ArticleBMJ open2021
Neighbourhood material deprivation and severe maternal morbidity: a population-based cohort study in Ontario, Canada.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Article
- Exploring prenatal care experiences in Ontario, Canada: An equity-oriented qualitative study.PloS one · 2026Article
- Effect of disability, homelessness, and neighborhood marginalization on risk adjustment for hospital performance measurement.American journal of epidemiology · 2025Article
- Neighborhood-level fatal police violence and severe maternal morbidity in California.American journal of epidemiology · 2024Article
- Associations between neighbourhood deprivation, ethnicity and maternal health outcomes in England: a nationwide cohort study using routinely collected healthcare data.Journal of epidemiology and community health · 2024Article
- Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada.JAMA network open · 2023Article
- Article
- Racial/ethnic disparities in severe maternal morbidity: An intersectional lifecourse approach.Annals of the New York Academy of Sciences · 2022Article
- Preeclampsia and Severe Maternal Morbidity During the COVID-19 Pandemic: A Population-Based Cohort Study in Ontario, Canada.Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 2022Article
- A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality.Children (Basel, Switzerland) · 2022Review
- Informing Equity-Oriented Approaches to Postpartum Care Following Severe Maternal Morbidity Events: A Qualitative Descriptive Study Protocol.Global qualitative nursing researchArticle
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesRates 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
participantsA 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.
resultsThere 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.
conclusionSMM 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.
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