Income inequality and health: Lessons from a refugee residential assignment program

Grönqvist, Hans; Johansson, Per; Niknami, Susan

doi:10.1016/j.jhealeco.2012.05.003

Cited by 28 publications

(38 citation statements)

References 50 publications

(57 reference statements)

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“…Instead, we followed prior research in which the sample was identified based on the year and region of migration to Sweden. 2, 14 Government statistics show that most immigrants to Sweden during the study period were refugees (46.5%) or those moving to rejoin family members (i.e., “tied movers”) (47.7%), compared to labor immigrants (0.6%), guest students (2.4%), or adopted children (2.7%). Adopted children and many students would not meet our age inclusion criterion, and we exclude tied movers.…”

Section: Discussionmentioning

confidence: 98%

“…In our search of the broader literature on neighborhood health effects, we found no other randomized trials and one quasi-experimental study, which found no relationship between neighborhood-level income inequality and hospitalization risk. 2 …”

Section: Figurementioning

confidence: 99%

“…14–16 Only one has examined health, finding that neighborhood income inequality was not associated with risk of hospitalization. 2 A significant contribution of the present study is the follow-up period of more than 20 years, longer than existing experimental or quasi-experimental studies of neighborhoods and health.…”

Section: Introductionmentioning

confidence: 96%

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Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden

White

Hamad

et al. 2016

The Lancet Diabetes & Endocrinology

103

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SUMMARY Background While numerous studies have shown associations between neighborhood quality and chronic disease outcomes, such correlations are potentially confounded by selection of different types of people into different neighborhood environments. We sought to identify the causal effects of neighborhood deprivation on type 2 diabetes risk, by comparing refugees to Sweden who were actively dispersed by government policy to low-, moderate-, or high-deprivation neighborhoods. Methods We studied national register data on N=61,386 refugees who arrived in Sweden at age 25–50 during 1987–1991, a period of quasi-random dispersal of refugees to Swedish neighborhoods varying in poverty, unemployment levels, schooling, and social welfare participation. Individuals in our sample were assigned to one of 4,833 neighborhoods, categorized as high-deprivation” (≥1 SD above the mean), “moderate deprivation” (within 1 SD of the mean), or “low-deprivation” (≥1 SD below the mean). The primary outcome was diagnosis with type 2 diabetes measured through 2010. We 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. Findings Being assigned to an area deemed high-deprivation versus low-deprivation was associated with an increased risk of diabetes among refugees (OR 1·22, 95% CI: 1·07, 1·38; p=0·001). In analyses that included fixed effects for assigned municipality, the increased diabetes risk was estimated to be 0·85 percentage points (−0·030, 1·728; p=0·058). Neighborhood effects grew over time, such that 5 years of additional exposure to high-deprivation versus low-deprivation neighborhoods was associated with a 9% increase in diabetes risk. Interpretation This study leverages a natural experiment to show that neighborhood deprivation increased the risk of diabetes among refugees to Sweden. This finding has heightened significance in the context of the current refugee crisis in Europe. Funding U.S. National Heart, Lung, and Blood Institute, U.S. National Center for Advancing Translational Sciences, U.S. National Institute on Minority Health and Health Disparities, Swedish Research Council.

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Section: Discussionmentioning

confidence: 98%

Section: Figurementioning

confidence: 99%

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Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden

White

Hamad

et al. 2016

The Lancet Diabetes & Endocrinology

103

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“…Few studies have exploited the quasi-experimental feature of dispersal policies to assess health outcomes. One of these has assessed the association between neighbourhood income inequality (based on the Gini coefficient) and the risk of being admitted to hospitals among refugees in Sweden and found no statistically significant effect of the exposure on the outcome 25. Another study from Sweden created a historical cohort to test the hypothesis that neighbourhood deprivation affects the development of type 2 diabetes among refugees quasi-randomly assigned to neighbourhoods throughout the country 26.…”

Section: Discussionmentioning

confidence: 99%

Regional deprivation is associated with the distribution of vulnerable asylum seekers: a nationwide small area analysis in Germany

Bozorgmehr

Razum

Szécsényi

et al. 2017

J Epidemiol Community Health

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“…A considerable body of research demonstrates the impact of societal-level distribution of income on health, and mortality (Marmot and Wilkinson 1999;Raphael 2004;Auger and Raynault 2006;Gronqvist et al 2012). People who live in areas with higher income inequality have poorer health and higher mortality rates (Gronqvist et al 2012).…”

Section: Economic Environmentmentioning

confidence: 99%

Refuge and Resilience

Simich¹,

Andermann²

2014

International Perspectives on Migration

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The series publishes original scholarly books that advance our understanding of international migration and immigrant integration. Written by academic experts and policy specialists, each volume addresses a clearly defined research question or theme, employs critical analysis and develops evidence-based scholarship. The series includes single-or multi-authored monographs, volumes and edited collections.The scope of the series is international migration and integration research. Topics include but are not limited to thematic and current issues and debates; comparative research of a regional, national or international nature; the changing character of urban areas in which migrants or refugees settle; the reciprocal influence of migrants/ refugees and host communities; issues of integration and social inequality as well as policy analysis in migration research.

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Income inequality and health: Lessons from a refugee residential assignment program

Cited by 28 publications

References 50 publications

Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden

Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden

Regional deprivation is associated with the distribution of vulnerable asylum seekers: a nationwide small area analysis in Germany

Refuge and Resilience

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