Access to Emergency Rooms of Italian and foreign women for conditions and complications related to pregnancy and reproduction: the case of five hospitals in Rome, Italy, 1999-2014

Background: Obstetric complications, including those that narrowly avoid death, the Maternal Near Miss (MNM), are an issue of concern for immigrant women. The objective of this study was to describe immigrant women’s access for these complications to emergency rooms (ERs) in Rome, Italy. Methods: Data on access to ERs in five large hospitals from 1999 to 2014 were collected. Foreign patients were divided into 23 foreign patient groups (FPGs). A Poisson regression model was used to estimate the incidence rate ratios (IRRs) of the various groups for: complications of pregnancy (CP, ICD9-CM 11); circumstances related to reproduction (CRR, ICD9-CM V20-29); MNM (for this model we collapsed non-EU citizens together due to the low incidence of this condition). Results: 7.4% of the 2,668,537 women’s accesses to ERs led to a diagnosis of CP, and 4.1% of CRR. The FPGs with higher percentage of diagnoses were: Southern Asia (22.8%), Eastern Asia (19.9%) and South-Eastern Asia (16.6%) for CP; Southern Asia (12.9%), Middle Africa (8.9%) and Romania (8%) for CRR. Almost all FPGs had a higher risk than Italians of having a CP or CRR diagnosis, with the exception of Southern Africa, Northern America, Australia and New Zealand and stateless. Globally, non-EU citizens showed a higher risk of having an MNM than Italians (IRR:2.20; 95% CI: 1.50-3.24). Conclusion: The higher risk of all the FPGs - excluding those probably composed mostly by tourists - of a CP, CRR or MNM 66 European Journal of Public Health,Vol. 28, Supplement 1, 2018 Downloaded from https://academic.oup.com/eurpub/article-abstract/28/suppl_1/cky096/4994353 by Sapienza Università di Roma user on 11 July 2018 diagnosis underlines the need of interventions aimed at improving the access of immigrant women to prenatal care services. Main messages: The increased risk of a CP or CRR diagnosis concerning almost all the FPGs, suggests a deficiency in the delivery of prenatal care services to immigrant women. The access of immigrant women to prenatal care services should be improved by tailored health policy interventions