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Brown HK, Saunders N, Chen S, Leslie K, Vigod SN, Fung K, Guttmann A, Havercamp SM, Parish SL, Ray JG, Lunsky Y. Disability and Interpersonal Violence in the Perinatal Period. Obstet Gynecol 2022; 140:797-805. [PMID: 36201763 PMCID: PMC9588770 DOI: 10.1097/aog.0000000000004950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the risk of interpersonal violence experienced by pregnant and postpartum individuals with physical disabilities, sensory disabilities, or intellectual or developmental disabilities with those without disabilities, and to examine whether a prepregnancy history of interpersonal violence puts individuals with disabilities, at excess risk of interpersonal violence in the perinatal period. METHOD This population-based study included all individuals aged 15-49 years with births in Ontario, Canada, from 2004 to 2019. Individuals with physical (n=147,414), sensory (n=47,459), intellectual or developmental (n=2,557), or multiple disabilities (n=9,598) were compared with 1,594,441 individuals without disabilities. The outcome was any emergency department visit, hospital admission, or death related to physical, sexual, or psychological violence between fertilization and 365 days postpartum. Relative risks (RRs) were adjusted for baseline social and health characteristics. Relative excess risk due to interaction (RERI) was estimated from the joint effects of disability and prepregnancy violence history; RERI>0 indicated positive interaction. RESULTS Individuals with physical (0.8%), sensory (0.7%), intellectual or developmental (5.3%), or multiple disabilities (1.8%) were more likely than those without disabilities (0.5%) to experience perinatal interpersonal violence. The adjusted RR was 1.40 (95% CI 1.31-1.50) in those with physical disabilities, 2.39 (95% CI 1.98-2.88) in those with intellectual or developmental disabilities, and 1.96 (95% CI 1.66-2.30) in those with multiple disabilities. Having both a disability and any violence history produced a positive interaction for perinatal interpersonal violence (adjusted RERI 0.87; 95% CI 0.47-1.29). CONCLUSION The perinatal period is a time of relative high risk for interpersonal violence among individuals with pre-existing disabilities, especially those with a history of interpersonal violence.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - Natasha Saunders
- ICES, Toronto, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Kelly Leslie
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Simone N. Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- ICES, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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Brown HK, Chen S, Guttmann A, Havercamp SM, Parish S, Ray JG, Vigod SN, Tarasoff LA, Lunsky Y. Neonatal Outcomes of Mothers With a Disability. Pediatrics 2022; 150:e2021055318. [PMID: 35934737 PMCID: PMC9694113 DOI: 10.1542/peds.2021-055318] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the risk of neonatal complications among women with a disability. METHODS This population-based cohort study comprised all hospital singleton livebirths in Ontario, Canada from 2003 to 2018. Newborns of women with a physical (N = 144 187), sensory (N = 44 988), intellectual or developmental (N = 2207), or ≥2 disabilities (N = 8823) were each compared with 1 593 354 newborns of women without a disability. Outcomes were preterm birth <37 and <34 weeks, small for gestational age birth weight (SGA), large for gestational age birth weight, neonatal morbidity, and mortality, neonatal abstinence syndrome (NAS), and NICU admission. Relative risks were adjusted for social, health, and health care characteristics. RESULTS Risks for neonatal complications were elevated among newborns of women with disabilities compared with those without disabilities. Adjusted relative risks were especially high for newborns of women with an intellectual or developmental disability, including preterm birth <37 weeks (1.37, 95% confidence interval 1.19-1.58), SGA (1.37, 1.24-1.59), neonatal morbidity (1.42, 1.27-1.60), NAS (1.53, 1.12-2.08), and NICU admission (1.53, 1.40-1.67). The same was seen for newborns of women with ≥2 disabilities, including preterm birth <37 weeks (1.48, 1.39-1.59), SGA (1.13, 1.07-1.20), neonatal morbidity (1.28, 1.20-1.36), NAS (1.87, 1.57-2.23), and NICU admission (1.35, 1.29-1.42). CONCLUSIONS There is a mild to moderate elevated risk for complications among newborns of women with disabilities. These women may need adapted and enhanced preconception and prenatal care, and their newborns may require extra support after birth.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Astrid Guttmann
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin HS Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan M. Havercamp
- Center for Psychiatry and Behavioral Health, Wexner Medical Center, Ohio State University, Columbus, Ohio, United States
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Joel G. Ray
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lesley A. Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Yona Lunsky
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
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Brown HK, Saha S, Chan TCY, Cheung AM, Fralick M, Ghassemi M, Herridge M, Kwan J, Rawal S, Rosella L, Tang T, Weinerman A, Lunsky Y, Razak F, Verma AA. Outcomes in patients with and without disability admitted to hospital with COVID-19: a retrospective cohort study. CMAJ 2022; 194:E112-E121. [PMID: 35101870 PMCID: PMC8900770 DOI: 10.1503/cmaj.211277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods: We conducted a retrospective cohort study that included adults with COVID-19 who were admitted to hospital and discharged between Jan. 1, 2020, and Nov. 30, 2020, at 7 hospitals in Ontario, Canada. We compared in-hospital death, admission to the intensive care unit (ICU), hospital length of stay and unplanned 30-day readmission among patients with and without a physical disability, hearing or vision impairment, traumatic brain injury, or intellectual or developmental disability, overall and stratified by age (≤ 64 and ≥ 65 yr) using multivariable regression, controlling for sex, residence in a long-term care facility and comorbidity. Results: Among 1279 admissions to hospital for COVID-19, 22.3% had a disability. We found that patients with a disability were more likely to die than those without a disability (28.1% v. 17.6%), had longer hospital stays (median 13.9 v. 7.8 d) and more readmissions (17.6% v. 7.9%), but had lower ICU admission rates (22.5% v. 28.3%). After adjustment, there were no statistically significant differences between those with and without disabilities for in-hospital death or admission to ICU. After adjustment, patients with a disability had longer hospital stays (rate ratio 1.36, 95% confidence interval [CI] 1.19–1.56) and greater risk of readmission (relative risk 1.77, 95% CI 1.14–2.75). In age-stratified analyses, we observed longer hospital stays among patients with a disability than in those without, in both younger and older subgroups; readmission risk was driven by younger patients with a disability. Interpretation: Patients with a disability who were admitted to hospital with COVID-19 had longer stays and elevated readmission risk than those without disabilities. Disability-related needs should be addressed to support these patients in hospital and after discharge.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Sudipta Saha
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Timothy C Y Chan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Angela M Cheung
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Michael Fralick
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Marzyeh Ghassemi
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Margaret Herridge
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Janice Kwan
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Shail Rawal
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Laura Rosella
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Terence Tang
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Adina Weinerman
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Yona Lunsky
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Fahad Razak
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont
| | - Amol A Verma
- Department of Health and Society (Brown), University of Toronto Scarborough, Scarborough, Ont.; Li Ka Shing Knowledge Institute (Saha, Chan, Razak, Verma), St. Michael's Hospital; Dalla Lana School of Public Health (Brown, Rosella), Departments of Mechanical and Industrial Engineering (Chan), Medicine (Cheung, Fralick, Herridge, Kwan, Rawal, Tang, Weinerman, Razak, Verma), Computer Science (Ghassemi) and Psychiatry (Lunsky), University of Toronto; Department of Medicine (Cheung, Fralick, Rawal), Sinai Health System; Vector Institute (Ghassemi), Toronto General Hospital; Department of Medicine (Herridge, Cheung), University Health Network; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Azrieli Adult Neurodevelopmental Centre (Lunsky), Centre for Addiction & Mental Health; Department of Medicine (Razak, Verma), Unity Health Toronto, Toronto, Ont.; Institute for Better Health (Rosella, Tang), Trillium Health Partners, Mississauga, Ont.
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Tarasoff LA, Lunsky Y, Chen S, Guttmann A, Havercamp SM, Parish SL, Vigod SN, Carty A, Brown HK. Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study. J Womens Health (Larchmt) 2020; 29:1564-1575. [PMID: 32678692 DOI: 10.1089/jwh.2019.8273] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. Materials and Methods: We conducted a population-based cross-sectional study of 15- to 44-year-old women with physical (n = 253,184), sensory (n = 93,170), intellectual/developmental (n = 8,986), and multiple disabilities (n = 29,868), and women without these disabilities (n = 2,307,822) using Ontario health administrative data (2017-2018). We described preconception health variables related to social determinants of health, physical health status, psychosocial well-being, history of assault, medication use, and continuity of primary care and compared women with and without disabilities in crude and age-standardized analyses, with standardized differences >0.10 indicating clinically meaningful results. Results: Women with physical, sensory, intellectual/developmental, and multiple disabilities had poorer preconception health than women without disabilities. Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. Conclusion: Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.
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Affiliation(s)
- Lesley A Tarasoff
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | | | - Astrid Guttmann
- ICES, Toronto, Canada.,Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
| | - Adele Carty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.,ICES, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Women's College Hospital and Research Institute, Toronto, Canada
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