Abstract
Objective. We use a case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new home address. Methods. We conducted an ambidirectional case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new address using data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults from four U.S. sites beginning in 1989. Relocation was assessed twice a year during follow-up. Event occurrences were classified as present or absent for the period preceding the first reported move, as compared with an equal length of time immediately prior to and following this period. Results. Older adults (65+) that experience incident cardiovascular disease had an increased probability of reporting a change of residence during the following year (OR 1.6, 95% confidence interval (CI) = 1.2–2.1). Clinical conditions associated with relocation included stroke (OR: 2.0, 95% CI: 1.2–3.3), angina (OR: 1.6, 95% CI: 1.0–2.6), and congestive heart failure (OR: 1.5, 95% CI: 1.0–2.1). Conclusions. Major incident cardiovascular disease may increase the probability of residential relocation in older adults. Case-crossover analyses represent an opportunity to investigate triggering events, but finer temporal resolution would be crucial for future research on residential relocations.
Highlights
Case-crossover designs [1] offer the possibility of investigating time-varying exposures as triggering subsequent events, while allowing each person to serve as his or her own control
Residential relocation during the course of follow-up was more likely to be reported by participants who were female, non-Black, not married/separated, lower income, in better health at baseline, and with more years of Cardiovascular Health Study (CHS) follow-up (Table 1)
Comparing the case and control time periods, the odds of any event were higher in the case time periods (Table 2), suggesting that cardiovascular events were more likely to occur around the time of the first reported residential relocation
Summary
Case-crossover designs [1] offer the possibility of investigating time-varying exposures as triggering subsequent events, while allowing each person to serve as his or her own control. A case-crossover design may be useful for studying a transient increase in the risk of experiencing an acute-onset event. We illustrate the potential relevance of this design to research on neighborhoods and health by considering the temporal association between incident cardiovascular disease events and residential relocation to a new home address. Residential relocation by older adults may be considered a consequence of disease or disability [2] that could be addressed as part of a public health strategy for tertiary prevention because it is likely to be followed by further declines in physical health and quality of life.
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