wow-inequalities/02-data/intermediate/wos_sample/fb24db3a77f95041413d4f159e60aee2-hamad-rita-and-oztu/info.yaml

abstract: 'Question Is there an association of neighborhood socioeconomic

  disadvantage with the development of cardiovascular risk factors,

  myocardial infarction, and stroke among refugees? Findings In this

  quasi-experimental cohort study, 49.305 refugees who were assigned to

  more disadvantaged neighborhoods across Denmark were at increased risk

  of developing hypertension, hyperlipidemia, diabetes, and myocardial

  infarction over subsequent decades. No associations were found for

  stroke. Meaning Neighborhood characteristics may be associated with

  long-term cardiovascular risk among refugees.

  This quasi-experimental cohort study uses data from the Danish

  population register of adult immigrants arriving from 1986 to 1998 and

  health outcomes from the inpatient clinic register, outpatient clinic

  register, and prescription drug register to assess the association

  between disadvantaged neighborhoods and cardiovascular disease risk

  among refugees.

  Importance Refugees are among the most disadvantaged individuals in

  society, and they often have elevated risks of cardiovascular risk

  factors and events. Evidence is limited regarding factors that may

  worsen cardiovascular health among this vulnerable group. Objective To

  test the hypothesis that refugee placement in socioeconomically

  disadvantaged neighborhoods is associated with increased cardiovascular

  risk. Design, Setting, and Participants The study population of this

  quasi-experimental, registry-based cohort study included 49.305 adults

  18 years and older who came to Denmark as refugees from other countries

  during the years of Denmark''s refugee dispersal policy from 1986 to

  1998. Refugees were dispersed to neighborhoods with varying degrees of

  socioeconomic disadvantage in an arbitrary manner conditional on

  observed characteristics. The association of neighborhood disadvantage

  on arrival with several cardiovascular outcomes in subsequent decades

  was evaluated using regression models that adjusted for individual,

  family, and municipal characteristics. Health outcomes were abstracted

  from the inpatient register, outpatient specialty clinic register, and

  prescription drug register through 2016. Data analysis was conducted

  from May 2018 to July 2019. Exposures A composite index of neighborhood

  disadvantage was constructed using 8 neighborhood-level socioeconomic

  characteristics derived from Danish population register data. Main

  Outcomes and Measures Primary study outcomes included hypertension,

  hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke.

  Before data analysis commenced, it was hypothesized that higher levels

  of neighborhood disadvantage were associated with an increased risk of

  cardiovascular risk factors and events. Results A total of 49 305

  participants were included (median {[}interquartile range] age, 30.5

  {[}24.9-39.8] years; 43.3\% women). Participant region of origin

  included 6318 from Africa (12.8\%), 7253 from Asia (14.7\%), 3446 from

  Eastern Europe (7.0\%), 5416 from Iraq (11.0\%), 6206 from Iran

  (12.6\%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian

  Territories; 11.3\%), and 15 108 from Yugoslavia (30.6\%). Adjusted

  models revealed an association between placement in disadvantaged

  neighborhoods and increased risk of hypertension (0.71 {[}95\% CI,

  0.30-1.13] percentage points per unit of disadvantage index; P < .01),

  hyperlipidemia (0.44 {[}95\% CI, 0.06-0.83] percentage points; P = .01),

  diabetes (0.45 {[}95\% CI, 0.09-0.81] percentage points; P = .01), and

  myocardial infarction (0.14 {[}95\% CI, 0.03-0.25] percentage points; P

  = .01). No association was found for stroke. Individuals who arrived in

  Denmark before age 35 years had an increased risk of hyperlipidemia

  (1.16 {[}95\% CI, 0.41-1.92] percentage points; P < .01), and there were

  no differences by sex. Conclusions and Relevance In this

  quasi-experimental cohort study, neighborhood disadvantage was

  associated with increased cardiovascular risk in a relatively young

  population of refugees. Neighborhood characteristics may be an important

  consideration when refugees are placed by resettlement agencies and host

  countries. Future work should examine additional health outcomes as well

  as potential mediating pathways to target future interventions (eg,

  neighborhood ease of walking, employment opportunities).'
affiliation: 'Hamad, R (Corresponding Author), Univ Calif San Francisco, Sch Med,
  Philip R Lee Inst Hlth Policy Studies, 995 Potrero Ave,Bldg 80,Ward 83, San Francisco,
  CA 94110 USA.

  Hamad, Rita; Foverskov, Else; White, Justin S., Univ Calif San Francisco, Sch Med,
  Philip R Lee Inst Hlth Policy Studies, 995 Potrero Ave,Bldg 80,Ward 83, San Francisco,
  CA 94110 USA.

  Hamad, Rita, Univ Calif San Francisco, Dept Family \& Community Med, Sch Med, San
  Francisco, CA 94110 USA.

  Ozturk, Buket; Foverskov, Else; Pedersen, Lars; Sorensen, Henrik T., Aarhus Univ,
  Dept Clin Epidemiol, Aarhus, Denmark.

  Sorensen, Henrik T., Stanford Univ, Ctr Populat Hlth Sci, Stanford, CA 94305 USA.

  Botker, Hans E., Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.

  White, Justin S., Univ Calif San Francisco, Dept Epidemiol \& Biostat, Sch Med,
  San Francisco, CA 94110 USA.'
article-number: e2014196
author: Hamad, Rita and Ozturk, Buket and Foverskov, Else and Pedersen, Lars and Sorensen,
  Henrik T. and Botker, Hans E. and White, Justin S.
author-email: rita.hamad@ucsf.edu
author_list:
- family: Hamad
  given: Rita
- family: Ozturk
  given: Buket
- family: Foverskov
  given: Else
- family: Pedersen
  given: Lars
- family: Sorensen
  given: Henrik T.
- family: Botker
  given: Hans E.
- family: White
  given: Justin S.
da: '2023-09-28'
doi: 10.1001/jamanetworkopen.2020.14196
files: []
issn: 2574-3805
journal: JAMA NETWORK OPEN
keywords-plus: 'CORONARY-HEART-DISEASE; MENTAL-HEALTH; SOCIOECONOMIC ENVIRONMENT;

  RESIDENTIAL SEGREGATION; DEPRIVATION; OUTCOMES; STRESS; HYPERTENSION;

  IMMIGRANTS; MULTILEVEL'
language: English
month: AUG 21
number: '8'
number-of-cited-references: '73'
orcid-numbers: 'Sørensen, Henrik Toft/0000-0003-4299-7040

  Esen, Buket Ozturk/0000-0003-2957-7797

  Botker, Hans Erik/0000-0001-6358-8962

  Foverskov, Else/0000-0003-4407-0759'
papis_id: ffb3eb8615e9433faf46f5a3ab461749
ref: Hamad2020associationneighborh
researcherid-numbers: 'Sørensen, Henrik Toft/Z-6181-2019

  '
times-cited: '11'
title: Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and
  Events Among Refugees in Denmark
type: article
unique-id: WOS:000564286200003
usage-count-last-180-days: '2'
usage-count-since-2013: '7'
volume: '3'
web-of-science-categories: Medicine, General \& Internal
year: '2020'