In low-income neighbourhoods, babies of immigrant parents are born healthier: study

Jennifer Tano holds her son Thomas in the neonatal intensive care unit of Mount Sinai Hospital in Toronto on Wednesday, Sept. 11, 2013. Thomas was born premature at 27 weeks gestation. THE CANADIAN PRESS/Galit Rodan

In Ontario's poorest neighbourhoods, newborns of non-refugee immigrant mothers face a lower risk of serious illness and death than those born to Canadian-born mothers, according to a study published in the Canadian Medical Association Journal on Monday.

Both immigration status and living in a low-income neighbourhood are associated with worse outcomes for newborns, write researchers from the University of Toronto, two Toronto hospitals, the Institute for Clinical Evaluative Sciences and the University of North Carolina-Chapel Hill.

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However, while previous research has looked at the risk of adverse outcomes for newborns in low- versus high-income neighbourhoods, the study's authors said it has overlooked the comparative risks for babies born to immigrant and non-immigrant parents living in similar low-income neighbourhoods.

"Efforts should be aimed at improving the overall health and well-being of all females residing in low-income areas, and at determining if the risk of adverse birth outcomes can be equitably reduced among immigrant and non-immigrant groups," wrote co-author Jennifer Jairam.

To compare the risk of severe neonatal illness and death in immigrant- and non-immigrant-born infants, researchers looked at data on all live, in-hospital births of single babies from 20 to 42 weeks' gestation between 2002 and 2019 in Ontario.

Ontario, they wrote, is the landing place for about 53 per cent of all female immigrants who enter Canada.

They measured severe neonatal illness or disease by looking at breathing support, intravenous fluid use, birth before 32 weeks' gestation, very low birth weight and respiratory distress.

During the study period, there were 414,241 single babies born to 312,124 mothers aged 15 years and older living in low-income urban neighbourhoods. Of all the live births during this period, 148,050 were to mothers who had immigrated to Canada, and 266,191 to Canadian-born mothers. Most of the mothers who immigrated to Canada came from South Asia and the East Asia and Pacific regions and had lived in Ontario for less than 10 years.

Jairam and her team found the risk of severe neonatal illness and death for newborns of mothers who had immigrated to Canada was significantly lower than for newborns of Canadian-born mothers, at 49.7 per 1,000 live births compared with 65.6 per 1,000 live births.

However, they said that risk varied depending on the country of origin, with a higher risk of severe neonatal illness and death in newborns of immigrants from Jamaica and Ghana, and in those who had lived for a greater length of time in Ontario.

THE 'HEALTHY IMMIGRANT EFFECT'

Rather than suggesting immigrant mothers and their newborns receive better care in Ontario than Canadian-born mothers and babies, the authors believe their findings might be explained by the "healthy immigrant" effect.

"Immigrant females who are healthier and more resilient may be most capable of migration; the immigration policy of a host country may preferentially select healthy immigrants," wrote Dr. Joel Ray, a physician at St. Michael's Hospital and one of the study's co-authors, adding that, paradoxically, immigrants face greater barriers to health care access.

According to the researchers, the "healthy immigrant" effect wanes relative to the length of time an immigrant spends living in a new country.

Another explanation the researchers suggested is some immigrants have greater net income, educational achievement and health literacy than the average for a low-income neighbourhood.

Either way, Jairam, Ray and their co-authors said the study underscores the importance of paying attention to trends at the neighbourhood level so pregnant parents and babies in low-income communities can hope for better health outcomes.