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 Researchers analyzed data for more than 61,000 refugees who arrived
in Sweden from 1987 to 1991 to see how many of them developed
diabetes roughly two decades after settling into their new
communities.
“Our study takes advantage of a natural experiment the Swedish
government unwittingly created when it dispersed refugees across the
country, more or less at random, to ease labor market conditions and
help new arrivals integrate more easily into Swedish society,” said
lead study author Justin White, a health economics researcher at the
University of California, San Francisco.
“After two decades, refugees who had been assigned to the most
deprived neighborhoods were 15 percent more likely to develop type 2
diabetes than those in the least deprived neighborhoods,” White
added by email.
Globally, about one in nine adults have diabetes, and the disease
will be the seventh leading cause of death by 2030, according to the
World Health Organization.
Most of these people have what’s known as type 2 diabetes, which
happens when the body can't properly use or make enough of the
hormone insulin to convert blood sugar into energy. Advanced age,
obesity and stress are among the factors that can lead to this type
of diabetes.
To see how different settlement communities influenced the odds of
diabetes among refugees, White and colleagues used data on poverty,
unemployment, schooling and welfare enrollment to sort neighborhoods
into three groups based on overall deprivation levels.
Then, they looked at how many refugees were diagnosed with new cases
of diabetes from 2002 to 2010 and mapped these cases to the level of
deprivation in the communities where people lived.
Refugees included in the study were from 25 to 50 years old and most
were married with children. Half of them came from Iran or
Arabic-speaking parts of the Middle East and northern Africa, while
10 percent came from other parts of Africa, 19 percent from Eastern
Europe and 14 percent arrived from Latin America.
Most refugees settled in larger cities, with 47 percent in
high-deprivation areas and another 45 percent in
moderate-deprivation communities.
Overall, about 4,500 of them developed diabetes, or 7.4 percent of
the study population.
But when researchers sorted diabetes cases based on the neighborhood
characteristics, they found 7.9 percent developed diabetes in the
highest deprivation areas, compared with just 5.8 percent in the
least deprived communities.
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One limitation of the study is that even though researchers focused
on a period in Swedish history when most refugees were randomly
assigned to housing, they can’t be certain all refugees in the study
were in fact subject to this policy. It’s possible some refugees
selected their own housing, and the factors influencing this might
also impact their odds of developing diabetes.
The study can’t prove that bad neighborhoods cause diabetes or show
which specific types of deprivation – like poverty or bad schools –
might be most responsible for the added disease risk.
“It could be related to a variety of effects – such as poorer access
to healthy food, less opportunity for physical activity, perhaps
greater psychological stress which of itself might increase diabetes
risk,” said Nigel Unwin, a professor at the Chronic Disease Research
Center at the University of the West Indies and author of an
accompanying editorial.
Still, the findings highlight a need to consider the health impacts
of neighborhoods when assigning refugees to housing as Europe
grapples with high unemployment and historically high numbers of
incoming refugees, the authors conclude.
“It’s well known that people living in poorer neighborhoods in high
income countries, such as in North America or Western Europe, tend
to have higher rates of chronic health problems including obesity,
type 2 diabetes, and greater risk of stroke and heart attack,” Unwin
added by email.
“It could simply be that the people who are unable to afford to live
in more affluent neighborhoods are at greater risk of these
conditions, perhaps related to poorer education and a greater
prevalence of unhealthy behaviors,” Unwin added.
SOURCE: http://bit.ly/1SPafn1 and http://bit.ly/1VLuR1T The Lancet
Diabetes and Endocrinology, online April 27, 2016.
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