1
|
Timmis A, Aboyans V, Vardas P, Townsend N, Torbica A, Kavousi M, Boriani G, Huculeci R, Kazakiewicz D, Scherr D, Karagiannidis E, Cvijic M, Kapłon-Cieślicka A, Ignatiuk B, Raatikainen P, De Smedt D, Wood A, Dudek D, Van Belle E, Weidinger F. European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics. Eur Heart J 2024:ehae466. [PMID: 39189413 DOI: 10.1093/eurheartj/ehae466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/22/2024] [Accepted: 07/03/2024] [Indexed: 08/28/2024] Open
Abstract
This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.
Collapse
Affiliation(s)
- Adam Timmis
- The William Harvey Research Institute, Queen Mary University London, London E1 4NS, UK
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and EpiMaCT, Inserm 1098/IRD270, Limoges University, Limoges, France
| | - Panos Vardas
- Biomedical Research Foundation Academy of Athens and Hygeia Hospitals Group, HHG, Athens, Greece
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Nick Townsend
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Radu Huculeci
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Denis Kazakiewicz
- European Society of Cardiology, European Heart Agency, European Heart Health Institute, Brussels, Belgium
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Efstratios Karagiannidis
- Second Department of Cardiology, General Hospital 'Hippokration', Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Barbara Ignatiuk
- Department of Cardiology, Humanitas Gavazzeni University Hospital, Bergamo, Italy
| | - Pekka Raatikainen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Angela Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Dariusz Dudek
- Instytut Kardiologii, Uniwersytet Jagielloński, Collegium Medicum, Kraków, Poland
| | - Eric Van Belle
- Cardiologie, Institut cœur-poumon, CHU de Lille, Lille, France
| | - Franz Weidinger
- Department of Cardiology and Intensive Care Medicine, Landstrasse Clinic, Vienna, Austria
| |
Collapse
|
2
|
Schofield P, Jamil de Montgomery C, Damm AP, Agerbo E. Neighborhood social composition and refugee mental health - quasi-experimental evidence of associations from a Danish population register study. Psychol Med 2024:1-9. [PMID: 38766806 DOI: 10.1017/s0033291724001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design. METHODS We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders. RESULTS Refugees assigned to neighborhoods with fewer co-nationals (lowest v. highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06-1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05-1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03-1.50). We found no statistically significant associations with proportion of migrants. CONCLUSIONS For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.
Collapse
Affiliation(s)
- Peter Schofield
- Population Health Science, King's College London, London, UK
| | | | - Anna Piil Damm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Bann D, Wright L, Hughes A, Chaturvedi N. Socioeconomic inequalities in cardiovascular disease: a causal perspective. Nat Rev Cardiol 2024; 21:238-249. [PMID: 37821646 DOI: 10.1038/s41569-023-00941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Socioeconomic inequalities in cardiovascular disease (CVD) persist in high-income countries despite marked overall declines in CVD-related morbidity and mortality. After decades of research, the field has struggled to unequivocally answer a crucial question: is the association between low socioeconomic position (SEP) and the development of CVD causal? We review relevant evidence from various study designs and disciplinary perspectives. Traditional observational, family-based and Mendelian randomization studies support the widely accepted view that low SEP causally influences CVD. However, results from quasi-experimental and experimental studies are both limited and equivocal. While more experimental and quasi-experimental studies are needed to aid causal understanding and inform policy, high-quality descriptive studies are also required to document inequalities, investigate their contextual dependence and consider SEP throughout the lifespan; no simple hierarchy of evidence exists for an exposure as complex as SEP. The COVID-19 pandemic illustrates the context-dependent nature of CVD inequalities, with the generation of potentially new causal pathways linking SEP and CVD. The linked goals of understanding the causal nature of SEP and CVD associations, their contextual dependence, and their remediation by policy interventions necessitate a detailed understanding of society, its change over time and the phenotypes of CVD. Interdisciplinary research is therefore key to advancing both causal understanding and policy translation.
Collapse
Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK.
| | - Liam Wright
- Centre for Longitudinal Studies, Social Research Institute, IOE, UCL's Faculty of Education and Society, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health & Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
| |
Collapse
|
4
|
Hamad R. Immigrants to the United States contribute to society: Here are 3 ways to support their transition. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae019. [PMID: 38435810 PMCID: PMC10906102 DOI: 10.1093/haschl/qxae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
The number of migrants entering the United States in 2023 shattered records. Despite prevailing narratives, immigrants, on average, contribute substantially to US society. Rather than slamming the door in the faces of newcomers, federal, state, and local policymakers should provide services to these individuals to ensure they have the maximum opportunity to thrive, both for their own benefit and for the greater social good. Public health and social science research provides ample rigorous evidence on the benefits of different types of investments in these vulnerable individuals upon their arrival in our country. In this Commentary, I review 3 examples of potential evidence-based investments: social inclusion, meeting basic needs, and supportive neighborhoods.
Collapse
Affiliation(s)
- Rita Hamad
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA 02115, United States
| |
Collapse
|
5
|
Abreu TC, Mackenbach JD, Heuvelman F, Schoonmade LJ, Beulens JW. Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis. SSM Popul Health 2024; 25:101559. [PMID: 38148999 PMCID: PMC10749911 DOI: 10.1016/j.ssmph.2023.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD). Methods We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses. Results From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
Collapse
Affiliation(s)
- Taymara C. Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Joreintje D. Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
| | - Linda J. Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, Noord-Holland, the Netherlands
| |
Collapse
|
6
|
Biddle L, Bozorgmehr K. Effect of area-level socioeconomic deprivation on mental and physical health: A longitudinal natural experiment among refugees in Germany. SSM Popul Health 2024; 25:101596. [PMID: 38304416 PMCID: PMC10832457 DOI: 10.1016/j.ssmph.2023.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/18/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Existing studies on contextual health effects struggle to account for compositional bias, limiting causal interpretation. We use refugee dispersal in Germany as a natural experiment to study the effect of area-level socioeconomic deprivation on mental and physical health, while considering the potential mediating role of neighbourhood characteristics. Refugees subject to dispersal (n = 1466) are selected from a nation-wide longitudinal refugee study (IAB-SOEP-BAMF Panel; 2016-2018). Multi-level linear regression models, adjusted for age, sex, education, country of origin, federal state, asylum status and length of residence in Germany, are fitted to the change in mental and physical health subscales of the SF-12 depending on quintiles (Q1 - Q5) of commune-level socioeconomic deprivation (German Index of Socioeconomic Deprivation, GISD). This is followed by sensitivity analyses and mediation analyses for housing, social cohesion, proportion of non-citizens in the neighbourhood, access to green space, population density and primary care physician density. Residency in districts with moderate-high deprivation (Q4) has a negative impact on physical health (coef.: -2.2, 95%CI: -4.1;-0.2) compared to lowest deprivation (Q1). Moderate-high deprivation (Q4) has a positive impact on mental health, but the effect is statistically insignificant (coef.: 1.6, 95%CI: -0.7; 3.9). Comparisons with other deprivation quintiles are statistically insignificant. Sensitivity analyses confirm results of the final models, while no mediating factors show a substantial impact on the observed relationship. The results point to gaps in health and social service provision for refugees living in the most deprived regions, but further research is required to understand the precise mechanisms behind the observed relationships. Further research using longer timeframes and larger sample sizes are required to confirm results.
Collapse
Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- German Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
7
|
Jensen NK, Frøslev T, Foverskov E, Glymour M, Sørensen HT, Hamad R. The association of neighborhood socioeconomic characteristics with cardiovascular health: A quasi-experimental study of refugees to Denmark. Health Place 2023; 84:103128. [PMID: 37844523 PMCID: PMC10823536 DOI: 10.1016/j.healthplace.2023.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023]
Abstract
Neighborhood socioeconomic disadvantage is associated with cardiovascular health, although it is unclear which specific aspects of neighborhoods matter most. We leveraged a natural experiment in which refugees to Denmark were quasi-randomly assigned to neighborhoods across the country during 1986-1998, creating variation in exposure to various aspects of neighborhood disadvantage. The cohort was followed through December 2018. Exposures included neighborhood-level family income, educational attainment, unemployment, and welfare transfers measured in the first neighborhood after arrival to Denmark. Outcomes included cardiovascular risk factors (hyperlipidemia, hypertension, diabetes and anxiety/depression) and cardiovascular disease (acute myocardial infarction and ischemic heart disease). Neighborhood-level income and education were most consistently associated with cardiovascular risk factors, whereas welfare transfers were most consistently associated with cardiovascular disease. Addressing these specific aspects of neighborhood disadvantage could therefore lower the risk of poor cardiovascular health among refugees. Future research is warranted to examine if results are generalizable to other immigrant groups, countries or time periods.
Collapse
Affiliation(s)
- Natasja Koitzsch Jensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Else Foverskov
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Glymour
- Department of Epidemiology, Boston University, School of Public Health, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rita Hamad
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Bozorgmehr K, McKee M, Azzopardi-Muscat N, Bartovic J, Campos-Matos I, Gerganova TI, Hannigan A, Janković J, Kállayová D, Kaplan J, Kayi I, Kondilis E, Lundberg L, Mata IDL, Medarević A, Suvada J, Wickramage K, Puthoopparambil SJ. Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100744. [PMID: 37927430 PMCID: PMC10625017 DOI: 10.1016/j.lanepe.2023.100744] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
Coverage of migrant and refugee data is incomplete and of insufficient quality in European health information systems. This is not because we lack the knowledge or technology. Rather, it is due to various political factors at local, national and European levels, which hinder the implementation of existing knowledge and guidelines. This reflects the low political priority given to the topic, and also complex governance challenges associated with migration and displacement. We review recent evidence, guidelines, and policies to propose four approaches that will advance science, policy, and practice. First, we call for strategies that ensure that data is collected, analyzed and disseminated systematically. Second, we propose methods to safeguard privacy while combining data from multiple sources. Third, we set out how to enable survey methods that take account of the groups' diversity. Fourth, we emphasize the need to engage migrants and refugees in decisions about their own health data. Based on these approaches, we propose a change management approach that narrows the gap between knowledge and action to create healthcare policies and practices that are truly inclusive of migrants and refugees. We thereby offer an agenda that will better serve public health needs, including those of migrants and refugees and advance equity in European health systems. Funding No specific funding received.
Collapse
Affiliation(s)
- Kayvan Bozorgmehr
- Department of Population Medicine & Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Lancet Migration European Hub
| | - Martin McKee
- European Observatory on Health Systems and Policies, London, UK
- London School of Medicine & Tropical Hygiene, London, UK
| | | | | | - Ines Campos-Matos
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | | | - Ailish Hannigan
- WHO Collaborating Centre for Migrant’s Involvement in Health Research, School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Daniela Kállayová
- Lancet Migration European Hub
- Department of Public Health, Screening and Prevention, Ministry of Health, Slovak Republic
- Trnava University, Trnava, Slovak Republic
| | - Josiah Kaplan
- UNICEF Global Office of Research and Foresight, Florence, Italy
| | - Ilker Kayi
- Department of Public Health, School of Medicine, Koç University, Istanbul, Türkiye
| | - Elias Kondilis
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lene Lundberg
- Lancet Migration European Hub
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Aleksandar Medarević
- Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut', Belgrade, Serbia
| | - Jozef Suvada
- St. Elizabeth University of Public Health and Social Work, Slovak Republic
- WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, and McMaster GRADE Centre, Department of Health Research Methods, Evidence and Impact, McMaster University, Canada
| | - Kolitha Wickramage
- UN Migration Agency Global Data Institute, Migration Health Division, International Organization for Migration, Berlin, Germany
| | - Soorej Jose Puthoopparambil
- WHO Collaborating Centre on Migration and Health Data and Evidence, Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Sweden
| |
Collapse
|
9
|
Biddle L, Hintermeier M, Costa D, Wasko Z, Bozorgmehr K. Context, health and migration: a systematic review of natural experiments. EClinicalMedicine 2023; 64:102206. [PMID: 37936656 PMCID: PMC10626165 DOI: 10.1016/j.eclinm.2023.102206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Migration health research pays little attention to the places into which people migrate. Studies on health effects of contextual factors are often limited because of the ability of individuals to self-select their environment, but natural experiments may allow for the causal effect of contexts to be examined. The objective was to synthesise the evidence on contextual health effects from natural experiments among migrant groups. Methods We performed a systematic review of natural experiments among migrant populations in PubMed/MEDLINE, The Cochrane Library, Web of Science, CINAHL and Google Scholar for literature published until 13 October 2022. 5870 articles were screened in duplicate using the following inclusion criteria: quantitative natural experiment design, migrant population, context factor as treatment variable and health or healthcare outcome variable. Synthesis without meta-analysis was performed following quality appraisal using the EPHPP tool for quantitative studies and data extraction (PROSPERO: CRD42020169236). Findings The 46 included articles provide evidence for negative effects of neighbourhood disadvantage on physical health and mortality, while finding mixed effects on mental health. Articles comparing migrants with those that stayed behind demonstrate detrimental effects of migration and adverse post-migratory contexts on physical health and mortality, while demonstrating favourable effects for mental and child health. Natural experiments of policy environments indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality, as well as the positive health effects when restrictions are lifted. Interpretation Natural experiments complement observational studies and provide robust evidence to advocate for more inclusive migration, health and social policies as well as neighbourhood improvement programmes. In order to strengthen the methodological approach, future research utilising natural experiments should be more explicit in the mechanisms underlying the experiment and provide details on potential causal mechanisms for the observed effects. Funding German Science Foundation (FOR: 2928/GZ: BO5233/1-1).
Collapse
Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- German Socio-Economic Panel, German Institute for Economic Research (DIW Berlin), Mohrenstraße 58, 10117, Berlin, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Maren Hintermeier
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
| | - Zahia Wasko
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Universitätsstraße 25, 33501, Bielefeld, Germany
- Section Health Equity Studies & Migration, Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
10
|
Mujahid MS, Maddali SR, Gao X, Oo KH, Benjamin LA, Lewis TT. The Impact of Neighborhoods on Diabetes Risk and Outcomes: Centering Health Equity. Diabetes Care 2023; 46:1609-1618. [PMID: 37354326 PMCID: PMC10465989 DOI: 10.2337/dci23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
Neighborhood environments significantly influence the development of diabetes risk factors, morbidity, and mortality throughout an individual's life. The social, economic, and physical environments of a neighborhood all affect the health risks of individuals and communities and also affect population health inequities. Factors such as access to healthy food, green spaces, safe housing, and transportation options can impact the health outcomes of residents. Social factors, including social cohesion and neighborhood safety, also play an important role in shaping neighborhood environments and can influence the development of diabetes. Therefore, understanding the complex relationships between neighborhood environments and diabetes is crucial for developing effective strategies to address health disparities and promote health equity. This review presents landmark findings from studies that examined associations between neighborhood socioeconomic, built and physical, and social environmental factors and diabetes-related risk and outcomes. Our framework emphasizes the historical context and structural and institutional racism as the key drivers of neighborhood environments that ultimately shape diabetes risk and outcomes. To address health inequities in diabetes, we propose future research areas that incorporate health equity principles and place-based interventions.
Collapse
Affiliation(s)
- Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Sai Ramya Maddali
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Khin H. Oo
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Larissa A. Benjamin
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
11
|
Nielsen NO, Benedikz E, Dahl M, Præstegaard J, Lindahl M. Health and wellbeing in refugee families from Syria resettled in Denmark. J Migr Health 2023; 8:100200. [PMID: 37538300 PMCID: PMC10393817 DOI: 10.1016/j.jmh.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/03/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023] Open
Abstract
Aims The aim was to evaluate self-reported health status and wellbeing in a well-defined group of refugee families from Syria 2-4 years after resettlement in Denmark, and, where possible, compare it with a Danish reference population. The purpose was to determine the need for specialized health care to resettled refugees. Methods This cross-sectional study involved 90 individuals from Syria aged 13-56 years. We used questionnaire survey to assess the general health and wellbeing in the study population in relation to a Danish reference population. Objective measurements of selected health indicators like overweight, hypertension and levels of cholesterol and blood glucose (HbA1c) were also determined for the study population. Results Mean wellbeing scores and the proportion of study participants rating their health as good were lower among the study participants compared with the Danish population for all age groups. The proportion of participants who reported often being alone against their will was significantly higher than among Danes, as was the proportion who had nobody to talk to when having problems. A significantly higher proportion of participants experienced various forms of pain or discomfort than in the Danish population. Overall, 23.6% and 3.4% of participants had elevated cholesterol and HbA1c levels, respectively, and the prevalence of overweight (BMI ≥ 25) was 70%. Hypertension was more frequent (16.2%) than in another refugee population in Denmark (9%). Conclusions The study demonstrated various mental and physical health challenges among the Syrian refugee families, and their health and wellbeing appeared to be substantially poorer as compared to the Danish reference population. The findings emphasize the need for systematic and specialized health care services at a municipality level to resettling refugees as a prerequisite for the refugees to become contributing citizens.
Collapse
Affiliation(s)
- Nina Odgaard Nielsen
- Centre for Health and Rehabilitation, University College Absalon, Sdr. Stationsvej 30, Slagelse 4200, Denmark
| | - Eirikur Benedikz
- Faculty of Health, University of Southern Denmark, J.B. Winsløws Vej 19, Odense C 5000, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, Lykkebækvej 1, Køge 4600, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Jeanette Præstegaard
- Centre for Health and Rehabilitation, University College Absalon, Sdr. Stationsvej 30, Slagelse 4200, Denmark
| | - Marianne Lindahl
- Centre for Health and Rehabilitation, University College Absalon, Sdr. Stationsvej 30, Slagelse 4200, Denmark
| |
Collapse
|
12
|
Dugani SB, Zubaid M, Rashed W, Girardo ME, Balayah Z, Mora S, Alsheikh-Ali AA. Social Determinants of Health and Mortality After Premature and Non-premature Acute Coronary Syndrome. Mayo Clin Proc Innov Qual Outcomes 2023; 7:153-164. [PMID: 37152409 PMCID: PMC10160579 DOI: 10.1016/j.mayocpiqo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Objective To describe and compare the determinants of 1-year mortality after premature vs non-premature acute coronary syndrome (ACS). Patients and Methods Participants presenting with ACS were enrolled in a prospective registry of 29 hospitals in 4 countries, from January 22, 2012 to January 22, 2013, with 1-year of follow-up data. The primary outcome was all-cause 1-year mortality after premature ACS (men aged <55 years and women aged <65 years) and non-premature ACS (men aged ≥55 years and women aged ≥65 years). The associations between the baseline patient characteristics and 1-year mortality were analyzed in models adjusting for the Global Registry of Acute Coronary Events (GRACE) score and reported as adjusted odds ratio (aOR) (95% CI). Results Of the 3868 patients, 43.3% presented with premature ACS that was associated with lower 1-year mortality (5.7%) than those with non-premature ACS. In adjusted models, women experienced higher mortality than men after premature (aOR, 2.14 [1.37-3.41]) vs non-premature ACS (aOR, 1.28 [0.99-1.65]) (P interaction=.047). Patients lacking formal education vs any education had higher mortality after both premature (aOR, 2.92 [1.87-4.61]) and non-premature ACS (aOR, 1.78 [1.36-2.34]) (P interaction=.06). Lack of employment vs any employment was associated with approximately 3-fold higher mortality after premature and non-premature ACS (P interaction=.72). Using stepwise logistic regression to predict 1-year mortality, a model with GRACE risk score and 4 characteristics (education, employment, body mass index [kg/m2], and statin use within 24 hours after admission) had higher discrimination than the GRACE risk score alone (area under the curve, 0.800 vs 0.773; P comparison=.003). Conclusion In this study, women, compared with men, had higher 1-year mortality after premature ACS. The social determinants of health (no formal education or employment) were strongly associated with higher 1-year mortality after premature and non-premature ACS, improved mortality prediction, and should be routinely considered in risk assessment after ACS.
Collapse
Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine and Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait
| | - Wafa Rashed
- Division of Cardiology, Mubarak Al Kabeer Hospital, Kuwait University, Kuwait
| | | | - Zuhur Balayah
- Bayes Business School, Centre for Health Care Innovation Research, University of London, UK
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| |
Collapse
|
13
|
Foverskov E, White JS, Norredam M, Frøslev T, Kim MH, Glymour MM, Pedersen L, Sørensen HT, Hamad R. Neighbourhood socioeconomic disadvantage and psychiatric disorders among refugees: a population-based, quasi-experimental study in Denmark. Soc Psychiatry Psychiatr Epidemiol 2023; 58:711-721. [PMID: 35597890 PMCID: PMC9676407 DOI: 10.1007/s00127-022-02300-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Refugees are vulnerable to psychiatric disorders because of risk factors linked to migration. Limited evidence exist on the impact of the neighbourhood in which refugee resettle. We examined whether resettling in a socioeconomically disadvantaged neighbourhood increased refugees' risk of psychiatric disorders. METHODS This register-based cohort study included 42,067 adults aged 18 years and older who came to Denmark as refugees during 1986-1998. Resettlement policies in those years assigned refugees in a quasi-random fashion to neighbourhoods across the country. A neighbourhood disadvantage index was constructed using neighbourhood-level data on income, education, unemployment, and welfare receipt. Main outcomes were psychiatric diagnoses and psychiatric medication usage ascertained from nationwide patient and prescription drug registers, with up to 30-year follow-up. Associations of neighbourhood disadvantage with post-migration risk of psychiatric disorders were examined using Cox proportional hazards and linear probability models adjusted for individual, family, and municipality characteristics. RESULTS The cumulative risk of psychiatric diagnoses and medication was 13.7% and 46.1%, respectively. Refugees' risk of psychiatric diagnoses and psychiatric medication usage was higher among individuals assigned to high-disadvantage compared with low-disadvantage neighbourhoods in analyses including fixed effects for assigned municipality (psychiatric diagnoses: hazard ratio (HR) = 1.14, 95% CI 1.04, 1.25; psychiatric medication: HR = 1.05, 95% CI 1.00, 1.11). Consistent results were found using linear probability models. Results for diagnostic categories and subclasses of medications suggested that the associations were driven by neurotic and stress-related disorders and use of anxiolytic medications. CONCLUSION Resettlement in highly disadvantaged neighbourhoods was associated with an increase in refugees' risk of psychiatric disorders, suggesting that targeted placement of newly arrived refugees could benefit refugee mental health. The results contribute quasi-experimental evidence to support links between neighbourhood characteristics and health.
Collapse
Affiliation(s)
- Else Foverskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA.
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Marie Norredam
- Danish Research Centre for Migration, Department of Public Health, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Kim MH, Foverskov E, Frøslev T, White JS, Glymour MM, Hainmueller J, Pedersen L, Sørensen HT, Hamad R. Neighborhood disadvantage and the risk of dementia and mortality among refugees to Denmark: A quasi-experimental study. SSM Popul Health 2022; 21:101312. [PMID: 36589275 PMCID: PMC9795514 DOI: 10.1016/j.ssmph.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/08/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Min Hee Kim
- Philip 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.
| | - Else Foverskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Justin S. White
- Philip 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, USA
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jens Hainmueller
- Department of Political Science, Stanford University, Stanford, CA, USA
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark,Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Rita Hamad
- Philip 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, USA
| |
Collapse
|
15
|
Foverskov E, White JS, Frøslev T, Sørensen HT, Hamad R. Risk of Psychiatric Disorders Among Refugee Children and Adolescents Living in Disadvantaged Neighborhoods. JAMA Pediatr 2022; 176:1107-1114. [PMID: 36094528 PMCID: PMC9468942 DOI: 10.1001/jamapediatrics.2022.3235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/10/2022] [Indexed: 12/15/2022]
Abstract
Importance Refugee children and adolescents are at increased risk of mental health difficulties, but little is known about how the characteristics of the neighborhood in which they resettle may affect vulnerability and resilience. Objective To test whether neighborhood socioeconomic disadvantage is associated with risk of psychiatric disorders among refugee children and adolescents and examine whether the association differs by sex, age at arrival, and family structure. Design, Setting, and Participants This quasi-experimental register-based cohort study included refugees in Denmark aged 0 to 16 years at the time of resettlement from 1986 to 1998. A refugee dispersal policy implemented during those years assigned housing to refugee families in neighborhoods with varying degrees of socioeconomic disadvantage in a quasi-random (ie, arbitrary) manner conditional on refugee characteristics observed by placement officers. Cox proportional hazard models were used to examine the association between neighborhood disadvantage and risk of psychiatric disorders, adjusting for relevant baseline covariates. Exposures A neighborhood disadvantage index combining information on levels of income, education, unemployment, and welfare assistance in the refugees' initial quasi-randomly assigned neighborhood. Main Outcomes and Measures First-time inpatient or outpatient diagnosis of a psychiatric disorder before age 30 years. Results Median (IQR) baseline age in the sample of 18 709 refugee children and adolescents was 7.9 (4.7-11.7) years; 8781 participants (46.9%) were female and 9928 (53.1%) were male. During a median (IQR) follow-up period of 16.1 (10.2-20.8) years, 1448 refugees (7.7%) were diagnosed with a psychiatric disorder (incidence rate, 51.2 per 10 000 person-years). An increase of 1 SD in neighborhood disadvantage was associated with an 11% increase in the hazard of a psychiatric disorders (hazard ratio [HR], 1.11; 95% CI, 1.03-1.21). This association did not differ between male and female individuals, refugees who arrived at different ages, or those from single- vs dual-parent households. In secondary analyses using prescribed psychiatric medication as the outcome, a similar association with neighborhood disadvantage was found (HR, 1.08; 95% CI, 1.03-1.14). Conclusions and Relevance In this cohort study, neighborhood disadvantage was associated with an increase in risk of psychiatric disorders. The results suggest that placement of refugee families in advantaged neighborhoods and efforts to enhance the neighborhood context in disadvantaged areas may improve mental health among refugee children and adolescents.
Collapse
Affiliation(s)
- Else Foverskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Clinical Excellence Research Center, Stanford University, Stanford, California
| | - Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Family & Community Medicine, University of California, San Francisco
| |
Collapse
|
16
|
Wang G, Schwartz GL, Kershaw KN, McGowan C, Kim MH, Hamad R. The association of residential racial segregation with health among U.S. children: A nationwide longitudinal study. SSM Popul Health 2022; 19:101250. [PMID: 36238814 PMCID: PMC9550534 DOI: 10.1016/j.ssmph.2022.101250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Residential racial segregation in the U.S. has been hypothesized as a fundamental cause driving health disparities across racial groups. Potential mechanisms include economic and social marginalization, subsequent constrained opportunities, and high stress. Yet evidence on residential segregation's association with health among Black and White children-particularly longitudinally-is sparse. This study aims to address this gap. We used data from the Panel Study of Income Dynamics (PSID), a national longitudinal study of U.S. households, analyzing information on 1,251 Black and 1,427 White children who participated in the Child Development Supplement (CDS) at least twice (survey waves 1997, 2002, 2007, 2014). We fit individual fixed-effects models to estimate the within-person association of neighborhood-level residential segregation, measured with local Getis-Ord G* statistics, with three outcomes (general health, weight status, and behavioral problems). We examined heterogeneous effects by age and sex. We also examined associations between health and childhood segregation trajectories, i.e., the pattern of children's residential segregation exposures from birth through when their health outcomes were measured, providing additional insight on dynamic experiences of segregation. In fixed effects models, among Black children, higher segregation was associated with worse self-rated health, especially for Black children who were older (aged 11-17 years). In trajectory models, among White children, moving out of highly segregated neighborhoods was associated with a lower probability of poor self-rated health, while moving into those neighborhoods or back and forth between neighborhood types were both associated with increased behavioral problems. Our findings highlight the importance of early-life residential segregation in shaping persistent racial health disparities, as well as the costs of segregation for all children living in highly segregated neighborhoods.
Collapse
Affiliation(s)
- Guangyi Wang
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Gabriel L. Schwartz
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Kiarri N. Kershaw
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Cyanna McGowan
- Northwestern University Feinberg School of Medicine, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Min Hee Kim
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| | - Rita Hamad
- UCSF Philip R. Lee Institute for Health Policy Studies, 490 Illinois St, 7th Floor, San Francisco, CA, 94158, United States
| |
Collapse
|
17
|
Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
|
18
|
Noppert GA, Martin CL, Zivich PN, Aiello AE, Harris KM, O'Rand A. Adolescent neighborhood disadvantage and memory performance in young adulthood. Health Place 2022; 75:102793. [PMID: 35367864 PMCID: PMC9721118 DOI: 10.1016/j.healthplace.2022.102793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/28/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Using data from the National Longitudinal Study of Adolescent to Adult Health, we estimated the average causal effect of neighborhood disadvantage in adolescence on memory performance in young adulthood. We contrasted several different ways of operationalizing a continuous measure of neighborhood disadvantage including a continuous neighborhood disadvantage score and ordinal measures. RESULTS Neighborhood disadvantage was measured in Wave I when participants were a mean age of 15.41 years (SE: 0.12) and memory performance was measured in Wave IV when participants were a mean age of 28.24 years (SE: 0.12). We found that adolescent neighborhood disadvantage was associated with decreased memory performance in young adulthood. Notably, we observed a linear decline in word recall score among those in the less disadvantaged tail of the distribution (neighborhood disadvantage <1), a finding not observed using traditional ordinal variable classifications of disadvantage. CONCLUSION Experiencing neighborhood disadvantage in adolescence may have lasting impacts on cognitive health throughout the life course.
Collapse
Affiliation(s)
| | - Chantel L Martin
- Carolina Population Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Paul N Zivich
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | | | - Angela O'Rand
- Duke University Population Research Institute, Duke University, USA
| |
Collapse
|
19
|
Al-Rousan T, AlHeresh R, Saadi A, El-Sabrout H, Young M, Benmarhnia T, Han BH, Alshawabkeh L. Epidemiology of cardiovascular disease and its risk factors among refugees and asylum seekers: Systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 12:200126. [PMID: 35199106 PMCID: PMC8851152 DOI: 10.1016/j.ijcrp.2022.200126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/31/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023]
Abstract
Background Methods and results Conclusions
Collapse
Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Corresponding author. Herbert Wertheim School of Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - Rawan AlHeresh
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hannah El-Sabrout
- University of California San Francisco Medical School, San Francisco, CA, USA
| | - Megan Young
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Benjamin H. Han
- Division of Geriatrics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Laith Alshawabkeh
- Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
20
|
Pase MP, Rowsthorn E, Cavuoto MG, Lavale A, Yassi N, Maruff P, Buckley RF, Lim YY. Association of Neighborhood-Level Socioeconomic Measures With Cognition and Dementia Risk in Australian Adults. JAMA Netw Open 2022; 5:e224071. [PMID: 35333361 PMCID: PMC8956972 DOI: 10.1001/jamanetworkopen.2022.4071] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Up to 40% of dementia cases are potentially preventable; therefore, it is important to identify high-risk groups to whom resources could be targeted for maximal impact in preventing late-life dementia. The association of neighborhood-level socioeconomic status (SES) with cognition and dementia risk is not well known, particularly in midlife when late-life dementia may still be preventable through established interventions, such as blood pressure management. OBJECTIVE To examine whether neighborhood-level SES is associated with differences in cognitive performance and dementia risk scores. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data collected between November 17, 2016, and April 14, 2020, from 4656 participants in the longitudinal population-based Healthy Brain Project cohort. This large online cohort comprised community-dwelling individuals geographically dispersed across Australia. Participants were aged 40 to 70 years without dementia or other major neurological conditions. EXPOSURES Neighborhood-level SES was computed by matching participants' residential addresses to the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Postcodes provided by each participant were used to derive an IRSAD score that ranked participants according to deciles of neighborhood-level SES (range, 1-10, with higher deciles indicating greater socioeconomic advantage); neighborhoods in deciles 1 to 7 were considered to have low or intermediate SES, and neighborhoods in deciles 8 to 10 were considered to have high SES. MAIN OUTCOMES AND MEASURES Dementia risk estimated using the dementia risk score from the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) tool (n = 4656) and cognitive composite scores for memory and attention measured by the Cogstate Brief Battery (n = 2181). RESULTS Of 4656 participants (mean [SD] age, 56.1 [7.2] years; 3445 women [74.0%]), 2688 individuals (57.7%) lived in areas with high neighborhood-level SES (IRSAD decile ≥8), and 1968 (42.3%) lived in areas with low or intermediate neighborhood-level SES (IRSAD decile <8), with 1263 individuals (27.1%) residing in rural or regional areas. A total of 6 participants (0.1%) identified as African, 121 (2.6%) as Asian, 57 (1.2%) as Indigenous Australian, 24 (0.5%) as Latin American, 9 (0.2%) as Pacific Islander, 3671 (78.8%) as White or European, and 768 (16.5%) indicated other race (not specified). Each decile unit increase in neighborhood-level SES was associated with a lower CAIDE dementia risk score after adjustment for race and rurality (β [SE] = -0.070 [0.019]; P = .004). Each decile unit increase was also associated with better memory (β [SE] = 0.022 [0.006]; P = .006) but not with better attention (β [SE] = 0.009 [0.007]; P = .34), as measured by Cogstate Brief Battery composite z scores after adjustment for age, sex, race, years of education, and rurality. When comparing memory performance between individuals with IRSAD scores higher and lower than decile 8, neighborhood-level SES interacted with age (F1-2171 = 6.33; P = .02) and CAIDE dementia risk scores (F1-2173 = 4.02; P = .08). Differences in memory between neighborhood-level SES categories were larger among participants who were older and had a higher risk of dementia. CONCLUSIONS AND RELEVANCE In this study, higher neighborhood-level SES was associated with better memory and lower dementia risk scores. These results suggest that efforts to lower dementia risk factors in disadvantaged areas are needed to curtail the increasing burden of dementia and that inclusion of individuals living in areas with lower SES in research on dementia is warranted to improve understanding and potential interventions.
Collapse
Affiliation(s)
- Matthew P. Pase
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ella Rowsthorn
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Marina G. Cavuoto
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Alexandra Lavale
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Paul Maruff
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Cogstate Ltd, Melbourne, Victoria, Australia
| | - Rachel F. Buckley
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
21
|
Affiliation(s)
- Rita Hamad
- From the Department of Family & Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
| |
Collapse
|
22
|
Agyemang C, Norredam M. Neighborhood Environment Has a Profound Association With Refugees' Health. JAMA Netw Open 2020; 3:e2014355. [PMID: 32821918 DOI: 10.1001/jamanetworkopen.2020.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, University of Amsterdam, the Netherlands
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| |
Collapse
|