• Jennifer A Jairam, Simone N Vigod, Arjumand Siddiqi, Jun Guan, Alexa Boblitz, Xuesong Wang, Patricia O'Campo, and Joel G Ray.
• Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont.
• CMAJ. 2023 Apr 17; 195 (15): E537E547E537-E547.

BackgroundLiving in low-income neighbourhoods and being an immigrant are each independently associated with adverse neonatal outcomes, but it is unknown if disparities exist in the neonatal period for children of immigrant and nonimmigrant females living in low-income areas. We sought to compare the risk of severe neonatal morbidity and mortality (SNMM) between newborns of immigrant and nonimmigrant mothers who resided in low-income neighbourhoods.MethodsThis population-based cohort study used administrative data for females residing in low-income urban neighbourhoods in Ontario, who had an in-hospital, singleton live birth at 20-42 weeks' gestation, from 2002 to 2019. We defined immigrant status as nonrefugee immigrant or nonimmigrant, further detailed by country of birth and duration of residence in Ontario. The primary outcome was a SNMM composite (with 16 diagnoses, including neonatal death and 7 neonatal procedures as indicators), arising within 0-27 days after birth. We estimated relative risks (RRs) and 95% confidence intervals (CIs) using modified Poisson regression with generalized estimating equations.ResultsOur cohort included 148 050 and 266 191 live births among immigrant and nonimmigrant mothers, respectively. Compared with newborns of non-immigrant females, SNMM was less frequent among newborns of immigrant females (49.7 v. 65.6 per 1000 live births), with an adjusted RR of 0.76 (95% CI 0.74 to 0.79). The most frequent SNMM indicator was receipt of ventilatory support. Relative to neonates of nonimmigrant females, the risk of SNMM was highest among those of immigrants from Jamaica (adjusted RR 1.14, 95% CI 1.05 to 1.23) and Ghana (adjusted RR 1.20, 95% CI 1.05 to 1.38), and lowest among those of immigrants from China (adjusted RR 0.44, 95% CI 0.40 to 0.48). Among immigrants, the risk of SNMM declined with shorter duration of residence before the index birth.InterpretationWithin low-income urban areas, newborns of immigrant females had an overall lower risk of SNMM than those of nonimmigrant females, with considerable variation by maternal birthplace and duration of residence. Initiatives should focus on improving preconception health and perinatal care within subgroups of females residing in low-income neighbourhoods.© 2023 CMA Impact Inc. or its licensors.

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