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Author
J.J. Zwart
M.D. Jonkers
A. Richters
F. Öry
K.W. Bloemenkamp
J.J. Duvekot
J. van Roosmalen
Year
2011
Title
Ethnic disparity in severe acute maternal morbidity: a nationwide cohort study in the Netherlands
Journal
European Journal of Public Health
Volume | Issue number
21 | 2
Pages (from-to)
229-234
Document type
Article
Faculty
Faculty of Social and Behavioural Sciences (FMG)
Institute
Amsterdam Institute for Social Science Research (AISSR)
Abstract
Background: There are concerns about ethnic disparity in outcome of obstetric health care in high-income countries. Our aim was to assess these differences in a large cohort of women having experienced severe acute maternal morbidity (SAMM) during pregnancy, delivery and puerperium.

Methods: All women experiencing SAMM were prospectively collected in a nationwide population-based design from August 2004 to August 2006. Women delivering in the same period served as reference cohort. Population-based risks were calculated by ethnicity and by type of morbidity. Additionally, non-Western and Western women having experienced SAMM were compared in multivariable logistic regression analysis.

Results: All 98 Dutch maternity units participated. There were 371 021 deliveries during the study period. A total of 2506 women with SAMM were included, 21.1% of whom were non-Western immigrants. Non-Western immigrants showed a 1.3-fold [95% confidence interval (CI) 1.2-1.5] increased risk to develop SAMM. Large differences were observed among different ethnic minority groups, ranging from a non-increased risk for Moroccan and Turkish women to a 3.5-fold (95% CI 2.8-4.3) increased risk for sub-Saharan African women. Low socio-economic status, unemployment, single household, high parity and prior caesarean were independent explanatory factors for SAMM, although they did not fully explain the differences. Immigration-related characteristics differed by ethnic background.

Conclusions: Non-Western immigrants have an increased risk of developing SAMM as compared to Western women. Risks varied largely by ethnic origin. Immigration-related characteristics might partly explain the increased risk. The results suggest that there are opportunities for quality improvement by targeting specific disadvantaged groups.
URL
go to publisher's site
Language
English
Permalink
http://hdl.handle.net/11245/1.333665

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