TY - JOUR

T1 - Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark

T2 - A quasi-experimental study

AU - Kim, Min Hee

AU - Foverskov, Else

AU - Frøslev, Trine

AU - White, Justin S.

AU - Glymour, M. Maria

AU - Hainmueller, Jens

AU - Pedersen, Lars

AU - Sørensen, Henrik T.

AU - Hamad, Rita

N1 - Publisher Copyright: © 2022 The Authors

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - Immigration policy

KW - Natural experiment

KW - Place-based effects

KW - Policy evaluation

KW - Survival analysis

U2 - 10.1016/j.ssmph.2022.101312

DO - 10.1016/j.ssmph.2022.101312

M3 - Journal article

C2 - 36589275

AN - SCOPUS:85144579577

VL - 21

JO - SSM - Population Health

JF - SSM - Population Health

SN - 2352-8273

M1 - 101312

ER -