Residential Mobility Across Local Areas in the United States and the Geographic Distribution of the Healthy Population

Abstract

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.

Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample

“…Greater percentages of study participants also report having less than a high school education than nationally, with the difference especially stark among white participants, who are almost four times more likely to have less than a high school education than their counterparts nationwide. Also, compared to national averages, the study sample has smaller percentages of the youngest and oldest adults-results consistent with younger adults moving out of the financially strapped city in search of better jobs or better resourced residential areas (Geronimus, Bound, and Ro 2014) and with older adults experiencing excess mortality (Geronimus, Bound, and Colen 2011).…”

Inequality in Place: Effects of Exposure to Neighborhood-Level Economic Inequality on Mortality

“…No coef fi cient on inequal ity has a sig nifi cant impact on mor tal ity. It seems that com pared to the health and mor tal ity of older adults, the health and mor tal ity of work ingage and mid dleaged adults are more sen si tive to inequal ity and socio eco nomic cir cum stances (Backlund et al 2007;Lynch et al 2004), as well as placeeffects (Geronimus et al 2014). Lastly, we repeat our ana ly ses but mea sure income inequal ity at the state level rather than the tract level (Table A4, online appen dix).…”

“…For exam ple, if local income inequal ity lim its socio eco nomic gains in that area by fail ing to attract businesses or offer ing fewer rel e vant ser vices, and socio eco nomic dis ad van tage increases mor tal ity risk, then the effects of inequal ity on mor tal ity risk may be medi ated by abso lute dis ad van tage. There is cur rently no con sen sus on whether res i den tial mobil ity is selected on fac tors related to health, such as abso lute advan tage, in ways that would bias esti ma tes of place effects (Geronimus et al 2014), such as inequal ityeffects. However, the poten tial for indi rect effects should be ana lyzed with care because they could in the ory also be con found ers (e.g., if indi vid u als with lower socio eco nomic sta tus are more likely to be selected into unequal neigh bor hoods).…”

The Neighbourhood Effects on Health and Well-being (NEHW) study

“…Instead, we selected controls that are plausible sources of selection into neighbourhoods and thus affect neighborhood composition overall. These include the respondent's education (in years), their age (in years), gender, and nativity (Canadian versus foreign born) (Sassler and White, 2000;Geronimus et al, 2014;Schaake et al, 2014). The city of Toronto is close to 50% foreign-born and thus sorting into neighbourhoods is partially based on this variable.…”