TY - JOUR
T1 - Neighborhood Disadvantage and Birth Outcomes Among Refugees
AU - Foverskov, Else
AU - White, Justin S
AU - Frøslev, Trine
AU - Pedersen, Lars
AU - Sørensen, Henrik T
AU - Hamad, Rita
N1 - Copyright © 2024 by the American Academy of Pediatrics.
PY - 2024
Y1 - 2024
N2 - OBJECTIVE: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.METHODS: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement.RESULTS: Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations.CONCLUSIONS: Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.
AB - OBJECTIVE: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.METHODS: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement.RESULTS: Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations.CONCLUSIONS: Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation.
KW - Humans
KW - Refugees/statistics & numerical data
KW - Female
KW - Infant, Newborn
KW - Pregnancy
KW - Adult
KW - Pregnancy Outcome/epidemiology
KW - Infant, Low Birth Weight
KW - Premature Birth/epidemiology
KW - Denmark/epidemiology
KW - Young Adult
KW - Socioeconomic Factors
KW - Registries
KW - Infant, Small for Gestational Age
KW - Neighborhood Characteristics
KW - Residence Characteristics
U2 - 10.1542/peds.2024-065750
DO - 10.1542/peds.2024-065750
M3 - Journal article
C2 - 39429017
VL - 154
JO - Pediatrics
JF - Pediatrics
SN - 0031-4005
IS - 5
M1 - e2024065750
ER -