Add wos sample results library
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abstract: 'Question Is there an association of neighborhood socioeconomic
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disadvantage with the development of cardiovascular risk factors,
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myocardial infarction, and stroke among refugees? Findings In this
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quasi-experimental cohort study, 49.305 refugees who were assigned to
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more disadvantaged neighborhoods across Denmark were at increased risk
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of developing hypertension, hyperlipidemia, diabetes, and myocardial
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infarction over subsequent decades. No associations were found for
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stroke. Meaning Neighborhood characteristics may be associated with
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long-term cardiovascular risk among refugees.
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This quasi-experimental cohort study uses data from the Danish
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population register of adult immigrants arriving from 1986 to 1998 and
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health outcomes from the inpatient clinic register, outpatient clinic
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register, and prescription drug register to assess the association
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between disadvantaged neighborhoods and cardiovascular disease risk
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among refugees.
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Importance Refugees are among the most disadvantaged individuals in
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society, and they often have elevated risks of cardiovascular risk
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factors and events. Evidence is limited regarding factors that may
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worsen cardiovascular health among this vulnerable group. Objective To
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test the hypothesis that refugee placement in socioeconomically
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disadvantaged neighborhoods is associated with increased cardiovascular
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risk. Design, Setting, and Participants The study population of this
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quasi-experimental, registry-based cohort study included 49.305 adults
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18 years and older who came to Denmark as refugees from other countries
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during the years of Denmark''s refugee dispersal policy from 1986 to
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1998. Refugees were dispersed to neighborhoods with varying degrees of
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socioeconomic disadvantage in an arbitrary manner conditional on
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observed characteristics. The association of neighborhood disadvantage
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on arrival with several cardiovascular outcomes in subsequent decades
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was evaluated using regression models that adjusted for individual,
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family, and municipal characteristics. Health outcomes were abstracted
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from the inpatient register, outpatient specialty clinic register, and
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prescription drug register through 2016. Data analysis was conducted
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from May 2018 to July 2019. Exposures A composite index of neighborhood
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disadvantage was constructed using 8 neighborhood-level socioeconomic
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characteristics derived from Danish population register data. Main
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Outcomes and Measures Primary study outcomes included hypertension,
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hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke.
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Before data analysis commenced, it was hypothesized that higher levels
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of neighborhood disadvantage were associated with an increased risk of
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cardiovascular risk factors and events. Results A total of 49 305
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participants were included (median {[}interquartile range] age, 30.5
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{[}24.9-39.8] years; 43.3\% women). Participant region of origin
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included 6318 from Africa (12.8\%), 7253 from Asia (14.7\%), 3446 from
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Eastern Europe (7.0\%), 5416 from Iraq (11.0\%), 6206 from Iran
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(12.6\%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian
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Territories; 11.3\%), and 15 108 from Yugoslavia (30.6\%). Adjusted
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models revealed an association between placement in disadvantaged
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neighborhoods and increased risk of hypertension (0.71 {[}95\% CI,
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0.30-1.13] percentage points per unit of disadvantage index; P < .01),
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hyperlipidemia (0.44 {[}95\% CI, 0.06-0.83] percentage points; P = .01),
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diabetes (0.45 {[}95\% CI, 0.09-0.81] percentage points; P = .01), and
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myocardial infarction (0.14 {[}95\% CI, 0.03-0.25] percentage points; P
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= .01). No association was found for stroke. Individuals who arrived in
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Denmark before age 35 years had an increased risk of hyperlipidemia
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(1.16 {[}95\% CI, 0.41-1.92] percentage points; P < .01), and there were
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no differences by sex. Conclusions and Relevance In this
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quasi-experimental cohort study, neighborhood disadvantage was
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associated with increased cardiovascular risk in a relatively young
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population of refugees. Neighborhood characteristics may be an important
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consideration when refugees are placed by resettlement agencies and host
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countries. Future work should examine additional health outcomes as well
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as potential mediating pathways to target future interventions (eg,
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neighborhood ease of walking, employment opportunities).'
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affiliation: 'Hamad, R (Corresponding Author), Univ Calif San Francisco, Sch Med,
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Philip R Lee Inst Hlth Policy Studies, 995 Potrero Ave,Bldg 80,Ward 83, San Francisco,
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CA 94110 USA.
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Hamad, Rita; Foverskov, Else; White, Justin S., Univ Calif San Francisco, Sch Med,
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Philip R Lee Inst Hlth Policy Studies, 995 Potrero Ave,Bldg 80,Ward 83, San Francisco,
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CA 94110 USA.
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Hamad, Rita, Univ Calif San Francisco, Dept Family \& Community Med, Sch Med, San
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Francisco, CA 94110 USA.
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Ozturk, Buket; Foverskov, Else; Pedersen, Lars; Sorensen, Henrik T., Aarhus Univ,
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Dept Clin Epidemiol, Aarhus, Denmark.
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Sorensen, Henrik T., Stanford Univ, Ctr Populat Hlth Sci, Stanford, CA 94305 USA.
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Botker, Hans E., Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark.
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White, Justin S., Univ Calif San Francisco, Dept Epidemiol \& Biostat, Sch Med,
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San Francisco, CA 94110 USA.'
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article-number: e2014196
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author: Hamad, Rita and Ozturk, Buket and Foverskov, Else and Pedersen, Lars and Sorensen,
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Henrik T. and Botker, Hans E. and White, Justin S.
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author-email: rita.hamad@ucsf.edu
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author_list:
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- family: Hamad
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given: Rita
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- family: Ozturk
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given: Buket
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- family: Foverskov
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given: Else
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- family: Pedersen
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given: Lars
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- family: Sorensen
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given: Henrik T.
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- family: Botker
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given: Hans E.
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- family: White
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given: Justin S.
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da: '2023-09-28'
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doi: 10.1001/jamanetworkopen.2020.14196
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files: []
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issn: 2574-3805
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journal: JAMA NETWORK OPEN
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keywords-plus: 'CORONARY-HEART-DISEASE; MENTAL-HEALTH; SOCIOECONOMIC ENVIRONMENT;
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RESIDENTIAL SEGREGATION; DEPRIVATION; OUTCOMES; STRESS; HYPERTENSION;
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IMMIGRANTS; MULTILEVEL'
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language: English
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month: AUG 21
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number: '8'
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number-of-cited-references: '73'
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orcid-numbers: 'Sørensen, Henrik Toft/0000-0003-4299-7040
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Esen, Buket Ozturk/0000-0003-2957-7797
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Botker, Hans Erik/0000-0001-6358-8962
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Foverskov, Else/0000-0003-4407-0759'
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papis_id: ffb3eb8615e9433faf46f5a3ab461749
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ref: Hamad2020associationneighborh
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researcherid-numbers: 'Sørensen, Henrik Toft/Z-6181-2019
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'
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times-cited: '11'
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title: Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and
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Events Among Refugees in Denmark
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type: Article
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unique-id: WOS:000564286200003
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usage-count-last-180-days: '2'
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usage-count-since-2013: '7'
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volume: '3'
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web-of-science-categories: Medicine, General \& Internal
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year: '2020'
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