with concomitant preterm delivery, fetal death, or maternal hospitalization of seven days or more, and evaluated its risk in association with world region of origin among recent immigrants to Ontario. MethodsUsing the federal Landed Immigrant Data System database (LIDS), we completed a population-based study of 18 849 women who immigrated to Ontario between 1985 and 2000. The LIDS was linked to the Canadian Institute for Health Information’s Discharge Abstracts Database, thereby capturing all hospitalizations with subsequent delivery in Ontario between April 1, 2002, and March 31, 2009. Rates for serious PET were determined according to maternal world region of birth, and odds ratios were adjusted for maternal age, number of live births, multifetal pregnancy, diabetes mellitus status, level of formal education, place of residence, neighbourhood income quintile, duration of residence in Canada, and fiscal year of delivery. ResultsImmigrant women from the Caribbean (6.8 per 1000; OR 3.34; 95% CI 2.25 to 4.96), Sub-Saharan Africa (6.8 per 1000; OR 3.14; 95% CI 2.04 to 4.83) and Hispanic America (5.9 per 1000; OR 3.11; 95% CI 1.97 to 4.88) were at highest risk of serious PET relative to immigrant women from industrialized nations. The ORs were either unchanged or higher when restricted to women without a prior live birth. ConclusionWe identified immigrant groups at higher risk of serious PET, whose consequences would presumably include greater financial costs for hospital care and a negative impact on maternal and newborn well-being.

African-Born Men in the United States Are Diagnosed With HIV Later Than African-Born Women

This paper evaluates gender differences in CD4 cell counts at human immunodeficiency virus (HIV) diagnosis of an African-born population receiving care for HIV infection in a publicly financed clinic setting in Philadelphia, Pennsylvania, in comparison with a non-African, foreign-born cohort in the same setting. Records of foreign-born individuals receiving HIV care at the Philadelphia city health centers between January 2007 and December 2008 were reviewed. Data abstracted included demographics, country of origin, reason for HIV testing, and baseline CD4 cell count. Associations among baseline CD4 cell count, demographic variables and reason for testing were assessed by gender and by world region of origin (African or non-African). During the review period, 107 African patients and 127 non-African patients met inclusion criteria. Mean CD4 cell counts at diagnosis were 263 cells/mm3 for African men and 362 cells/mm3 for African women (p = .055). For other foreign-born individuals, mean CD4 cell counts did not vary by gender. African women were more likely than African men to undergo routine testing in the setting of reproductive health care, while there was no gender difference in rates of reproduction-related testing for non-Africans. African men in Philadelphia are diagnosed with HIV at a later stage of disease than African women are. This difference is associated with higher rates of routine testing of African women in reproductive health care settings. Efforts to engage African men in the United States in routine HIV testing are urgently needed as part of the national "test and treat" strategy of HIV testing and linkage to care.

P2-100 The relationship between post traumatic stress disorder and hypertension among 105 180 asylum seekers in the Netherlands

ObjectiveTo determine the relationship between post-traumatic stress disorder (PTSD) and hypertension among asylum seekers in the Netherlands.MethodsData were obtained from the Dutch national electronic database of the Community Health Services...

Expanding Entrepreneurship: Female and Foreign-Born Founders of New England Biotechnology Firms

Research on immigrant entrepreneurs in the United States has focused on small businesses in the retail and food service sectors rather than on high-technology start ups. Scholarship on women and immigrants in the U.S. science and technology workforce has focused on academia rather than scientists in industry. This article aims to bridge the gaps in these two literatures by examining the role of women and immigrants in founding science-based biotechnology firms. This research thus speaks to the sociological perspective on power inequalities for women and foreign-born people in entrepreneurship and in the U.S. science and technology workforce. Opportunities and barriers vary by organizational context, and the flexibility of the biotechnology industry has previously been found to benefit female scientists. But what of foreign-born scientists and women who play founding roles in biotech firms? A survey conducted of 261 biotechnology firms located in Massachusetts and New England in 2006 provides the data. The results show that 42% of the firms had at least one foreign-born founder, and 21% of firms had at least one female founder. These numbers suggest that foreign-born life scientists are well represented and female life scientists are somewhat underrepresented in founding roles in biotech. The role of entrepreneurs who have the double status of female immigrants is less clear and needs further study. The research finds significant variation in biotech entrepreneurship of immigrants by their world region of origin. Interviews supplement the survey data to illustrate the barriers and opportunities for foreign-born biotech entrepreneurs.

International migration and adverse birth outcomes: role of ethnicity, region of origin and destination

BackgroundThe literature on international migration and birth outcomes shows mixed results. This study examined whether low birth weight (LBW) and preterm birth differed between non-migrants and migrant subgroups, defined by...