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'