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Patterns of Residential Mobility by Social Vulnerability Among Individuals With Rheumatic and Musculoskeletal
Leah M Santacroce1, Candace H Feldman1,2
1Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital.
Summary
Individuals with rheumatic conditions who are Black or on Medicaid are more likely to move to areas with higher social vulnerability. Longitudinal address history from electronic health records (EHR) reveals mobility patterns impacting health outcomes.
Area of Science:
- Rheumatology
- Social Determinants of Health
- Geospatial Health
Background:
- Area-level factors like neighborhood poverty significantly influence health outcomes for individuals with rheumatic conditions.
- Electronic health records (EHR) typically link area-level data to patient health data using the most recent address.
- Patient mobility and residential history are crucial for understanding exposure to varying social vulnerability.
Purpose of the Study:
- To investigate longitudinal address history in individuals with rheumatic conditions.
- To understand patterns of residential mobility to areas with differing degrees of social vulnerability.
- To identify patient characteristics associated with moving to higher or lower vulnerability areas.
Main Methods:
- A cohort study identified individuals with rheumatic or musculoskeletal conditions receiving rheumatology care between 2019-2024.
- Geocoding of patient addresses over five years was performed, merging data with census tract-level Social Vulnerability Index (SVI).
- Multinomial regression analysis examined associations between patient characteristics and movement to areas with different SVIs.
Main Results:
- Among 10,376 individuals, 25% moved at least once.
- 20% moved to a higher vulnerability census tract, while 16% moved to a lower vulnerability tract.
- Black individuals (OR 3.43) and Medicaid beneficiaries (OR 1.87) had increased odds of moving to higher vulnerability areas.
Conclusions:
- Longitudinal address histories from EHR provide a detailed view of area-level social determinants of health for patients with rheumatic conditions.
- Black patients and those with lower incomes (Medicaid beneficiaries) are disproportionately affected by residential mobility to vulnerable areas.
- This data can inform targeted interventions to identify and support high-risk patients, improving health equity.
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