Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study
Objectives: Neighborhood disadvantage may increase the risk of adverse health outcomes among older refugees. Yet few studies rigorously estimate the effects of place-based factors on later-life health, particularly dementia and mortality. Evidence about refugees is especially sparse. Methods: This s...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | SSM: Population Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352827322002919 |
| _version_ | 1811164958612783104 |
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| author | Min Hee Kim Else Foverskov Trine Frøslev Justin S. White M. Maria Glymour Jens Hainmueller Lars Pedersen Henrik T. Sørensen Rita Hamad |
| author_facet | Min Hee Kim Else Foverskov Trine Frøslev Justin S. White M. Maria Glymour Jens Hainmueller Lars Pedersen Henrik T. Sørensen Rita Hamad |
| author_sort | Min Hee Kim |
| collection | DOAJ |
| description | Objectives: Neighborhood disadvantage may increase the risk of adverse health outcomes among older refugees. Yet few studies rigorously estimate the effects of place-based factors on later-life health, particularly dementia and mortality. Evidence about refugees is especially sparse. Methods: This study leveraged a natural experiment in the form of a Danish policy (1986–1998) that dispersed refugees quasi-randomly across neighborhoods upon arrival. We used longitudinal registers allowing 30 years of follow-up among refugees aged 40+ years upon arrival in Denmark (N = 9,854). Cox models assessed the association between neighborhood disadvantage and risk of dementia and mortality. We examined heterogeneous effects by sex, age, and family size. We also examined associations among non-refugee immigrants and native-born Danes. Results: Neighborhood disadvantage was not associated with dementia in any group. One unit increase in neighborhood disadvantage index (ranges −8 to 5.7) was associated with greater mortality risk among non-refugee immigrants (HR 1.06, 95%CI: 1.02, 1.10) and native-born Danes (HR 1.11, 95%CI: 1.06, 1.17). In contrast, neighborhood disadvantage was associated with lower mortality risk among refugees (HR 0.96, 95%CI: 0.93, 0.99). Neighborhood disadvantage remained negatively associated with mortality risk in subgroups: refugees who are female (on moderate-disadvantage compared to low-disadvantage), aged 60+, and who arrived with families. Discussion: While neighborhood disadvantage was associated with lower mortality risk among refugees, it was associated with greater mortality risk among non-refugee immigrants and native-born Danes, perhaps due to confounding in the latter groups or different place-based experiences by immigration status. Future research is warranted to explain the reasons for contrasting findings. |
| first_indexed | 2024-04-10T15:30:48Z |
| format | Article |
| id | doaj.art-fced251c771c475798de4e1a03494a1d |
| institution | Directory Open Access Journal |
| issn | 2352-8273 |
| language | English |
| last_indexed | 2024-04-10T15:30:48Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Population Health |
| spelling | doaj.art-fced251c771c475798de4e1a03494a1d2023-02-14T04:06:56ZengElsevierSSM: Population Health2352-82732023-03-0121101312Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental studyMin Hee Kim0Else Foverskov1Trine Frøslev2Justin S. White3M. Maria Glymour4Jens Hainmueller5Lars Pedersen6Henrik T. Sørensen7Rita Hamad8Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Corresponding author. 3333 California St, San Francisco, CA, 94118, USA.Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, DenmarkDepartment of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, DenmarkPhilip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USADepartment of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USADepartment of Political Science, Stanford University, Stanford, CA, USADepartment of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, DenmarkDepartment of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Clinical Excellence Research Center, Stanford University, Stanford, CA, USAPhilip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Department of Family & Community Medicine, University of California San Francisco, San Francisco, CA, USAObjectives: Neighborhood disadvantage may increase the risk of adverse health outcomes among older refugees. Yet few studies rigorously estimate the effects of place-based factors on later-life health, particularly dementia and mortality. Evidence about refugees is especially sparse. Methods: This study leveraged a natural experiment in the form of a Danish policy (1986–1998) that dispersed refugees quasi-randomly across neighborhoods upon arrival. We used longitudinal registers allowing 30 years of follow-up among refugees aged 40+ years upon arrival in Denmark (N = 9,854). Cox models assessed the association between neighborhood disadvantage and risk of dementia and mortality. We examined heterogeneous effects by sex, age, and family size. We also examined associations among non-refugee immigrants and native-born Danes. Results: Neighborhood disadvantage was not associated with dementia in any group. One unit increase in neighborhood disadvantage index (ranges −8 to 5.7) was associated with greater mortality risk among non-refugee immigrants (HR 1.06, 95%CI: 1.02, 1.10) and native-born Danes (HR 1.11, 95%CI: 1.06, 1.17). In contrast, neighborhood disadvantage was associated with lower mortality risk among refugees (HR 0.96, 95%CI: 0.93, 0.99). Neighborhood disadvantage remained negatively associated with mortality risk in subgroups: refugees who are female (on moderate-disadvantage compared to low-disadvantage), aged 60+, and who arrived with families. Discussion: While neighborhood disadvantage was associated with lower mortality risk among refugees, it was associated with greater mortality risk among non-refugee immigrants and native-born Danes, perhaps due to confounding in the latter groups or different place-based experiences by immigration status. Future research is warranted to explain the reasons for contrasting findings.http://www.sciencedirect.com/science/article/pii/S2352827322002919Immigration policyPolicy evaluationNatural experimentSurvival analysisPlace-based effects |
| spellingShingle | Min Hee Kim Else Foverskov Trine Frøslev Justin S. White M. Maria Glymour Jens Hainmueller Lars Pedersen Henrik T. Sørensen Rita Hamad Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study SSM: Population Health Immigration policy Policy evaluation Natural experiment Survival analysis Place-based effects |
| title | Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study |
| title_full | Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study |
| title_fullStr | Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study |
| title_full_unstemmed | Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study |
| title_short | Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study |
| title_sort | neighborhood disadvantage and the risk of dementia and mortality among refugees to denmark a quasi experimental study |
| topic | Immigration policy Policy evaluation Natural experiment Survival analysis Place-based effects |
| url | http://www.sciencedirect.com/science/article/pii/S2352827322002919 |
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