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Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada
OBJECTIVES: Rates of age-associated severe maternal morbidity (SMM) have increased in Canada, and an association with neighbourhood income is well established. Our aim was to examine SMM trends according to neighbourhood material deprivation quintile, and to assess whether neighbourhood deprivation...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496377/ https://www.ncbi.nlm.nih.gov/pubmed/34615673 http://dx.doi.org/10.1136/bmjopen-2020-046174 |
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author | Snelgrove, John W Lam, Melody Watson, Tristan Richard, Lucie Fell, Deshayne B Murphy, Kellie E Rosella, Laura C |
author_facet | Snelgrove, John W Lam, Melody Watson, Tristan Richard, Lucie Fell, Deshayne B Murphy, Kellie E Rosella, Laura C |
author_sort | Snelgrove, John W |
collection | PubMed |
description | OBJECTIVES: Rates of age-associated severe maternal morbidity (SMM) have increased in Canada, and an association with neighbourhood income is well established. Our aim was to examine SMM trends according to neighbourhood material deprivation quintile, and to assess whether neighbourhood deprivation effects are moderated by maternal age. DESIGN, SETTING AND PARTICIPANTS: A population-based retrospective cohort study using linked administrative databases in Ontario, Canada. We included primiparous women with a live birth or stillbirth at ≥20 weeks’ gestational age. PRIMARY OUTCOME: SMM from pregnancy onset to 42 days postpartum. We calculated SMM rate differences (RD) and rate ratios (RR) by neighbourhood material deprivation quintile for each of four 4-year cohorts from 1 April 2002 to 31 March 2018. Log-binomial multivariable regression adjusted for maternal age, demographic and pregnancy-related variables. RESULTS: There were 1 048 845 primiparous births during the study period. The overall rate of SMM was 18.0 per 1000 births. SMM rates were elevated for women living in areas with high material deprivation. In the final 4-year cohort, the RD between women living in high vs low deprivation neighbourhoods was 3.91 SMM cases per 1000 births (95% CI: 2.12 to 5.70). This was higher than the difference observed during the first 4-year cohort (RD 2.09, 95% CI: 0.62 to 3.56). SMM remained associated with neighbourhood material deprivation following multivariable adjustment in the pooled sample (RR 1.16, 95% CI: 1.11 to 1.21). There was no evidence of interaction with maternal age. CONCLUSION: SMM rate increases were more pronounced for primiparous women living in neighbourhoods with high material deprivation compared with those living in low deprivation areas. This raises concerns of a widening social gap in maternal health disparities and highlights an opportunity to focus risk reduction efforts toward disadvantaged women during pregnancy and postpartum. |
format | Online Article Text |
id | pubmed-8496377 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-84963772021-10-22 Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada Snelgrove, John W Lam, Melody Watson, Tristan Richard, Lucie Fell, Deshayne B Murphy, Kellie E Rosella, Laura C BMJ Open Obstetrics and Gynaecology OBJECTIVES: Rates of age-associated severe maternal morbidity (SMM) have increased in Canada, and an association with neighbourhood income is well established. Our aim was to examine SMM trends according to neighbourhood material deprivation quintile, and to assess whether neighbourhood deprivation effects are moderated by maternal age. DESIGN, SETTING AND PARTICIPANTS: A population-based retrospective cohort study using linked administrative databases in Ontario, Canada. We included primiparous women with a live birth or stillbirth at ≥20 weeks’ gestational age. PRIMARY OUTCOME: SMM from pregnancy onset to 42 days postpartum. We calculated SMM rate differences (RD) and rate ratios (RR) by neighbourhood material deprivation quintile for each of four 4-year cohorts from 1 April 2002 to 31 March 2018. Log-binomial multivariable regression adjusted for maternal age, demographic and pregnancy-related variables. RESULTS: There were 1 048 845 primiparous births during the study period. The overall rate of SMM was 18.0 per 1000 births. SMM rates were elevated for women living in areas with high material deprivation. In the final 4-year cohort, the RD between women living in high vs low deprivation neighbourhoods was 3.91 SMM cases per 1000 births (95% CI: 2.12 to 5.70). This was higher than the difference observed during the first 4-year cohort (RD 2.09, 95% CI: 0.62 to 3.56). SMM remained associated with neighbourhood material deprivation following multivariable adjustment in the pooled sample (RR 1.16, 95% CI: 1.11 to 1.21). There was no evidence of interaction with maternal age. CONCLUSION: SMM rate increases were more pronounced for primiparous women living in neighbourhoods with high material deprivation compared with those living in low deprivation areas. This raises concerns of a widening social gap in maternal health disparities and highlights an opportunity to focus risk reduction efforts toward disadvantaged women during pregnancy and postpartum. BMJ Publishing Group 2021-10-06 /pmc/articles/PMC8496377/ /pubmed/34615673 http://dx.doi.org/10.1136/bmjopen-2020-046174 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Obstetrics and Gynaecology Snelgrove, John W Lam, Melody Watson, Tristan Richard, Lucie Fell, Deshayne B Murphy, Kellie E Rosella, Laura C Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title | Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title_full | Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title_fullStr | Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title_full_unstemmed | Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title_short | Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada |
title_sort | neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in ontario, canada |
topic | Obstetrics and Gynaecology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496377/ https://www.ncbi.nlm.nih.gov/pubmed/34615673 http://dx.doi.org/10.1136/bmjopen-2020-046174 |
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