The researchers also reported that half of the refugees moved away from their initial assigned neighborhood during the 10 years after their arrival in Sweden,1 noting that moving to a less deprived neighborhood may mitigate the adverse effects of living in a more deprived area. However, in the study, initial neighborhood deprivation level appeared to be strongly linked to deprivation level in the neighborhood of residence after 5, 10, and 15 years, “suggesting that initial assignment had long-term consequences on residential decisions and might be a mediating pathway through which initial neighborhood placement affected diabetes risk.”1

The study had some limitations, the researchers noted, including the fact that register data did not indicate which refugees were subject to the dispersal policy, Sweden’s comprehensive social welfare program, the exclusion of areas with fewer than 50 residents, among others.


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Results Are Relevant

Although these findings are based on data from several decades ago, they may be particularly pertinent in light of current events, Dr White explained.

“Our study has direct relevance to the ongoing period of immigration to Europe. Because of the historically high numbers of incoming refugees, combined with already high unemployment rates, the new entrants are encountering less hospitable political and social environments,” he said, noting that these conditions could contribute to existing public health concerns. “Our data suggest that decisions affecting the settlement and integration of immigrants can have long-term consequences for the health of the new arrivals, and that these societies may end up paying the price decades later if refugees do not receive adequate support up front.”

Moreover, these patients may require more consideration due to their circumstances, Dr White added.

“Refugees are among the most vulnerable populations in any society, and as such deserve special attention from governments in creating policies that protect and promote their health,” he said. “Future studies should also consider the effects of dispersal policies and neighborhood deprivation on other factors such as mental health or child health.”

Clinical Perspective

In a linked comment, also published in The Lancet Diabetes & Endocrinology, Nigel Unwin, BM, BCh, MSc, DM, and Ian R. Hambleton, MSc, PhD, both from the Chronic Disease Research Centre at the University of West Indies in Barbados, noted that these findings are consistent with those from a previous study conducted in the United States demonstrating an association between living in a less deprived area and lower risk for obesity and type 2 diabetes.3

“Although White and colleagues’ study clarifies little about the mechanisms of the increased risk associated with moving to a deprived area, it emphasizes the need to understand them to inform preventive interventions,” Drs Hambleton and Unwin, who is also with the MRC Epidemiology Unit at the University of Cambridge in the United Kingdom, wrote. “The findings also support the notion that the most effective approaches to prevention will entail addressing both neighborhood and individual level factors.”

References

  1. White JS, Hamad R, Basu S, et al. Long-term effects of neighbourhood deprivation on diabetes risk: quasi-experimental evidence from a refugee dispersal policy in Sweden. Lancet Diabetes Endocrinol. 2016. doi:10.1016/S2213-8587(16)30009-2.
  2. Unwin N, Hambleton IR. Neighbourhood of residence and the risk of type 2 diabetes. Lancet Diabetes Endocrinol. 2016. doi:10.1016/S2213-8587(16)30056-0.
  3. Ludwig J, Sanbonmatsu L, Gennetian L, et al. Neighborhoods, Obesity, and Diabetes — A Randomized Social Experiment. N Engl J Med. 2011; 365:1509-1519. doi:10.1056/NEJMsa1103216.