{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T04:18:47Z","timestamp":1787545127807,"version":"build-2736575974"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n This study examined the association between maternal immigrant status and survival of children with congenital heart diseases (CHD) in Ontario, Canada.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective population\u2010based cohort study of hospital live births between April 2002 to September 2020 in Ontario, Canada was conducted at the Institute for Clinical Evaluative Sciences. Multilevel Cox hazard regression models generated hazard ratios (HR) for the association between maternal immigrant status and child death while accounting for hospitals as a cluster factor and adjusting for maternal age at birth, neighborhood income and education quintiles, comorbidities, a composite of severe maternal morbidity, gestational age at birth, birth weight, infant sex and residential rurality among all CHD, severe CHD or single ventricle patients.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among children with any CHD, relative to children born to nonimmigrants, the adjusted HR was 1.17 (95% CI: 1.06\u20131.30) in children born to nonrefugee immigrants, and 1.33 (95% CI: 1.07\u20131.65) in those born to refugees. Similar patterns were observed in children with severe CHD, particularly within the single ventricle CHD subcohort, where the adjusted HR for children born to refugees was 2.01 (95% CI: 1.5\u20132.7) relative to those born to nonimmigrants.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Health policy decision\u2010makers should prioritize understanding the underlying causes of mortality in these populations to reduce health inequities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/bdr2.70056","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T07:59:58Z","timestamp":1780127998000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Immigrant Status and Mortality in Children With Congenital Heart Disease: A Population\u2010Based Cohort Study"],"prefix":"10.1002","volume":"118","author":[{"given":"Qun","family":"Miao","sequence":"first","affiliation":[{"name":"Better Outcomes Registry & Network (BORN) Ontario Ottawa Ontario Canada"},{"name":"Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada"},{"name":"School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra I.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry & Network (BORN) Ontario Ottawa Ontario Canada"},{"name":"Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada"},{"name":"School of Nursing University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi Wu","family":"Wen","sequence":"additional","affiliation":[{"name":"School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute Ottawa Ontario Canada"},{"name":"Department of Obstetrics & Gynecology Faculty of Medicine, University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Lougheed","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada"},{"name":"Department of Cardiology, Children's Hospital of Eastern Ontario Ottawa Ontario Canada"},{"name":"Department of Pediatrics Faculty of Medicine, University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Griffiths","sequence":"additional","affiliation":[{"name":"ICES Queen's Queen's University Kingston Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Lavin","family":"Venegas","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry & Network (BORN) Ontario Ottawa Ontario Canada"},{"name":"Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria P.","family":"Velez","sequence":"additional","affiliation":[{"name":"ICES Queen's Queen's University Kingston Ontario Canada"},{"name":"Department of Obstetrics and Gynaecology McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Walker","sequence":"additional","affiliation":[{"name":"Better Outcomes Registry & Network (BORN) Ontario Ottawa Ontario Canada"},{"name":"Children's Hospital of Eastern Ontario Research Institute Ottawa Ontario Canada"},{"name":"School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada"},{"name":"OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute Ottawa Ontario Canada"},{"name":"Department of Obstetrics & Gynecology Faculty of Medicine, University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2025.1517669"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12564"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.124.3.803"},{"key":"e_1_2_15_5_1","unstructured":"CDC.2024.\u201cCongenital Heart Defects (CHDs). Data and Statistics\u201d[cited 2025 Aug 7].https:\/\/www.cdc.gov\/heart\u2010defects\/data\/index.html."},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.10.033"},{"key":"e_1_2_15_7_1","unstructured":"CIHI.2025.\u201cNational Ambulatory Care Reporting System (NACRS) Metadata | CIHI [Internet].\u201dhttps:\/\/www.cihi.ca\/en\/national\u2010ambulatory\u2010care\u2010reporting\u2010system\u2010nacrs\u2010metadata."},{"key":"e_1_2_15_8_1","unstructured":"CIHI.2025.Discharge Abstract Database. 2025. Discharge Abstract Database (DAD) Metadata | CIHI [Internet].\u201dhttps:\/\/www.cihi.ca\/en\/discharge\u2010abstract\u2010database\u2010dad\u2010metadata."},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-053793"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-13"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2013-028"},{"key":"e_1_2_15_12_1","unstructured":"ICES.2025.\u201cICES | Use ICES Data | Data Dictionary [Internet].\u201dICES.https:\/\/www.ices.on.ca\/use\u2010ices\u2010data\/data\u2010dictionary\/."},{"key":"e_1_2_15_13_1","unstructured":"Immigration and Citizenship Canada.2024. \u201cStatistics and Open Data [Internet].\u201d [cited 2025 Aug 14].https:\/\/www.canada.ca\/en\/immigration\u2010refugees\u2010citizenship\/corporate\/reports\u2010statistics\/statistics\u2010open\u2010data.html."},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-315505"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-020-03512-8"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-051020"},{"key":"e_1_2_15_17_1","volume-title":"Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report","author":"PHAC","year":"2013"},{"key":"e_1_2_15_18_1","unstructured":"PHAC.2025.Congenital Anomalies in Canada\u2014Canada.ca [Internet].[cited 2025 Aug 7].https:\/\/health\u2010infobase.canada.ca\/congenital\u2010anomalies\/Index."},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s43032-022-00871-9"},{"key":"e_1_2_15_20_1","first-page":"1","article-title":"Refugee and Asylum Seekers in Canada: Barriers to Health Care Services","volume":"9","author":"Saberpor T.","year":"2016","journal-title":"Glendon Journal of International Studies [Internet]"},{"key":"e_1_2_15_21_1","volume-title":"SAS Help Center: SAS\/SHARE 9.4: User's Guide [Internet]","author":"SAS Institute Inc","year":"2025"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2016-042276"},{"key":"e_1_2_15_23_1","volume-title":"Epidemiology and Etiology of Congenital Heart Diseases","author":"Sayasathid J.","year":"2008"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/69.1.239"},{"key":"e_1_2_15_25_1","unstructured":"The Government of Ontario.2025.\u201cOntario Demographic Quarterly: Highlights of Fourth Quarter | ontario.ca [Internet].\u201d[cited 2025 Aug 7].http:\/\/www.ontario.ca\/page\/ontario\u2010demographic\u2010quarterly\u2010highlights\u2010fourth\u2010quarter."},{"key":"e_1_2_15_26_1","unstructured":"The Johns Hopkins University.2025.\u201cJohns Hopkins ACG System.\u201dhttps:\/\/www.hopkinsacg.org\/."},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-016-0101-5"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.7326\/M24-0417"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.230878"}],"container-title":["Birth Defects Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.70056","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/bdr2.70056","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/bdr2.70056","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T03:28:34Z","timestamp":1787542114000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/bdr2.70056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,30]]},"references-count":28,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/bdr2.70056"],"URL":"https:\/\/doi.org\/10.1002\/bdr2.70056","archive":["Portico"],"relation":{},"ISSN":["2472-1727","2472-1727"],"issn-type":[{"value":"2472-1727","type":"print"},{"value":"2472-1727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,30]]},"assertion":[{"value":"2026-01-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70056"}}