Comparing pregnancy outcomes of immigrants from Ethiopia and the former Soviet Union to Israel to those of native-born Israelis
Pregnancy outcomes of two immigrant groups to Israel, from Europe and Africa, were compared those of native-born Israelis, in a context of universal health insurance and equal access to perinatal services.
METHODS:
The data source was the computerized perinatal database of Soroka University Medical Center, the regional hospital, where most births in southern Israel occur. All singleton deliveries in the years 1988-2011 of immigrants from Ethiopia (n=1,667) and Former-USSR (n=12,920) who began their childbearing in Israel were compared with those of Israeli-born women (n=63,405). Primary outcomes were: preterm delivery (<37 weeks gestation) (PTD) and perinatal mortality (PM). Generalized equation estimation (GEE) multivariable models were used to adjust for potential confounders.
RESULTS:
PTD rates of immigrants from Ethiopia and former-USSR were similar to those of Israeli-born (8.7%, 7.5% and 7.5% respectively), but both immigrant groups had significantly (p<0.001) higher rates of PM than Israeli-born (21/1000 in the Ethiopian group, and 11/1000 in the Former-USSR group, compared to 9/1000). When adjusted for lack of antenatal care, out-of-hospital births, preterm, and extremes of maternal age, both immigrant groups, compared to Israeli-born, had significantly increased risk for perinatal mortality; however, the relative risk associated with Ethiopian origin was about twice that associated with former-USSR origin (OR=2.349, 95%CI: 1.609; 3.429, and OR=1.303, 95%CI: 1.067; 1.592, respectively).
CONCLUSIONS:
Universal health care insurance and equal access to perinatal services do not eliminate gaps in perinatal mortality between immigrants and native-born nor do they eliminate differences between immigrants from Africa and Europe.