Immigrant enclaves and risk of diabetes: a prospective study.

Briana Mezuk,Xinjun Li,Jan Sundquist,Klas Cederin,Kristina Sundquist,Kristen Rice,Kenneth S Kendler

doi:10.1186/1471-2458-14-1093

Abstract

BackgroundThe diversity of the Swedish population has increased substantially over the past three decades. The aim of this study was to assess whether living in an ethnic enclave is associated with risk of diabetes mellitus (DM) among first and second-generation immigrants and native Swedes.MethodsCumulative incidence of DM in three urban municipalities was assessed from 2006–2010 by linking records from the national census, multi-generational family register, and prescription drug register. Immigrant enclaves were identified using Moran’s Index. Multi-level logistic regression was used to assess the relationship between enclave residence and risk of DM for three groups: Iraqi immigrants, non-Iraqi immigrants, and native Swedes (N = 887,603).ResultsThe cumulative incidence of DM was greater in Iraqi enclaves compared to other neighborhoods (4.7% vs. 2.3%). Among Iraqi immigrants, enclave residence was not associated with odds of DM (Odds ratio (OR): 1.03, 95% Confidence Interval (CI): 0.86 – 1.24). Among other immigrants, enclave residence was not associated with DM after accounting for neighborhood deprivation. Among native Swedes, enclave residence was associated with elevated risk of DM even after accounting for neighborhood deprivation and individual-level characteristics (OR: 1.23, 95% CI: 1.11 – 1.36).ConclusionsResidential ethnic composition is associated with DM but this relationship differs across ethnic group. Enclave residence is not associated with increased odds of DM for immigrants, regardless of their nation of origin, but it is associated with increased likelihood of DM for native Swedes.

Highlights

The diversity of the Swedish population has increased substantially over the past three decades
The aim of this study was to assess whether living in an ethnic enclave is associated with risk of diabetes mellitus (DM) among first and second-generation immigrants and native Swedes
This elevated risk was seen in all subpopulations living in the enclaves, but the difference was least pronounced for the Iraqi immigrants

Summary

Introduction

The diversity of the Swedish population has increased substantially over the past three decades. The aim of this study was to assess whether living in an ethnic enclave is associated with risk of diabetes mellitus (DM) among first and second-generation immigrants and native Swedes. In 2000, over 171 million adults had diabetes mellitus (DM) worldwide, and the prevalence of this condition is projected to increase substantially over the 15 years [1]. There is a growing appreciation of the role that contextual environmental factors (e.g., “neighborhood” factors) may have on health. Neighborhoods have both physical (e.g., access to services, greenspace, availability of grocery, alcohol and tobacco outlets) and social (e.g., community unemployment, segregation, social capital, crime) attributes that may influence health [5]. Neighborhood deprivation and attributes of the physical environment (e.g. resources for physical activity, access to healthy food) have been associated with type 2

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