RESUMO
Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.
Assuntos
Cesárea/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mães/estatística & dados numéricos , Adolescente , Adulto , Declaração de Nascimento , Cesárea/tendências , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde , México/epidemiologia , Gravidez , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: While studies have attributed the favourable birth outcomes of Mexico-born mothers in the USA to a 'healthy immigrant effect' that confers protection to immigrants, a comparison of immigrants with the source population in Mexico has been lacking. We compared preterm delivery (PTD) rates of Mexico-born immigrants who delivered in California with Mexico-born women who delivered in Mexico (WIMX) and with a subgroup who delivered in the five top immigrant sending states in Mexico. METHODS: Using 2009 birth records, we selected all live-born singletons of primiparous WIMX (699â 129) and immigrants in California (33â 251). We examined the unadjusted and adjusted association between place of delivery and any PTD (<37â weeks gestation), including PTD subcategories (early, moderate, late), using relative risks (RR) and 95% CIs. Multivariate models controlled for demographic and health system characteristics. RESULTS: PTD rates were higher among immigrants in California (6.7%) than WIMX (5.8%) and compared to women in the sending states (5.5%). The unadjusted risk of any PTD (RR=1.17 (1.12 to 1.22)), early/moderate PTD (<34â weeks gestation; RR=1.27 (1.18 to 1.38)) and late PTD (34-36â weeks; RR=1.14 (1.08 to 1.19)) was higher for immigrants than for WIMX and remained higher when controlling for age, education and healthcare variables. Birth weight <1500â g was also higher among immigrants (RR=1.27 (1.14 to 1.44)). Similar patterns were observed when comparing women in the sending states. CONCLUSIONS: We found no evidence of a 'healthy immigrant effect'. Further research must assess the comparability of gestational-age data in Mexican and Californian birth certificates.
Assuntos
Seguro Saúde/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Nascimento Prematuro/etnologia , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Declaração de Nascimento , California/epidemiologia , Cesárea/estatística & dados numéricos , Estudos Transversais , Escolaridade , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Seguro Saúde/classificação , Idade Materna , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Gravidez , Medição de Risco , Adulto JovemRESUMO
INTRODUCTION: Mexican immigrant status has been associated with decreased obesity, but this pattern may be changing. We draw from 2001-2006 NHANES data on Mexican Americans to examine whether body mass index (BMI) and waist circumference vary by country of birth and among the U.S.-born by language. RESULTS: Among women, U.S.-born Spanish speakers had the highest mean BMI, followed by immigrant women, while U.S.-born English speakers had the lowest mean BMI. Immigrant men had a lower mean BMI than U.S.-born men. These patterns were similar for waist circumference and persisted after adjusting for socioeconomic status (SES) and other covariates. CONCLUSION: Immigrant women do not appear to be protected against a large body size, compared with immigrant men. Among the U.S.-born, women who retain Spanish are at higher risk for larger body size than exclusive English speakers. Initiatives targeting obesity should address differentials in body size patterns among immigrant and U.S.-born Mexican American men and women.
Assuntos
Índice de Massa Corporal , Emigrantes e Imigrantes/estatística & dados numéricos , Idioma , Americanos Mexicanos/estatística & dados numéricos , Circunferência da Cintura/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/etnologia , Fatores de Risco , Classe Social , Estados Unidos/etnologia , Adulto JovemRESUMO
In the US, the majority of deaths and serious complications of pregnancy occur during childbirth and are largely preventable. We conducted a population-based study to assess disparities in maternal health between Mexican-born and Mexican-American women residing in California and to evaluate the extent to which immigrants have better outcomes. Mothers in these two populations deliver 40% of infants in the state. We compared maternal mortality ratios and maternal morbidities during labour and delivery in the two populations using linked 1996-98 hospital discharge and birth certificate data files. For maternal morbidities, we calculated frequencies and observed and adjusted odds (OR) ratios using pre-existing maternal health, sociodemographic characteristics and quality of health care as covariates. Approximately 19% of Mexican-born women suffered a maternal disorder compared with 21% of Mexican-American women (Observed OR = 0.89, [95% CI 0.88, 0.90]). Despite their lower education and relative poverty, Mexican-born women still experienced a lower odds of any maternal morbidity than Mexican-American women, after adjusting for covariates (OR = 0.92, [95% CI 0.90, 0.93]). These findings suggest a paradox of more favourable outcomes among Mexican immigrants similar to that found with birth outcomes. Nevertheless, the positive aggregate outcome of Mexican-born women did not extend to maternal mortality, nor to certain conditions associated with suboptimal intrapartum obstetric care.
Assuntos
Bem-Estar Materno , Americanos Mexicanos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , California/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/normas , Mortalidade Materna , México/etnologia , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etnologia , Gravidez , Complicações na Gravidez/etnologia , Qualidade da Assistência à Saúde/normasRESUMO
OBJECTIVES: To assess maternal health disparities, we compared maternal morbidities during labor and delivery among Mexican-born and US-born White, non-Latina women residing in California. METHODS: This population-based study used linked hospital discharge and birth certificate data for 1996-1998 (862,723 deliveries). We calculated the frequency, and observed and adjusted odds ratios for obstetric complications. Covariates included maternal age, parity, education, prenatal care initiation and payment source, and hospital quality of care. RESULTS: Approximately 1 in 5 deliveries resulted in a obstetric complication. After control for covariates, Mexican-born women were significantly less likely to have 1 or more maternal morbidities than White, non-Latina women but more likely to have complications that reflect the quality of intrapartum care. CONCLUSIONS: Maternal morbidities during labor and delivery are a substantial burden for women in California. The favorable overall outcome of Mexican-born women over US-born White, non-Latinas is surprising given their lower educational attainment, relative poverty, and greater barriers to health care access. The favorable outcomes obscure vulnerabilities in those complications that are sensitive to the quality of intrapartum care.