202 lines
6.7 KiB
YAML
202 lines
6.7 KiB
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'
|