20 Oct Does Changing Zip Codes Change Your Risk of Chronic Health Conditions?
MedicalResearch.com Interview with:
Aaron Baum, PhD
Assistant Professor, Department of Health System Design & Global Health
Economist, Arnhold Institute for Global Health
Icahn School of Medicine at Mount Sinai Health System
MedicalResearch.com: What is the background for this study?
Response: To what degree are geographic health disparities in the leading risk factors for morbidity and mortality in the United States – including elevated blood pressure and blood sugar, obesity, and poor mental health – driven by the place where people live versus by characteristics of the people who live in different places?
For example, male adults in Mississippi are 33% more likely to have uncontrolled blood pressure and 54% more likely to be obese than male adults in Colorado. One explanation is that male adults who live in Mississippi are different is many other ways from male adults in Colorado, some of which can’t be directly measured and adjusted for, and that those unobserved differences cause the health disparity. Another possibility is that the place where a person lives actually contributes to the health disparity.
Using national electronic health records from the Veterans Health Administration, we conducted a retrospective cohort study of 5 million adults, including 1 million who moved zip codes exactly once between 2008-2018. Our goal was to isolate how a movers’ likelihood of uncontrolled blood pressure, uncontrolled diabetes, obesity and depression changed in response to changes in the prevalence of each outcome in his or her environment.
MedicalResearch.com: What are the main findings?
Response: We found that moving from a 10th to 90th percentile zip code for a given outcome was associated with a significantly increased prevalence of uncontrolled blood pressure of 7 percentage points (from a baseline of 29%), uncontrolled diabetes of 1 percentage point (from a baseline of 7%), obesity of 2 percentage points (from a baseline of 39%), and depressive symptoms of 3 percentage points (from a baseline of 19%) among movers.
MedicalResearch.com: What should readers take away from your report?
Response: The findings suggest that where people live may impact their risk for common chronic conditions, particularly high blood pressure and depression. Unlike prior research, this study evaluated changes in direct measures of health within the same individual before and after the person moved to a new environment.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It remains unclear what local, environmental, and policy characteristics underlie the associations we observed between place of residence and changes in individuals’ likelihood of uncontrolled chronic conditions, and what behavioral and biological processes mediate the associations. Future research that combines medical records with prospectively collected survey measures and biospecimens among participants’ enrolled in large cohort studies who move between areas and that incorporate longitudinal data on changes in contextual factors would be well positioned to advance our understanding of the causes of geographic health disparities in the United States further.
Any disclosures? None.
Baum A, Wisnivesky J, Basu S, Siu AL, Schwartz MD. Association of Geographic Differences in Prevalence of Uncontrolled Chronic Conditions With Changes in Individuals’ Likelihood of Uncontrolled Chronic Conditions. JAMA. 2020;324(14):1429–1438. doi:10.1001/jama.2020.14381
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