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Open AccessArticle

Neighborhood Deprivation and Risks of Autoimmune Disorders: A National Cohort Study in Sweden

Center for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden
Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Izumo 690-2406, Japan
Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto 520-0461, Japan
Department of Functional Pathology, Shimane University School of Medicine, Izumo 690-2406, Japan
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(20), 3798;
Received: 5 September 2019 / Revised: 2 October 2019 / Accepted: 4 October 2019 / Published: 9 October 2019
(This article belongs to the Section Environmental Health)
Background: No study to date, as far as we know, has analyzed the potential effect of neighborhood-level deprivation on autoimmune disorders (ADs), when adjusted for individual-level characteristics. Methods: A total of 5.4 million individuals from 8363 neighborhoods, comprising the whole Swedish population (ages 25–74 years), were followed for the period 1 January 2000, until admission due to diagnosis of ADs during the period of the study, or the conclusion of the study (31 December 2010). We used a neighborhood deprivation index, constructed from variables such as low education, low income, unemployment, and social welfare assistance, to assess the level of neighborhood deprivation. Multilevel logistic regression was used in the analysis with individual level characteristics at the first level and level of neighborhood deprivation at the second level. Results: A significant association between level of neighborhood deprivation and ADs was found. The crude odds were 1.32 (95% confidence interval 1.27–1.36) for those residing in the high-deprived neighborhoods compared to those living in low-deprivation neighborhoods. In the full model, where individual level characteristics were taken into account, the odds of ADs were 1.18 (1.14–1.22) in the most deprived neighborhoods. Certain Ads—angiitis hypersensitive (5.14), ankylosing spondylitis (1.66), celiac disease (1.65), Crohn’s disease (1.21), diabetes mellitus type 1 (1.45), Graves’s disease (1.13), Hashimoto thyroiditis (1.51), psoriasis (1.15), rheumatoid arthritis (1.15), sarcoidosis (1.20), and systemic sclerosis (1.27)—remained significantly associated with high level of neighborhood deprivation after adjustment for the individual-level variables. Conclusion: This study is the largest to date analyzing the potential influence of neighborhood deprivation on ADs. Our results indicate that neighborhood deprivation may affect risk of ADs, independent of individual level sociodemographic characteristics. For health care policies, both individual and neighborhood level approaches seem to be of importance. View Full-Text
Keywords: autoimmune disorders; neighborhood deprivation; risk factors; Sweden autoimmune disorders; neighborhood deprivation; risk factors; Sweden
MDPI and ACS Style

Li, X.; Sundquist, J.; Hamano, T.; Sundquist, K. Neighborhood Deprivation and Risks of Autoimmune Disorders: A National Cohort Study in Sweden. Int. J. Environ. Res. Public Health 2019, 16, 3798.

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