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Who Moves After SCI? Individual, Health, and Neighborhood Predictors of Residential Mobility Among Participants in the National Spinal Cord Injury Model Systems Database
Abstract
Objective
To investigate residential mobility among community-living adults with spinal cord injury (SCI) and the individual, health, and neighborhood factors associated with the propensity to relocate.
Design
Retrospective analysis of data from the National SCI Model Systems (SCIMS) database collected between 2006 and 2018 and linked with the American Community Survey five-year estimates.
Setting
Community.
Interventions
Not applicable.
Participants
People with traumatic SCI who participated in two waves of follow-up and had residential geographic identifiers at the census tract level (N = 4,599).
Main Outcome Measures
Moving was a binary measure reflecting change in residential locations over a five-year interval. Move distance distinguished non-movers from local movers (different tracts within the same county) and long distance movers (to different county or state). Move quality included four categories: stayed/low poverty tract, stayed/high poverty tract, moved/low poverty tract, and moved/high poverty tract.
Results
One in four people moved within a five-year interval (n=1,175). Of the movers, 55% relocated to a different Census tract within the same county and 45% relocated to a different county or state. Thirty-five percent of all movers relocated to a high poverty Census tract. Racial and ethnic minorities, people from low income households, and younger adults were more likely to move, move locally, and relocate to a high poverty neighborhood. High poverty and racial/ethnic segregation in the origin neighborhood predicted an increased risk for remaining in or moving to a high poverty neighborhood.
Conclusions
Although people with SCI relocated at a lower rate than has been reported in the general population, moving was a frequent occurrence post-injury. People from vulnerable groups were more likely to remain in or relocate to socioeconomically disadvantaged neighborhoods, thus increasing the risk for health disparities and poorer long-term outcomes among minorities and people from low income households. These findings inform policy makers’ considerations of housing, healthcare, and employment initiatives for persons with SCI and other chronic disabilities.
... 5 Although we were unable to incorporate information on how long individuals have lived at their current address, it should be noted that people tend to stay in the same residence over time, 18 and relocation tends to occur between census tracts with similar neighborhood socioeconomic characteristics. 32,33 Future research should investigate the cognitive effects of changes in and critical periods of neighborhood racial income inequality. ...
INTRODUCTION
Neighborhood socioeconomic status (SES) has been linked to dementia, but the distribution of SES within a neighborhood may also matter.
METHODS
Data from 460 (47% Black, 46% White) older adults from the Michigan Cognitive Aging Project were linked to census tract–level data from the National Neighborhood Data Archive (NaNDA). Neighborhood SES included two composites reflecting disadvantage and affluence. Neighborhood racial income inequality was the ratio of median incomes for White versus Black residents. Generalized estimating equations examined associations between neighborhood factors and cognitive domains.
RESULTS
Neighborhood racial income inequality was uniquely associated with worse cognitive health, and these associations did not differ by participant race. Neighborhood disadvantage was only associated with worse cognitive health among Black participants.
DISCUSSION
Both the level and racial distribution of SES within a neighborhood may be relevant for dementia risk. Racial differences in the level and impact of neighborhood SES contribute to dementia inequalities.
Highlights
Black participants lived in neighborhoods with lower socioeconomic status (SES) than White participants, on average.
Neighborhood SES and racial income inequality were associated with worse cognition.
Effects of neighborhood racial income inequality did not differ across racial groups.
Effects of neighborhood SES were only evident among Black participants.
... There is evidence that people tend to reside in the same residence over time, 25,37,38 and when they do move, people tend to move between tracts with similar NSES. 39,40 Finally, in the current study, cognitive function was measured at a single ...
INTRODUCTION
Neighborhood characteristics are increasingly implicated in cognitive health disparities, but no research has investigated how the historical context of neighborhoods shapes these disparities.
METHODS
Four hundred sixty‐four Black (55%) and White older adults (Mage = 63.6) were drawn from the Michigan Cognitive Aging Project, a community‐based, prospective study of older adults. Participants’ addresses at baseline (2017–2020) were geocoded and linked to 2000–2017 measures of neighborhood socioeconomic status (NSES): disadvantage [NDis] and affluence [NAff]. Latent class growth analysis (LCGA) characterized 18 interpolated year trajectories of NSES across 1344 census tracts. Path analysis examined whether NSES trajectory classes mediated the association between race and a global cognition composite.
RESULTS
LCGA identified three NDis and two NAff trajectory classes, which were associated with participant race. Only one NDis class was associated with cognition, and it mediated the association between the Black race and cognition.
DISCUSSION
Disinvestment in neighborhoods may be particularly salient in race disparities in cognitive function.
Highlights
Race is implicated in the likelihood of living in more disadvantaged neighborhoods.
Historical trends in neighborhood disadvantage are associated with cognitive function in older adulthood.
Identifying patterns of neighborhood change may inform neighborhood‐level interventions.
Background
Residential mobility after spinal cord injury (SCI) has not been extensively examined despite a growing interest in investigating the relationship between neighborhood exposures and community living outcomes.
Objectives
This study explores residential mobility patterns, the annual move rate, and reasons for moving among a community-living sample of adults with SCI.
Methods
A survey was conducted with 690 people at six SCI Model Systems centers in the United States between July 2017 and October 2020. The outcomes included move status in the past 12 months, move distance, and the primary reason for moving. A sample from the 2019 American Community Survey (ACS) 5-year pooled estimates was obtained for comparative analysis. Descriptive statistics were used to summarize the distributions of the outcomes and differences between the samples.
Results
The annual move rate for adults with SCI was 16.4%, and most moves were within the same county (56.6%). Recent movers were more likely to be young adults, be newly injured, and have low socioeconomic status. Housing quality, accessibility, and family were more frequently reported motivations for moving compared to employment. Young adults more commonly moved for family and accessibility, whereas middle-aged adults more commonly moved for housing quality. No notable difference was observed in the annual move rate between the SCI and the general population samples.
Conclusion
These findings suggest an age-related pattern of residential relocation after SCI, which may be indicative an extended search for optimal living conditions that meet the housing and accessibility needs of this population.
Background:
People with spinal cord injury (SCI) suffer from complex secondary health conditions and rely on specialized health care services, which are often centralized and difficult to reach for individuals living in remote areas. As a consequence, they might move to regions where they expect better access to care. The aims of this study were: 1) to identify regions where people with SCI live compared with the general population, 2) to examine whether their choice of residence is related to the availability of local health care infrastructure, and 3) to ascertain determinants of their consideration to change residence when aging.
Methods:
This study used information from a nationwide Swiss SCI cohort and inpatient hospital discharge data. To detect clusters in the distribution of people with chronic SCI in Switzerland, a spatial cluster detection test was conducted using the normative population of a region as offset. To identify associations between the residential location of people with SCI and infrastructure variables, a negative binomial model was set up at a regional level with the frequency of people with SCI as outcome, geographical indicators as explanatory variables, and the normative population as offset. Determinants of the consideration to change residence when aging were investigated using logistic regression models.
Results:
People with SCI were not living equally distributed among the normative population, but clustered in specific areas. They were more likely than the general population to reside close to specialized SCI centers, in areas with a high density of outpatient physicians, and in urban regions. People with SCI living in rural areas were more likely to consider relocating when aging than those living in urban areas. However, only a few people with SCI considered moving closer to specialized centers when such a move required crossing language barriers.
Conclusions:
Good access to appropriate health care services and amenities of daily life seems to play such an important role in the lives of people with SCI that they are willing to choose their residential location based on local availability of appropriate health care services.
Objective:
To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.
Method:
Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.
Results:
Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.
Discussion:
Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.
Determining whether population dynamics provide competing explanations to place effects for observed geographic patterns of population health is critical for understanding health inequality. We focus on the working-age population-the period of adulthood when health disparities are greatest-and analyze detailed data on residential mobility collected for the first time in the 2000 U.S. census. Residential mobility over a five-year period is frequent and selective, with some variation by race and gender. Even so, we found little evidence that mobility biases cross-sectional snapshots of local population health. Areas undergoing large or rapid population growth or decline may be exceptions. Overall, place of residence is an important health indicator; yet, the frequency of residential mobility raises questions of interpretation from etiological or policy perspectives, complicating simple understandings that residential exposures alone explain the association between place and health. Psychosocial stressors related to contingencies of social identity associated with being black, urban, or poor in the United States may also have adverse health impacts that track with structural location even with movement across residential areas.
The 1975-1980 migration stream and net migration patterns of persons younger than 65 and 65 + were examined using data from the 1980 U.S. Census. Central cities and suburbs of metropolitan areas (SMSAs) and nonmetropolitan areas (NonSMSAs) were distinguished as origins and destinations. Most elderly movers relocated within a fairly limited geographic context and revealed strong preferences for metropolitan living. Suburban locations were more favored than central city locations. Net migration findings may provide misleading interpretations of older movers' locational choices. The migration patterns of the 65 + population were similar to those of the 45- to 64-year-old population but differed from those of the more youthful U.S. populations. These findings highlight migration streams of elderly movers who likely have experienced changed in their life styles or personal resources.
Objective:
To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI).
Design:
A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract.
Setting:
A total of 17 SCI Model Systems centers.
Participants:
Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts.
Intervention:
Not applicable.
Main outcome measures:
Body mass index (BMI) (kg/m2).
Results:
The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods.
Conclusions:
Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.
Disability rates are higher in rural than in urban areas of the United States, raising the question: do residential preferences and selective migration of people with disabilities play a role in higher rural disability rates? Utilising concepts of environmental fit from the disability literature and ideas from classic, residential preference, and household migration studies, we examine the 2011–2015 American Community Survey Public Use Microdata Sample to understand whether migration contributes to higher rural disability. Results show only slightly different propensities to stay in rural than in urban areas and similar destination choices of people with or without disability, suggesting that migration does little to explain higher rates of rural disability. However, we detect noteworthy differences in age migration schedules for persons with disability, persons without disability in households with disability, and persons without disability in households without disability. Disability emerges as a relevant, although underresearched, dimension in household migration research.
Engaging with the natural environment contributes to favourable psychosocial health outcomes. A systematic review of research published before June 2017 was conducted to establish how engaging with natural environments impact the psychosocial health of people with a neurological disability. Identified studies included populations with dementia (n=14), brain injury (n=2), and stroke (n=2). Evidence suggests that engaging with gardens, and gardening, can favourably impact the emotional and social health of people with dementia and, an explanatory theoretical model is proposed. Considerable research gaps exist and further research investigating the psychosocial impact of engaging with natural environments for people with different neurological conditions (for example spinal cord injury or stroke) is warranted.
Study design:
Secondary analysis of cross-sectional data from a multisite cohort study.
Objectives:
To analyze the association between the built environment and physical functioning reported by adults living with chronic spinal cord injury (SCI).
Setting:
Four US Spinal Cord Injury Model Systems centers in New Jersey, Colorado, Illinois, and Michigan.
Methods:
Participants were from the Spinal Cord Injury-Functional Index/Capacity (SCI-FI/C) development study. Survey data from N = 402 participants were geocoded for analysis. Geographic Information Systems (GIS) analysis was used to define five- and half-mile buffer areas around participants' residential addresses to represent the community and neighborhood environments, respectively, and to create measures of land use, residential density, destination density, and park space. The relationships between these built environment features and four domains of physical functioning-basic mobility, wheelchair mobility, self-care, and fine motor function-were modeled using ordinary least squares (OLS) regression.
Results:
People with paraplegia living in neighborhoods with more destinations and a nearby park reported higher levels of self-care functioning. For people with tetraplegia, living in a community with more destinations was associated with better wheelchair mobility and fine motor functioning, and living in a neighborhood with high land use mix was associated with higher fine motor functioning scores.
Conclusions:
The association between the built environment and functioning after SCI is supported and in need of further investigation. Understanding the environmental context of disability may lead to community-based interventions and effective public policy that will attenuate the experience of limitations and promote accessibility on a larger scale.
Background: One of the most critical threats to the validity of any longitudinal research is the bias caused by study attrition. Prevention efforts should be focused on those individuals at high risk of non-participation to improve the generalizability of study findings. Objective: To identify demographic and clinical factors associated with loss to follow-up (FU) at post-injury years 1 to 35 among 25,871 people with spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Database. Methods: Loss to FU was defined as no research information obtained from participants who were eligible for the planned data collection. Generalized linear mixed models were used for analysis of factors at each post-injury year. Results: The loss to FU rates were 23.1% and 32.9% for post-injury years 1 and 5, respectively, and remained >40% between post-injury years 20 and 35. The FU rate varied by study sites and was improved in recent injury cohorts. People who were more seriously injured and those who attained higher levels of education were more likely to return for FU than their counterparts. People who were at risk of being marginalized in society (non-whites, those with less education, the unemployed, victims of violence, and those with no health insurance) had the highest odds of being lost to FU across all post-injury years. Conclusion: These findings can be used to identify individuals who are less likely to participate in follow-up, which may allow targeted attention to improve their response rate.
Objective:
To examine the role of residential neighborhood characteristics in accounting for race disparities in participation among a large sample of community-living adults with chronic spinal cord injury (SCI).
Design:
Secondary analysis of cross-sectional survey data from the national Spinal Cord Injury Model Systems (SCIMS) database linked with national survey and spatial data.
Setting:
SCIMS database participants enrolled at 10 collaborating centers active in follow up between 2000 and 2014.
Participants:
The sample consisted of 6,892 persons with SCI in 5,441 Census tracts from 50 states and the District of Columbia.
Intervention:
Not applicable.
Main outcome measure:
The Craig Handicap Assessment and Reporting Technique (CHART) was used to measure full participation across four domains-physical independence (PI), mobility, occupation, and social integration (SI).
Results:
Racial minority groups had lower odds of reporting full participation relative to Whites across all domains, suggesting that Blacks and Hispanics are at risk for poorer community reintegration following SCI. Neighborhood characteristics-notably differences in socioeconomic advantage-- reduced race group differences in the odds of full occupational, and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live.
Conclusion:
This investigation suggests that addressing disadvantage at the neighborhood level may modify gaps in community participation following medical rehabilitation and provides further support for the role of the environment in the experience of disability.
To assess the association between characteristics of the built environment and differences in perceived health among persons with spinal cord injury (SCI) using objective measures of the local community derived from Geographic Information Systems (GIS) data.
Secondary analysis of cross-sectional survey data.
Community.
503 persons with chronic SCI enrolled in the Spinal Cord Injury Model Systems (SCIMS) database. All cases were residents of New Jersey, completed an interview during the years 2000-2012, had a complete residential address, and were community living at the time of follow-up.
Not applicable.
Perceived health.
Bivariate tests indicated that persons with SCI residing in communities with more (versus less) mixed land use and small (versus large) amounts of open space were more likely to report poor perceived health. No associations were found between perceived health and differences in the residential or destination density of the community. Adjusting for variation in demographic, impairment, quality of life, and community socioeconomic characteristics accounted for the gap in the odds of reporting poor health between persons living in areas with large versus small amounts of open space (OR 0.54; 95% CI 0.28-1.02). However, even after accounting for individual background differences, persons living in communities characterized by more heterogeneous land use were twice as likely to report poor health compared to persons living in less mixed areas (OR 2.14; 95% CI 1.12-4.08).
Differences in the built characteristics of communities may be important to the long-term health and well-being of persons with SCI who may have greater exposure to the features of their local area due to limited mobility. The results of this study suggest living in a community with more heterogeneous land use was not beneficial to the perceived health of persons with chronic SCI living in New Jersey. Further investigation is needed to assess if the relationships observed in this analysis are influenced by differences in infrastructure and resources across communities. Further research is also needed to investigate the role built environment plays in the long-term health and well-being of persons with SCI in other geographic locales.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Neighbourhood deprivation has been associated with poor health. The evidence for social causation, however, remains scarce because selective residential mobility may also create neighbourhood differences. The present study examined whether individuals had poorer health when they were living in a deprived neighbourhood compared to another time when the same individuals were living in a less deprived neighbourhood.
Participants were from the British Household Panel Survey prospective cohort study with 18 annual measurements of residential location and self-reported health outcomes between 1991 and 2009 (n=137 884 person-observations of 17 001 persons in England). Neighbourhood deprivation was assessed concurrently with health outcomes using the Index of Multiple Deprivation at the geographically detailed level of Lower Layer Super Output Areas. The main analyses were replicated in subsamples from Scotland (n=4897) and Wales (n=4442). Multilevel regression was used to separate within-individual and between-individuals associations.
Neighbourhood deprivation was associated with poorer self-rated health, and with higher psychological distress, functional health limitations and number of health problems. These associations were almost exclusively due to differences between different individuals rather than within-individual variations related to different neighbourhoods. By contrast, poorer health was associated with lower odds of moving to less deprived neighbourhoods among movers. The analysis was limited by the restricted within-individual variation and measurement imprecision of neighbourhood deprivation.
Individuals living in deprived neighbourhoods have poorer health, but it appears that neighbourhood deprivation is not causing poorer health of adults. Instead, neighbourhood health differentials may reflect the more fundamental social inequalities that determine health and ability to move between deprived and non-deprived neighbourhoods.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Purpose
There is a need for empirical support of the association between the built environment and disability-related outcomes. This study explores the associations between community and neighborhood land uses and community participation among adults with acquired physical disability.
Methods
Cross-sectional data from 508 community-living, chronically disabled adults in New Jersey were obtained from among participants in national Spinal Cord Injury Model Systems database. Participants’ residential addresses were geocoded to link individual survey data with Geographic Information Systems (GIS) data on land use and destinations. The influence of residential density, land use mix, destination counts, and open space on four domains of participation were modeled at two geographic scales—the neighborhood (i.e., half mile buffer) and community (i.e., five mile) using multivariate logistic regression. All analyses were adjusted for demographic and impairment-related differences.
Results
Living in communities with greater land use mix and more destinations was associated with a decreased likelihood of reporting optimum social and physical activity. Conversely, living in neighborhoods with large portions of open space was positively associated with the likelihood of reporting full physical, occupational, and social participation.
Conclusions
These findings suggest that the overall living conditions of the built environment may be relevant to social inclusion for persons with physical disabilities.
The present study revisits Litwak and Longino’s seminal article, “Migration Patterns among the Elderly: A Developmental Perspective.” Data from the American Community Survey, 2005—2007 are exploited to partially replicate and build on the original study. Findings indicate that Florida later-life migrant exchanges with selected states in the Northeast and Midwest appear to be characterized by positively selected in-bound streams and negatively selected out-bound streams, consistent with the results reported by Litwak and Longino. The “amenity in-migrant, assistance out-migrant” pattern is also evident in the exchange of older migrants between Florida and other regions, excepting the West. Older in-migrants to Arizona from the Midwest and West similarly appear to be positively selected compared to their out-bound counterparts leaving Arizona for destinations in those same regions. Implications of these results are discussed together with study limitations and directions for further research.
This study investigates the role of area economic characteristics in predicting employment-a key aspect of social participation for adults with physical disabilities-using data from a national registry of persons with spinal cord injury (SCI). SCI results in chronic impairment and most commonly occurs during young adulthood when working is a key aspect of the adult social role. Geocoded data were collected from two of the 14 SCI Model Systems (SCIMS) centers involved in the National SCIMS database and used to link individual-level data with area-level measures extracted from the 2000 US Census. The analysis included participants of working-age (18-64 years) and living in the community (N=1013). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. The likelihood of employment for adults with SCI varied by area and was associated with area SES and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for persons who experience chronic physical disability during adulthood, thus limiting full participation in society.
Focusing on micro-level processes of residential segregation, this analysis combines data from the Panel Study of Income Dynamics with contextual information from three censuses and several other sources to examine patterns of residential mobility between neighborhoods populated by different combinations of racial and ethnic groups. We find that despite the emergence of multiethnic neighborhoods, stratified mobility dynamics continue to dominate, with relatively few black or white households moving into neighborhoods that could be considered multiethnic. However, we also find that the tendency for white and black households to move between neighborhoods dominated by their own group varies significantly across metropolitan areas. Black and white households' mobility into more integrated neighborhoods is shaped substantially by demographic, economic, political, and spatial features of the broader metropolitan area. Metropolitan-area racial composition, the stock of new housing, residential separation of black and white households, poverty rates, and functional specialization emerge as particularly important predictors. These macro-level effects reflect opportunities for intergroup residential contact as well as structural forces that maintain residential segregation.
Data from the Panel Study of Income Dynamics and three decennial U.S. censuses are used to examine the influence of metropolitan-area characteristics on black and white households' propensity to move into poor versus nonpoor neighborhoods. We find that a nontrivial portion of the variance in the odds of moving to a poor rather to a nonpoor neighborhood exists between metropolitan areas. Net of established individual-level predictors of inter-neighborhood migration, black and white households are more likely to move to a poor or extremely poor tract rather than to a nonpoor tract in metropolitan areas containing many poor neighborhoods and a paucity of recently-built housing in nonpoor areas. Blacks are especially likely to move to a poor tract in metropolitan areas characterized by high levels of racial residential segregation and in which poor tracts have a sizeable concentration of blacks. White households are more likely to move to a poor than to a nonpoor tract in metropolitan areas that have comparatively few African Americans.
To assess the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation.
Retrospective analysis of cross-sectional survey data.
Two participating centers in the SCI Model Systems (SCIMS) program.
Persons (N=1454) with traumatic SCI from New Jersey and Alabama enrolled in the SCIMS database in 2000 to 2009.
Not applicable.
Dichotomous measures of perceived health (ill vs good health), life satisfaction (dissatisfied vs satisfied), and depressive symptoms (presence of a syndrome vs not) to assess well-being.
Multilevel logistic regression was used to model community effects on each indicator of well-being. The likelihood of ill health and dissatisfaction with life in people with SCI, but not depressive symptoms, varied across communities. Community SES was related inversely to the odds of reporting ill health. However, the odds for dissatisfaction were higher in persons with SCI living in high SES and urban communities. Associations between community predictors and dissatisfaction with life were sustained after controlling for individual differences in injury severity, SES, and demographics, whereas individual SES was a stronger predictor of ill health than community SES.
This research suggests that community stratification influences the likelihood for diminished well-being for persons with SCI after rehabilitation. Understanding the contribution of communities in long-term outcomes after SCI rehabilitation is needed to inform future interventions aimed at preventing disability in this population.
To examine health trajectories among older migrants by reason for move.
Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves.
There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups.
The results are consistent with the predictions of Litwak and Longino's (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.
The paper reviews arguments that associations between small area socio-economic conditions and individual health are likely to vary according to the type of health condition considered. We comment on the importance of longitudinal research to examine how far area conditions predict later health outcomes, and also how far area variations in health may result from selective migration processes predicted by health status. Using data for 1996 and 2002, from the National Population Health Survey of Canada, linked to small area data on social and on material deprivation in the area of residence for 6950 survey respondents at the two time points, we report on analyses to address these questions. The area measures of material and social deprivation were previously developed by Pampalon and colleagues at the Institut National de Santé Publique de Québec and related to the dissemination area matching the informant's postal code. The health outcomes considered were restriction of activity due to chronic conditions and psychological distress. Our findings suggest that individuals living in materially deprived areas in 2002 were more likely to be affected by health conditions resulting in restriction of activity. Prevalence of psychological distress was higher in areas with greater social deprivation in 2002. Most of these area differences were attenuated when adjustment was made for individual socio-demographic characteristics. Measures recorded in 1996 of individual characteristics and measures of deprivation for area of residence were used to predict change in health outcomes by 2002. Several individual factors (sex, age group, income, household composition) in 1996 were predictive of later health outcomes. After controlling for these individual characteristics the only significant association between health change and area deprivation was with development of restricted activity, which was more common among people who, in 1996, had lived in areas that ranked moderately high on material deprivation. We also report some evidence for selective migration effects, though these mainly seem to operate indirectly via socio-economic characteristics that predict both health outcomes and differential migration patterns. The clearest evidence on this point is for those in with psychological distress in 1996, who were particularly likely to move to an area which was more socially or materially deprived by 2002. This supports the idea that area differences in psychological distress are partly the result of selective migration effects.
Building on prior conceptual schemes, this article presents a sociomedical model of disability, called The Disablement Process, that is especially useful for epidemiological and clinical research. The Disablement Process: (1) describes how chronic and acute conditions affect functioning in specific body systems, generic physical and mental actions, and activities of daily life, and (2) describes the personal and environmental factors that speed or slow disablement, namely, risk factors, interventions, and exacerbators. A main pathway that links Pathology, Impairments, Functional Limitations, and Disability is explicated. Disability is defined as difficulty doing activities in any domain of life (from hygiene to hobbies, errands to sleep) due to a health or physical problem. Feedback effects are included in the model to cover dysfunction spirals (pernicious loops of dysfunction) and secondary conditions (new pathology launched by a given disablement process). We distinguish intrinsic disability (without personal or equipment assistance) and actual disability (with such assistance), noting the scientific and political importance of measuring both. Disability is not a personal characteristic, but is instead a gap between personal capability and environmental demand. Survey researchers and clinicians tend to focus on personal capability, overlooking the efforts people commonly make to reduce demand by activity accommodations, environmental modifications, psychological coping, and external supports. We compare the disablement experiences of people who acquire chronic conditions early in life (lifelong disability) and those who acquire them in mid or late life (late-life disability). The Disablement Process can help inform research (the epidemiology of disability) and public health (prevention of disability) activities.
Health-selective migration within countries has been implicated as one of the mechanisms by which spatial disadvantage is created and maintained. However, there is conflicting evidence on the nature of the relationship between health and mobility, caused in part by diverse definitions, and age and sex differences. This paper uses the first two waves of data for the middle-aged cohort (aged 45-50 in 1996) of the Australian Longitudinal Study on Women's Health to investigate the relationship between four sets of health variables with subsequent local moves (within the same postcode), longer distance moves (between postcodes) and inter-regional migration from rural and remote areas 'up' the urban hierarchy. After adjusting for socio-economic and marital status, short and longer distance mobility among these middle-aged Australian women was positively associated with long-term and chronic poor health and being a smoker. Moves between postcodes and rural-to-urban migration were positively associated with multiple recent visits to a medical specialist. Our findings are consistent with UK and US studies that have found mobility to be more strongly associated with poor health than good health in mature adults. As the population ages, the health of receiving areas may be adversely affected by relatively unhealthy in-migrants seeking amenities not provided in their former place of residence.
This paper reports on residential mobility among patients treated in the Veterans Affairs (VA) health system. We examine mobility in relation to patients' psychiatric disorders, and we assess the impact of mobility on health system geographic accessibility and continuity of care following inpatient discharge. Subjects included 534,002 patients with schizophrenia, bipolar disorder, depression, or with none of these conditions, who received VA services in both FY 01 and FY 02. We report the frequency and predictors of residential moves; we examine distance moved and changes in the proximity of VA providers; and we evaluate associations with timely receipt of outpatient care following inpatient discharges. Approximately 25% of patients with bipolar disorder, 20% with schizophrenia, 16% with depression, and 9% of patients without these conditions completed a residential move in FY 2002. When relocating, patients with schizophrenia and bipolar disorder were more likely to move closer to providers, suggesting greater sensitivity to accessibility barriers.
Young adult migration
- M J Benetsky
- C A Burd
- M A Rapino
Great Recession spurs a shift to local moves
- M A Stoll
Geographical mobility: 2005 to 2010 population characteristics
- D K Ihrke
- C S Faber
Desire to move and residential mobility
- P J Mateyka
Migration patterns among the elderly
- Litwak