Discrimination and Romani health: a validation study of discrimination scales among Romani women in Macedonia and Serbia.

OBJECTIVES: Scales used to assess discrimination in public health research have rarely been validated outside of high income countries. Our objective was to validate the Experiences of Discrimination (EOD) scale and the Everyday Discrimination Scale (EDS) among 410 Romani women in Macedonia and Serbia. METHODS: Romani female interviewers conducted interviews in 2012-2013. We used a multiple indicator multiple cause approach to test a one-factor model for each scale and to assess differential item functioning (DIF) by age, wealth, country, and education. We also measured associations between the EOD and EDS with smoking in the past year and psychological distress. RESULTS: Three items of the EOD were conceptually irrelevant. Two items of the EDS were not conditionally independent. DIF was found by country for one item in each scale. After excluding these items, all scales exhibited good model fit and were associated with smoking (EOD beta = 0.40, 95% CI = 0.18, 0.63; EDS beta = 0.33, 95% CI = 0.12, 0.54) and psychological distress (EOD beta = 0.26, 95% CI = 0.15, 0.37; EDS beta = 0.26, 95% CI = 0.04, 0.47). CONCLUSIONS: Discrimination scales can be adapted for use among Romani women and are associated with both smoking and psychological distress.

Ethnic enclaves and gestational diabetes among immigrant women in New York City.

Previous research has shown that immigrants living in their own ethnic enclave are at decreased risk of poor health outcomes, but this question has not been studied in relation to gestational diabetes, an important early marker of lifecourse cardiovascular health. We ascertained gestational diabetes, census tract of residence, and individual-level covariates for Sub-Saharan African, Chinese, South Central Asian, Non-Hispanic Caribbean, Dominican, Puerto Rican, Mexican, and Central and South American migrant women using linked birth-hospital discharge data for 89,703 singleton live births in New York City for the years 2001-2002. Using 2000 census data, for each immigrant group we defined a given census tract as part of an ethnic enclave based on the population distribution for the corresponding ethnic group. We estimated odds ratios for associations between living in an ethnic enclave and risk of gestational diabetes adjusted for neighborhood deprivation, percent commercial space, education, age, parity, and insurance status, using multilevel logistic regression. Overall, we found no effect of ethnic enclave residence on gestational diabetes in most immigrant groups. Among South Central Asian and Mexican women, living in a residential ethnic enclave was associated with an increased odds of gestational diabetes. Several explanations are proposed for these findings. Mechanisms explaining an increased risk of gestational diabetes in South Central Asian and Mexican ethnic enclaves should be examined.

Disparities in pre-eclampsia and eclampsia among immigrant women giving birth in six industrialised countries.

OBJECTIVE: To assess disparities in pre-eclampsia and eclampsia among immigrant women from various world regions giving birth in six industrialised countries. DESIGN: Cross-country comparative study of linked population-based databases. SETTING: Provincial or regional obstetric delivery data from Australia, Canada, Spain and the USA and national data from Denmark and Sweden. POPULATION: All immigrant and non-immigrant women delivering in the six industrialised countries within the most recent 10-year period available to each participating centre (1995-2010). METHODS: Data was collected using standardised definitions of the outcomes and maternal regions of birth. Pooled data were analysed with multilevel models. Within-country analyses used stratified logistic regression to obtain odds ratios (OR) with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Pre-eclampsia, eclampsia and pre-eclampsia with prolonged hospitalisation (cases per 1000 deliveries). RESULTS: There were 9,028,802 deliveries (3,031,399 to immigrant women). Compared with immigrants from Western Europe, immigrants from Sub-Saharan Africa and Latin America & the Caribbean were at higher risk of pre-eclampsia (OR: 1.72; 95% CI: 1.63, 1.80 and 1.63; 95% CI: 1.57, 1.69) and eclampsia (OR: 2.12; 95% CI: 1.61, 2.79 and 1.55; 95% CI: 1.26, 1. 91), respectively, after adjustment for parity, maternal age and destination country. Compared with native-born women, European and East Asian immigrants were at lower risk in most industrialised countries. Spain exhibited the largest disparities and Australia the smallest. CONCLUSION: Immigrant women from Sub-Saharan Africa and Latin America & the Caribbean require increased surveillance due to a consistently high risk of pre-eclampsia and eclampsia.

Disparities in cesarean delivery by ethnicity and nativity in New York city.

Our objective was to examine differences in risk of cesarean delivery among diverse ethnic groups in New York City. Using cross-sectional New York City birth and hospitalization data from 1995 to 2003 (n = 961,381) we estimated risk ratios for ethnic groups relative to non-Hispanic whites and immigrant women relative to US-born women. Adjusting for insurance, pre-pregnancy weight, maternal age, education, parity, birthweight, gestational age, year, medical complications, and pregnancy complications, all ethnic groups except East Asian women were at an increased risk of cesarean delivery, with the highest risk among Hispanic Caribbean women [adjusted risk ratio (aRR) = 1.27, 95 % CI (confidence interval) = 1.24, 1.30] and African American women (aRR = 1.20, 95 % CI = 1.17, 1.23). Among Hispanic groups, immigrant status further increased adjusted risk of cesarean delivery; adjusted risk ratios for foreign-born women compared to US-born women of the same ethnic group were 1.27 for Mexican women (95 % CI = 1.05, 1.53), 1.23 for Hispanic Caribbean women (95 % CI = 1.20, 1.27), and 1.12 for Central/South American women (95 % CI = 1.04, 1.21). Similar patterns were found in subgroup analyses of low-risk women (term delivery and no pregnancy or medical complications) and primiparous women. We found evidence of disparities by ethnicity and nativity in cesarean delivery rates after adjusting for multiple risk factors. Efforts to reduce rates of cesarean delivery should address these disparities. Future research should explore potential explanations including hospital environment, provider bias, and patient preference.

Maternal education and adverse birth outcomes among immigrant women to the United States from Eastern Europe: a test of the healthy migrant hypothesis.

Immigrant women to the U.S. often have more favorable birth outcomes than their native-born counterparts, including lower rates of preterm birth and low birth weight, a phenomenon commonly attributed to a healthy migrant effect. However, this effect varies by ethnicity and country of origin. No previous study has examined birth outcomes among immigrants from the post-Communist countries of Eastern Europe, a group which includes both economic migrants and conflict refugees. Using data on 253,363 singletons births from New York City during 1995-2003 we examined the risk of preterm birth (PTB) (<37 weeks) or delivering a term small-for-gestational-age (SGA) infant among immigrants from Russia and Ukraine (RU), Poland, and former Yugoslavia Republics (FYR) relative to US-born non-Hispanic whites (NHW). Women in all three Eastern European groups had significantly later entry into prenatal care, were more likely to be Medicaid recipients, and had lower educational attainment than US-born NHW. In binomial regression analyses adjusting for age, education, parity, and pre-pregnancy weight, women from RU and FYR had lower risk of PTB than US-born NHW, whereas women from Poland had similar risk. Lower SGA risk was found among women from Poland and FYR, but not RU. When stratified by education, women with <12 years of education from all Eastern European groups had a reduced risk of PTB relative to US-born NHW. An educational gradient in PTB and SGA risk was less pronounced in all Eastern European groups compared to US-born NHW. The healthy migrant effect is present among immigrants from Eastern Europe to the U.S., especially among women with less education and those from the former Yugoslavia, a group that included many conflict refugees.

Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups.

PURPOSE: Living in a socioeconomically deprived neighborhood has been associated with an increased risk of adverse birth outcomes. However, variation in the effect of neighborhood deprivation among diverse ethnic groups has not been studied. METHODS: Using linked hospital discharge and birth data for 517,994 singleton live births in New York City from 1998 through 2002, we examined the association between neighborhood deprivation, preterm birth (PTB), and term low birthweight (TLBW) (>or=37 weeks and <2500g). Adjusted odds ratios (aORs) for PTB (<32 and 33-36 weeks) and TLBW were estimated using logistic regression. RESULTS: The aOR for PTB of less than 32 weeks for the highest quartile of deprivation compared to the lowest was 1.24 (95% confidence limit [CL] = 1.13, 1.36), for PTB 33-36 weeks was 1.06 (95% CL = 1.01, 1.11), and for TLBW was 1.19 (95% CL = 1.11, 1.27). Measures of association varied by ethnicity; aORs of the greatest magnitude for PTB were found among Hispanic Caribbean women (PTB < 32 weeks: aOR = 1.63, 95% CL = 1.27, 2.10; PTB 33-36 weeks: aOR = 1.32, 95% CL = 1.02, 1.70), and for TLBW among African women (aOR = 1.47, 95% CL = 1.02, 2.13). CONCLUSIONS: The mechanisms linking neighborhood deprivation to adverse birth outcomes may differ depending on individual ethnicity and/or cultural context and should be investigated in future research.

Ethnicity and gestational diabetes in New York City, 1995-2003.

OBJECTIVE: To characterise the patterns of occurrence of gestational diabetes among a wide range of ethnic groups that reside in New York City. DESIGN: Birth records and hospital discharge data were linked to more accurately assess the risk of gestational diabetes by ethnicity, compare risk in US-born to foreign-born women, and assess time trends. SETTING: New York City. POPULATION: All singleton live births occurring between 1995 and 2003. METHODS: Multivariable binomial regression analysis of ethnicity and gestational diabetes, yielding adjusted risk ratios with non-Hispanic white women as the referent. MAIN OUTCOME MEASURE: Diagnosis of gestational diabetes on birth certificate or in hospital discharge. RESULTS: Adjusted relative risks (aRRs) were modestly elevated for African-Americans and sub-Saharan Africans and somewhat higher (<2.0) for non-Hispanic Caribbeans, Hispanic Caribbeans, Central Americans, and South Americans. The aRR was 4.7 (95% CI = 4.6-4.9) for South Central Asians (with an absolute gestational diabetes risk of 14.3%), 2.8 (95% CI = 2.7-3.0) among South-East Asian and Pacific Islanders, and 2.3 (95% CI = 2.2-2.4) among East Asians. Among South Central Asians, the greatest risks were found for women from Bangladesh (aRR = 7.1, 95% CI = 6.8-7.3). Foreign-born women consistently had higher risk than US-born women. Risk for gestational diabetes increased over time among South Central Asians, some Hispanic groups, and African-Americans. CONCLUSIONS: Risk of gestational diabetes appears to vary markedly among ethnic groups, subject to potential artefacts associated with screening and diagnosis. These differences would have direct implications for health care and may suggest aetiologic hypotheses.