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Neighborhood deprivation increases type 2 diabetes risk
Refugees arriving in Sweden between 1987 and 1991 who resettled in more economically deprived neighborhoods were more likely to develop type 2 diabetes than those who were settled in more affluent communities, according to an analysis of long-term data.
“During a wave of immigration 30 years ago, the Swedish government dispersed incoming refugees across the country,” Rita Hamad, MD, MPH, MS, a family physician, epidemiologist and instructor at Stanford University School of Medicine, told Endocrine Today. “This created an unintended natural experiment, in which refugees were almost randomly assigned to live in neighborhoods with different levels of deprivation. We find that those who were settled in high-deprivation neighborhoods were 15% more likely to develop diabetes than those who were settled in low-deprivation neighborhoods. This speaks to the potentially important health effects of neighborhood factors, such as employment opportunities, psychosocial resources, food availability and walkability.”
Rita Hamad
Hamad and colleagues analyzed national register data (including inpatient register, outpatient register and prescription drug register) for 61,386 immigrants aged 25 to 50 years who obtained a Swedish residence permit between 1987 and 1991 and originated from a refugee-sending country (a nonmember country of the Organization for Economic Cooperation and Development in 1985). Refugees were assigned to 4,833 neighborhoods; government policy involved quasi-random dispersal of refugees to neighborhoods with different levels of poverty and unemployment, schooling and social welfare participation, according to study background.
Researchers assigned individuals to neighborhoods categorized as high deprivation (1 standard deviation [SD] above the mean), moderate deprivation (within 1 SD of the mean) or low deprivation (1 SD below the mean). The primary outcome was new diagnosis of type 2 diabetes between 2002 and 2010. Researchers used multivariate logistic and linear regressions to assess the effects of neighborhood deprivation on diabetes risk, controlling for potential confounders affecting neighborhood assignment, and assessing effects of cumulative exposure to different neighborhood conditions.
Within the cohort, 45% were assigned to moderate-deprivation neighborhoods; 47% were assigned to high-deprivation neighborhoods. Cumulative incidence of type 2 diabetes at follow-up was 7.4%. Refugees resettled in a high-deprivation vs. low-deprivation neighborhood increased the likelihood of developing type 2 diabetes (OR = 1.22; 95% CI, 1.07-1.38).
In fixed-effect analyses for assigned municipality, the increased diabetes risk was estimated to be 0.85 percentage points (95% CI, –0.03 to 1.728). Neighborhood effects grew over time; 5 years of additional exposure to high-deprivation vs. low-deprivation neighborhoods was associated with a 9% increase in diabetes risk.
“Social and contextual factors beyond medical care are potentially important determinants of diabetes,” Hamad said. “If we treat individuals clinically, but ignore the places in which they live, our impact on their health and well-being will be substantially reduced. Patients living in deprived neighborhoods may require additional resources and attention. Physicians can also work closely with social workers or community organizations to ensure the best outcomes for their patients. Doctors can play important roles as advocates in disadvantaged communities.” – by Regina Schaffer
For more information:
Rita Hamad, MD, MPH, MS, can be reached at Stanford School of Medicine, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304; email: rhamad@stanford.edu.
Disclosure: The researchers report no relevant financial disclosures.