Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study.
Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study.
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DOI：
10.1016/j.ssmph.2022.101312
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发表时间：
2023-03
影响因子：
4.7
通讯作者：
Hamad, Rita
中科院分区：
文献类型：
--
作者：
Kim, Min Hee;Foverskov, Else;Froslev, Trine;White, Justin S.;Glymour, M. Maria;Hainmueller, Jens;Pedersen, Lars;Sorensen, Henrik T.;Hamad, Rita
社区的不利条件可能会增加老年难民健康不良后果的风险。然而，很少有研究严格估计基于地点的因素对晚年健康的影响，特别是痴呆症和死亡率。有关难民的证据尤其稀少。这项研究利用了丹麦政策(1986-1998)形式的自然实验，即难民到达后准随机地分布在不同的社区。我们使用纵向登记表，允许40岁以上的难民在抵达丹麦后进行30年的跟踪调查(N=29854)。考克斯模型评估了社区劣势与痴呆症风险和死亡率之间的关系。我们检查了性别、年龄和家庭规模的异质性影响。我们还考察了非难民移民和土生土长的丹麦人之间的联系。在任何一组中，邻里劣势都与痴呆症无关。在非难民移民(HR 1.06，95%CI：1.02，1.10)和本地出生的丹麦人(HR 1.11，95%CI：1.06，1.17)中，邻里劣势指数增加一个单位(−8至5.7)与更高的死亡风险相关。相反，社区劣势与难民中较低的死亡风险相关(HR 0.96，95%CI：0.93，0.99)。在亚群中，邻里劣势仍然与死亡风险负相关：女性难民(与低度劣势相比处于中等劣势)、60岁以上的难民以及与家人一起抵达的难民。虽然邻里劣势与难民的死亡风险较低有关，但在非难民移民和土生土长的丹麦人中，这与较大的死亡风险有关，这可能是由于后一类群体的混淆或移民身份的不同地方经历所致。未来的研究有必要解释为什么会有不同的发现。我们利用丹麦难民分散政策(1986-1998)作为一项自然实验。在40岁及以上的难民中，社区劣势与较低的死亡率有关。这一劣势与非难民移民或土生土长的丹麦人中较高的道德风险有关。在任何一组中，社区劣势都与痴呆症风险无关。社区的不利地位可能会通过社会融合机制改善老年难民的健康。未来的研究需要解释不同移民身份对比研究结果的原因(例如，选择)。
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. 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. 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. 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. We leveraged a Danish refugee dispersal policy (1986–1998) as a natural experiment. Neighborhood disadvantage was associated with lower mortality among refugees age 40 and older. The disadvantage was associated with a higher morality risk among non-refugee immigrants or native-born Danes. Neighborhood disadvantage was not associated with dementia risk in any group. Neighborhood disadvantage may improve older refugees' health via social integration mechanisms. Future research is warranted to explain the reasons (e.g., selection) for contrasting findings by immigrant statuses.
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