Characteristics of the built environment, including access to unhealthy food outlets, are hypothesized to contribute to type 2 diabetes mellitus (T2D). Swedish nationwide registry data on 4,718,583 adults aged 35-80 years living in 9,353 neighborhoods, each with at least 1 food outlet, were geocoded and linked to commercial registers (e.g., restaurants and grocery stores). Multilevel logistic regression was used to examine the prospective relationship between characteristics of the food environment and T2D from 2005 to 2010. Relative access to health-harming food outlets was associated with greater likelihood of both prevalent and incident T2D in a curvilinear manner, with the highest risk being observed for environments in which one-third of outlets were health-harming. Relative to individuals whose food environment did not change, those who moved into areas with more health-harming food outlets had higher odds of developing T2D (odds ratio = 3.67, 95% confidence interval: 2.14, 6.30). Among those who did not move, living in an area that gained relative access to health-harming food outlets was also associated with higher odds of T2D (odds ratio = 1.72, 95% confidence interval: 1.27, 2.33). These results suggest that local food environment, including changes that result in greater access to unhealthy food outlets, is associated with T2D.

Purpose Some non-Western immigrant groups in Europe have elevated risk of psychosis relative to native-born. It is hypothesized that neighborhood ethnic density moderates this risk. Immigration to Sweden has increased substantially recently, particularly from the Middle East. This study examined the relationship between neighborhood ethnic density (i.e., living in an immigrant enclave) and risk of psychotic and affective disorders among three groups: Iraqi immigrants, immigrants from other nations, and native-born Swedes. Methods Individuals aged 15 to 60, without prevalent psychopathology, were drawn from Swedish population-based registries and followed from 2005 to 2010 (N=1,442,931). Multi-level logistic regression was used to examine the association between neighborhood ethnic composition and incident psychopathology. Results Cumulative incidence of psychopathology was greater in Iraqi enclaves relative to predominantly Swedish neighborhoods (6.3% vs. 4.5%). Iraqis living in enclaves did not have significantly greater risk of psychosis (Odds Ratio (OR): 1.66, 95% Confidence Interval (CI): 0.92 – 2.97) or affective disorders (OR: 1.04, 95%CI: 0.85 – 1.27) relative to those in predominantly Swedish neighborhoods. There was no increased risk of psychosis (OR: 0.93, p>0.05) or affective disorders (OR: 0.93, p>0.05) for other immigrants living in an enclave. Swedes living in an enclave had elevated risk of both psychosis (OR: 1.37, p<0.05) and affective disorders (OR: 1.14, p<0.05) relative to those in predominantly Swedish neighborhoods. Second-generation Iraqis had higher risk of psychotic but not affective disorders relative to first-generation. Conclusions Neighborhood ethnic density does not moderate risk of psychopathology for immigrants in Sweden. Findings regarding Swedes are consistent with social drift.

The findings of this study can serve as a basis for distribution of health-care resources, preventive measures and exploration of aetiological factors.

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