Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
Pediatrics. 2024 Nov 1;154(5). doi: 10.1542/peds.2024-065750.
To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment.
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.
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.
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.
利用自然实验，考察丹麦难民女性的社区社会经济劣势与生育结果之间的关联。
本注册研究纳入了 1986 年至 1998 年期间作为难民抵达丹麦的 15118 名婴儿，当时实行了一项分散政策，该政策将新来者随机分配到社会经济劣势程度不同的社区。使用代表邻里层面收入、教育、失业和福利援助的综合指数来衡量邻里劣势。这些数据与个体层面的出生登记数据相关联。结果包括低出生体重、早产和小于胎龄儿。使用多变量回归，在调整了重新安置时女性特征的情况下，检验重新安置后 20 年内邻里劣势与生育结果之间的关联。
邻里劣势每增加一个标准差，低出生体重风险增加 18%（0.61 个百分点[95%置信区间：0.19-1.02]），早产风险增加 15%（0.64 个百分点，95%置信区间：0.22-1.07），小于胎龄儿风险增加 7%（0.78 个百分点，95%置信区间：0.01-1.54）。调整城市化和原籍国密度后结果无差异，但调整市一级固定效应后关联减弱，表明地方政府特征可能部分解释了关联。
在弱势社区重新安置与难民女性不良生育结果的风险增加相关。这突显了影响难民安置的政策决策如何具有长期后果，包括对下一代的健康。
