Health Predictors of Neighborhood Selection: A Prospective Cohort Study of Residential Mobility in Ontario, Canada.

BACKGROUND

Health selection into neighborhoods describes unhealthy people moving disproportionately to lower-income neighborhoods, producing observable socioeconomic gradients sometimes falsely attributed to neighborhood effects on health. We investigated residential mobility outcomes and their relationship to baseline health using population-level data linkages in Ontario, Canada.

METHODS

We included Canadian Community Health Survey respondents ages 25 to 64 between 2005 and 2014 (n = 93,235). We assessed baseline health using self-reported health and multimorbidity. We captured moves using health administrative data and the Canadian census. We fit multinomial logistic regression models with a six-category residential mobility outcome: (1) nonmovers from low-income neighborhoods; (2) nonmovers from high-income neighborhoods; (3) movers from low-income to low-income; (4) movers from low-income to high-income; (5) movers from high-income to low-income; and (6) movers from high-income to high-income. We adjusted models for the Canadian Community Health Survey cycle, age, sex, household income, immigrant status, and residential instability.

RESULTS

Compared with those with very good or excellent health, respondents reporting fair or poor health at baseline had higher odds of moving from low- to low-income neighborhoods (Adjusted odds ratios [aOR] = 1.73; 95% confidence interval [CI] = 1.46, 2.05), moving from high- to low-income (aOR = 1.64; 95% CI = 1.35, 1.98), moving from low- to high-income (aOR = 1.26; 95% CI = 1.04, 1.54), and not moving within low-income (aOR = 1.36; 1.23, 1.51) relative to not moving within high-income. Results were consistent for objective health measures, comparing respondents with at least four chronic conditions to those with one or none.

CONCLUSIONS

In a large, population-based study, both subjective and objective measures of health had a strong relationship with residential mobility outcomes.