Health-Selective Migration among Patients with Rheumatoid Arthritis in Quebec :A Cohort Study Using Administrative Data

Abstract

Little is known about how rheumatoid arthritis (RA) affects an nindividual’s ability to relocate. The current literature suggests the nrelationship between health and migration is often disease-specific. We nsought to estimate the impact of RA diagnosis on migration within a nCanadian province, comparing migration rates in residents before and nafter RA diagnosis. We identified a cohort of 81,181 individuals ndiagnosed with RA between 1998 and 2009 using Quebec administrative ndatabases. A migration was defined as a change in the first three ncharacters of the postal code. We categorized migrations as urban or nrural depending upon an individual’s origin and destination. We nestimated the association between RA diagnosis and migration by fitting nmarginal models using a generalized estimating equations approach, nadjusting for age, sex, and population level socioeconomic status nindicators. The vast majority of moves after RA diagnosis were within nurban areas. RA diagnosis was associated with increased migration except nfor people around age 50 moving within urban areas. Although RA was nassociated with increased inter-urban migration in many demographic ngroups, the net result did not translate to higher rates of nrural-to-urban migration after RA diagnosis. Our results suggest fairly ncomplex associations between RA diagnosis and migration. Both age and nlocation (urban or rural) modify this effect. Overall, we did not see a ngreater movement from rural-to-urban areas after RA diagnosis. This is nof interest for studies of regional environmental effects on chronic ndisease patterns.

Publication
Rheumatology International