Municipality Of Residence Research Articles

Rural-Urban differences in Use of Rhythm Control Therapies in Patients with Incident Atrial Fibrillation: A Finnish Nationwide Cohort Study.

Background: Rural–urban disparities have been reported in the access, utilization, and quality of healthcare. We aimed to assess whether use of antiarrhythmic therapies (AATs) in patients with atrial fibrillation (AF) differs between those with rural and urban residence. Methods: The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The primary outcome was the use of any AAT, including cardioversion, catheter ablation, and fulfilled antiarrhythmic drug (AAD) prescription. Results: We identified 177,529 patients (49.9% female, mean age 73.0 (SD13.0) years) with incident AF during 2010–2018. Except for AADs, the differences in AAT use were nonsignificant when patients were stratified according to the rural–urban classification system (urban vs. rural adjusted incidence rate ratios (aIRRs) with 95% CIs for any AAT 1.01 (0.99–1.03), AADs 1.11 (1.07–1.15), cardioversion 1.01 (0.98–1.03), catheter ablation 1.05 (0.98–1.12)). However, slightly higher use of all rhythm control modalities was observed in the highest urbanization degree tertile when compared to the lowest tertile (aIRRs with 95% Cis for any AAT 1.06 (1.03–1.08), AADs 1.18 (1.14–1.23), cardioversion 1.05 (1.02–1.08), catheter ablation 1.10 (1.02–1.19)). Conclusions: This nationwide retrospective cohort study observed that urban residence is associated with higher use of AADs in patients with incident AF. Otherwise, the observed disparities were only marginal, suggesting that in the use of rhythm control therapies, no large rural–urban inequity exists in Finland.

Association of area-level education with the regional growth trajectories of rates of antibacterial dispensing to patients under 3 years in Norway: a longitudinal retrospective study

ObjectiveTo examine the association between area-level education and the local growth trajectories in antibacterial dispensing rates in Norwegian municipalities among children under 3 years old.DesignRetrospective, longitudinal study using individual primary...

Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling

BackgroundThe disease management program (DMP) for type 2 Diabetes Mellitus (T2DM) is the largest DMP in Germany. Our goal was to analyze regional differences in unenrollment rates, suggest areas for intervention and provide background information, which population groups in which locations are currently not enrolled in the DMP for T2DM.MethodsIn this study, we used data of the 1.7 mil. insurants of the AOK Nordost health insurance. For the visualization of enrollment potential, we used the Besag-York-Mollie model (BYM). The spatial scan statistic (SaTScan) was used to detect areas of unusually high rates of unenrolled diabetics to prioritize areas for intervention. To explore sociodemographic associations, we used Bayesian spatial global regression models. A Spatially varying coefficient model (SVC) revealed in how far the detected associations vary over space.ResultsThe proportion of diabetics currently not enrolled in the DMP T2DM was 36.8% in 2019 and varied within northeastern Germany. Local clusters were detected mainly in Mecklenburg-West-Pomerania and Berlin. The main sociodemographic variables associated with unenrollment were female sex, younger age, being unemployed, foreign citizenship, small household size and the proportion of persons commuting to work outside their residential municipality. The SVC model revealed important spatially varying effects for some but not all associations.ConclusionLower socioeconomic status and foreign citizenship had an ubiquitous effect on not being enrolled. The DMP T2DM therefore does currently not reach those population groups, which have a higher risk for secondary diseases and possible avoidable hospitalizations. Logically, future interventions should focus on these groups. Our methodology clearly suggests areas for intervention and points out, which population group in which locations should be specifically approached.

Factors associated with severe or fatal clinical manifestations of SARS-CoV-2 infection after receiving the third dose of vaccine.

BackgroundLittle is known about vulnerability to severe COVID‐19 illness after vaccination completion with three doses of vaccine against COVID‐19.ObjectivesTo identify individual features associated with increased risk of severe clinical manifestation of SARS‐CoV‐2 infections after receiving the third dose of vaccine against COVID‐19.MethodsWe performed a nested case‐control study based on 3,360,116 citizens from Lombardy, Italy, aged 12 years or older who received the third dose of vaccine against COVID‐19 from 20 September through 31 December 2021. Individuals were followed from 14 days after vaccination completion until the occurrence of severe COVID‐19 illness, death unrelated to COVID‐19, emigration or 15 March 2022. For each case, controls were randomly selected to be 1:10 matched for the date of vaccination completion and municipality of residence. The association between candidate predictors and outcome was assessed through multivariable conditional logistic regression models.ResultsDuring 12,538,330 person‐months of follow‐up, 5171 cases of severe illness occurred. As age increased, a trend towards increasing odds of severe illness was observed. Male gender was a significant risk factor. As the number of contacts with the Regional Health Service increased, a trend towards increasing odds of severe illness was observed. Having had a previous SARS‐CoV‐2 infection was a significant protective factor. Having received the Moderna vaccine significantly decreased the odds of severe illness. Significant higher odds were associated with 42 diseases/conditions. Odds ratios ranged from 1.23 (diseases of the musculoskeletal system) to 5.00 (autoimmune disease).ConclusionsThis study provides useful insights for establishing priority in fourth‐dose vaccination programs.

Gender Differences in Suicide and Homicide Rates in Mexico City during 2019.

Suicides and homicides are public health problems around the world. The rates of suicide and homicide have increased in the past years. The objectives of this study are to estimate the rates of suicide and homicide in Mexico City, and to determine the rates of suicide and homicide by sex in the different municipalities of Mexico City during 2019. Data analyzed were obtained from files of governmental organizations in Mexico City. From the general victims-in-research-folders, we choose “victims of crime” or “loss of life by suicide” that happened in 2019. Sex and municipality of residence were obtained. The rate of suicide was of 5.65 cases per 100,000 habitants. Stratified by gender and by municipalities, the highest rates observed were 6.8 suicides per 100,000 males and 29.6 suicides per 100,000 females. The sex ratio was 4.2:1 (males: females). Regarding homicides, the rates were 16.68 homicides per 100,000 females and 67.41 homicides per 100,000 males. The Venustiano Carranza Municipality showed the highest homicide rate in men with 131.72 homicides per 100,000 males. The homicide sex ratio was 7.8:1. The findings of the present study highlight that death by suicide is more common in men with 7.8 more times than in women. The municipalities with higher deaths by suicide have lower rates of homicides and the municipalities with higher deaths by suicide showed lower rates of suicide in men.

Effectiveness of BNT162b2 vaccine against SARS-CoV-2 infection and severe COVID-19 in children aged 5–11 years in Italy: a retrospective analysis of January–April, 2022

BackgroundBy April 13, 2022, more than 4 months after the approval of BNT162b2 (Pfizer–BioNTech) for children, less than 40% of 5–11-year-olds in Italy had been vaccinated against COVID-19. Estimating how effective vaccination is in 5–11-year-olds in the current epidemiological context dominated by the omicron variant (B.1.1.529) is important to inform public health bodies in defining vaccination policies and strategies.MethodsIn this retrospective population analysis, we assessed vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19, defined as an infection leading to hospitalisation or death, by linking the national COVID-19 surveillance system and the national vaccination registry. All Italian children aged 5–11 years without a previous diagnosis of infection were eligible for inclusion and were followed up from Jan 17 to April 13, 2022. All children with inconsistent vaccination data, diagnosed with SARS-CoV-2 infection before the start date of the study or without information on the municipality of residence were excluded from the analysis. With unvaccinated children as the reference group, we estimated vaccine effectiveness in those who were partly vaccinated (one dose) and those who were fully vaccinated (two doses).FindingsBy April 13, 2022, 1 063 035 (35·8%) of the 2 965 918 children aged 5–11 years included in the study had received two doses of the vaccine, 134 386 (4·5%) children had received one dose only, and 1 768 497 (59·6%) were unvaccinated. During the study period, 766 756 cases of SARS-CoV-2 infection and 644 cases of severe COVID-19 (627 hospitalisations, 15 admissions to intensive care units, and two deaths) were notified. Overall, vaccine effectiveness in the fully vaccinated group was 29·4% (95% CI 28·5–30·2) against SARS-CoV-2 infection and 41·1% (22·2–55·4) against severe COVID-19, whereas vaccine effectiveness in the partly vaccinated group was 27·4% (26·4–28·4) against SARS-CoV-2 infection and 38·1% (20·9–51·5) against severe COVID-19. Vaccine effectiveness against infection peaked at 38·7% (37·7–39·7) at 0–14 days after full vaccination and decreased to 21·2% (19·7–22·7) at 43–84 days after full vaccination.InterpretationVaccination against COVID-19 in children aged 5–11 years in Italy showed a lower effectiveness in preventing SARS-CoV-2 infection and severe COVID-19 than in individuals aged 12 years and older. Effectiveness against infection appears to decrease after completion of the current primary vaccination cycle.FundingNone.TranslationFor the Italian translation of the summary see Supplementary Materials section.

The contribution of urban garden cultivation to food self-sufficiency in areas at risk of food desertification during the Covid-19 pandemic

This paper assesses the contribution made by the cultivation of urban gardens to the food self-sufficiency of mountain municipalities at risk of food desertification during 2020 in South Tyrol (Italy). The pandemic-induced economic downturn and mobility restrictions have left more territories severely exposed to the adverse risk of food desertification. A food desert is a territory where people are food-insecure because of job/income loss or through the absence of food retail facilities. During lockdown, many non-essential firms were forced to close. This meant that many workers, especially those in more precarious positions, lost their jobs, while entrepreneurs had consistent financial shortcomings. Local population mobility was restricted to the municipality of residence, with reduced access to grocery stores outside that area. Disrupted food supply chains and panic buying stimulated short-term food shortages, emptied municipal food stores and meant that supplies often failed to meet local needs. This insecurity left mountain municipalities increasingly vulnerable to desertification. The most food-insecure areas are those that depend heavily on the tourism sector and those with limited access to food retail facilities or other organized forms of food supply in proximity. Their challenges through the period of Covid-19 have heightened questions about their access to food and possible initiatives to increase their food self-sufficiency. Among the initiatives most frequently debated in that period, gardening has been highly valued. This paper contributes to the debate by presenting a Decision Support System (DSS) that calculates the land required for food self-sufficiency in South Tyrolean municipalities and the percentage covered by the production of local urban gardens. The results demonstrate that urban gardens’ contribution to local food self-sufficiency is almost insignificant in these municipalities, representing less than 1 % of the municipal needs. Restricting the analysis to self-sufficiency in fruit and vegetable production only, findings derived from the DSS application confirm the insignificance of urban gardens’ production levels, which remains below 1 % of the municipal needs.

Change in covid-19 risk over time following vaccination with CoronaVac: test negative case-control study

ObjectiveTo estimate the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine CoronaVac (Sinovac Biotech) in São Paulo State, Brazil.DesignTest negative case-control...

Evaluating the controlled reopening of nightlife during the COVID-19 pandemic: a matched cohort study in Sitges, Spain, in May 2021 (Reobrim Sitges)

ObjectivesTo assess the impact of relaxing the state of alarm restrictions on SARS-CoV-2 infections at 14 days among people attending reopened nightclub venues.DesignMatched cohort study with a paired control group...

Vulnerability Predictors of Post-Vaccine SARS-CoV-2 Infection and Disease-Empirical Evidence from a Large Population-Based Italian Platform.

We aimed to identify individual features associated with increased risk of post-vaccine SARS-CoV-2 infection and severe COVID-19 illness. We performed a nested case–control study based on 5,350,295 citizens from Lombardy, Italy, aged ≥ 12 years who received a complete anti-COVID-19 vaccination from 17 January 2021 to 31 July 2021, and followed from 14 days after vaccine completion to 11 November 2021. Overall, 17,996 infections and 3023 severe illness cases occurred. For each case, controls were 1:1 (infection cases) or 1:10 (severe illness cases) matched for municipality of residence and date of vaccination completion. The association between selected predictors (sex, age, previous occurrence of SARS-CoV-2 infection, type of vaccine received, number of previous contacts with the Regional Health Service (RHS), and the presence of 59 diseases) and outcomes was assessed by using multivariable conditional logistic regression models. Sex, age, previous SARS-CoV-2 infection, type of vaccine and number of contacts with the RHS were associated with the risk of infection and severe illness. Moreover, higher odds of infection and severe illness were significantly associated with 14 and 34 diseases, respectively, among those investigated. These results can be helpful to clinicians and policy makers for prioritizing interventions.

Cohort profile: the Swedish Pancreatitis Cohort (SwePan)

PurposeThe Swedish Pancreatitis Cohort (SwePan) was designed to study long-term outcomes following an episode of acute pancreatitis. It can also be used to study various risk factors for developing acute...

Increasing incidence and spatial hotspots of hospitalized endometriosis in France from 2011 to 2017

Endometriosis is a female hormone-dependent disease, possibly related to endocrine disruptor exposure. We aimed to monitor this disease nationwide in France and analyze spatial trends at a fine scale to explore possible environmental contributing risk factors. We conducted a retrospective national descriptive study from 2011 to 2017 in females aged 10 years old and over, using comprehensive hospital discharge data. Cases were identified using ICD-10 N80 codes and were localized at their municipality of residence. We defined incident cases as the first hospital stay of patients, without a stay in at least the previous 5 years. We performed statistical analyses according to age and type of endometriosis, and we modeled the temporal, spatial and spatiotemporal trends. We identified 207,462 incident cases of all-type hospitalized endometriosis (83,112 for non-adenomyosis cases). The crude incidence rate for the study period was 9.85/10,000 person-years (3.95/10,000 for non-adenomyosis cases). From 2011 to 2017, the risk of all-type endometriosis increased by 8.5% (95% CI: 3.9; 13.4) (by 3.6% (95% CI: 0.6; 6.8) for non-adenomyosis cases). The risk was geographically heterogeneous, with 20 high-risk hotspots, showing similar results for non-adenomyosis cases. Shifting practice patterns, improved awareness and healthcare disparities interlinked with environmental risk factors could explain these trends.

The Influence of Message Framing on Consumers’ Selection of Local Food

Although local food purchasing provides several benefits to both consumers and producers, research on what recommendation messages can effectively promote the purchase of local food is still lacking. In the present study, 410 participants were involved in a 2-week intervention relying on prefactual (i.e., “If … then”) messages promoting the purchase of local food. All messages were sent through a research app to participants’ mobile phones and were focused on environmental consequences of purchasing (or not purchasing) local food. Four experimental conditions involving messages differing as to outcome sensitivity framing (i.e., gain, non-loss, non-gain and loss) were compared to a control condition. To test the effectiveness of the messages, before and after the 2-week intervention participants were involved in a choice task. They were asked to choose among fruits with different provenience, that is, from the participants’ municipality of residence or abroad. Results showed that all message frames increased the selection of local food, compared to control. Furthermore, pro-environmental consumers were more persuaded by messages formulated in terms of gains and non-gains, whereas healthy consumers were more persuaded by messages formulated in terms of losses or non-losses. Discussion focuses on the advantages of tailored communication to promote the purchase of local food.

COVID-19 in the pediatric population of the state of Jalisco: spatiotemporal analysis of 1,515 cases.

Initial publications of COVID-19 (2019 coronavirus disease) focused on the adult population until March 2020, when the first series in children was reported. Our objective was to analyze the spatiotemporal behavior of the pediatric population with COVID-19 in the state of Jalisco. We conducted a cross-sectional study including subjects < 18 years of age with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection confirmed by reverse transcription-polymerase chain reaction, registered in the RADAR platform. We investigated the prevalence, incidence rate, age, sex, outpatient or inpatient status, distribution of cases by time, municipality of residence, and geographical region. Descriptive statistics were used for data analysis. Of 58,231 subjects studied, 1,515 were children (3%): 768 males (51%) and 747 females (49%). The mean age was 12 ± 5 years; outpatients predominated (94%). The Central region concentrated the largest cases with 1,257 (82%) and was the second-highest incidence rate, behind the Occidental Coastal-Mountain region. The most affected municipality was Guadalajara. The distribution of new cases increased proportionally to mobility: after the holiday weekend in May, it rose from 28 to 161 cases; after the opening of beaches and recreational sites in June and July, to 539; and after the opening of movie theaters in August, to 673 cases. Although with a lower incidence, the pediatric population is not exempt from SARS-CoV-2 infection. We observed an increase in cases as restrictions on social activities diminished.

Improving morbidity information in Portugal: Evidence from data linkage of COVID-19 cases surveillance and mortality systems

BackgroundCOVID-19 rapidly spread around the world, putting health systems under unprecedented pressure and continuous adaptations. Well-established health information systems (HIS) are crucial in providing data to allow evidence-based policymaking and public health interventions in the pandemic response. This study aimed to compare morbidity information between two databases for COVID-19 management in Portugal and identify potential complementarities. MethodsThis is an observational study using records from both COVID-19 cases surveillance (National Epidemiological Surveillance System; SINAVE) and related deaths (National e-Death Certificates Information System; SICO) systems, which were matched on sex, age, municipality of residence and date of death. After the linkage, morbidity reported in SINAVE and identified in SICO, through the application of Charlson and Elixhauser comorbidity indexes algorithms, were compared to evaluate agreement level. ResultsOverall, 2285 matched cases were analyzed, including 53.9% males with a median age of 84 years. According to the method of data reporting assessment, the presence of any morbidity ranged between 26.3% and 62.5%. The reporting of ten morbidities could be compared between the information reported in SINAVE and SICO databases. The proportion of simultaneous reporting in both databases ranged between 5.7% for diabetes and 0.0% for human immunodeficiency virus infection or coagulopathy. Minimal or no agreement was found when assessing the similarity of the morbidity reporting in both databases, with neoplasms showing the highest level of agreement (0.352, 95% IC: 0.277–0.428; p < 0.001). ConclusionDifferent information about reported morbidity could be found in two HIS used to monitor COVID-19 cases and related deaths, as data are independently collected. These results show that the interoperability of SICO and SINAVE databases would potentially improve available HIS and improve available information to decision-making and address COVID-19 pandemic management.

HIV epidemic in a province of the Brazilian Amazon region: Temporal trend analysis.

BackgroundAlthough considerable progress has been made over the last decades, human immunodeficiency virus (HIV) incidence and acquired immunodeficiency syndrome (AIDS) mortality rates have remarkably increased in the Brazilian Amazon region. Here, we employed temporal analysis to determine the impact of public policies on the HIV epidemic in the state of Pará, Brazil, which has the second highest HIV incidence rate in the Amazon region.Design and methodsThis is an ecological study conducted in the state of Pará, employing secondary data of HIV/AIDS cases notified to the Information System for Notifiable Diseases, 2007– 2018. The following epidemiological variables were collected: year of notification, municipality of residence, age, sex, education, exposure category, and HIV/AIDS diagnostic criteria. The study population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence rates were analyzed employing the temporal trend analysis (TTA) followed by the chi-square test and residue analysis to determine the association between the epidemiological variables and time series periods.ResultsA total of 50% of the notifications were composed of AIDS cases. TTA identified two periods in HIV/AIDS incidence, with stabilization of cases in the first period (G1, 2007–2012) and an upward trend in the second period (G2, 2012–2018). The most prevalent epidemiological characteristics in G2 (versus G1) were as follows: young people, brown skin color, higher schooling, and homosexuals.ConclusionsPublic policy to control HIV infection in the Brazilian Amazon region has been partially effective. HIV screening tests and treatment should be made widely available to eradicate HIV infection in the Amazon region by 2030.

Associations between long-term exposure to PM2.5 and site-specific cancer mortality: A nationwide study in Brazil between 2010 and 2018

Long-term exposure to PM2.5 has been linked to lung cancer incidence and mortality, but limited evidence existed for other cancers. This study aimed to assess the association between PM2.5 on cancer specific mortality. An ecological study based on the cancer mortality data collected from 5,565 Brazilian cities during 2010–2018 using a difference-in-differences approach with quasi-Poisson regression, was applied to examine PM2.5-cancer mortality associations. Globally gridded annual average surface PM2.5 concentration was extracted and linked with the residential municipality of participants in this study. Sex, age stratified and exposure-response estimations were also conducted. Totalling 1,768,668 adult cancer deaths records of about 208 million population living across 5,565 municipalities were included in this study. The average PM2.5 concentration was 7.63 μg/m3 (standard deviation 3.32) with range from 2.95 μg/m3 to 28.5 μg/m3. With each 10 μg/m3 increase in three-year-average (current year and previous two years) concentrations of PM2.5, the relative risks (RR) of cancer mortality were 1.16 (95% confidence interval [CI]: 1.11–1.20) for all-site cancers. The PM2.5 exposure was significantly associated with several cancer-specific mortalities including oral, nasopharynx, oesophagus, and stomach, colon rectum, liver, gallbladder, larynx, lung, bone, skin, female breast, cervix, prostate, brain and leukaemia. No safe level of PM2.5 exposure was observed in the exposure-response curve for all types of cancer. In conclusion, with nationwide cancer death records in Brazil, we found that long-term exposure to ambient PM2.5 increased risks of mortality for many cancer types. Even low level PM2.5 concentrations had significant impacts on cancer mortality.

A Geodemographic View of the Accessibility of Selected Outpatient Services in Czechia.

Objectives: Although people use health services throughout their lives, there are important differences in timing, location, and frequency of utilization. The aim of this article is to identify and explain these differences in terms of healthcare accessibility. Methods: Outpatient health services—diabetology, cardiology, and psychiatry—are analysed using anonymized data from the General Health Insurance Company (GHIC) in Czechia for 2019. Healthcare utilization is studied in relation to selected geodemographic characteristics—patient’s age, sex, place of permanent residence, and location of healthcare provision. Results: The analysis found significant differences in the utilization of the selected health services in terms of age, sex, and size of the patient’s municipality of residence. Generally, men tended to travel outside their municipality for healthcare more than women. Young patients were more likely (and also further) to travel outside their municipality for healthcare than older patients. Conclusion: The reasons for this were the location of the health service provider (mostly concentrated in local/regional centres), the patient’s ability and willingness to travel for healthcare, and differences in the patient’s permanent and ordinary place of residence.

SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study.

Background:As in other countries, the COVID-19 pandemic has affected Norway’s immigrant population disproportionately, with significantly higher infection rates and hospitalisations. The reasons for this are uncertain.Methods:Through the national emergency preparedness register, BeredtC19, we have studied laboratory-confirmed infections with SARS-CoV-2 and related hospitalisations in the entire Norwegian population, by birth-country background for the period 15 June 2020 to 31 March 2021, excluding the first wave due to limited test capacity and restrictive test criteria. Straightforward linkage of individual-level data allowed adjustment for demographics, socioeconomic factors (occupation, household crowding, education and household income), and underlying medical risk for severe COVID-19 in regression models.Results:The sample comprised 5.49 million persons, of which 0.91 million were born outside of Norway, there were 82,532 confirmed cases and 3088 hospitalisations. Confirmed infections in this period (per 100,000): foreign-born 3140, Norwegian-born with foreign-born parents 4799 and Norwegian-born with Norwegian-born parent(s) 1011. Hospitalisations (per 100,000): foreign-born 147, Norwegian-born with foreign-born parents 47 and Norwegian-born with Norwegian-born parent(s) 37. The addition of socioeconomic and medical factors to the base model (age, sex, municipality of residence) attenuated excess infection rates by 12.0% and hospitalisations by 3.8% among foreign-born, and 10.9% and 46.2%, respectively, among Norwegian-born with foreign parents, compared to Norwegian-born with Norwegian-born parent(s).Conclusions: There were large differences in infection rates and hospitalisations by country background, and these do not appear to be fully explained by socioeconomic and medical factors. Our results may have implications for health policy, including the targeting of mitigation strategies.

Cannot keep up with the Joneses: how relative deprivation pushes internal migration in Austria

PurposeUsing aggregated data at the municipality level allows the authors to assess the role of relative deprivation (RD) – a measure of income inequality – on top of absolute income in shaping internal migration in Austria.Design/methodology/approachIn this study, the authors analyse the effect of regional income inequality on emigration rates of Austrian municipalities using a unique spatial dataset that is constructed based on Austrian administrative register data. The register-based data contain information on the municipality of residence of all individuals aged 16 and over that have their main residency in Austria, as well as their income and socio-demographic characteristics.FindingsThe authors find that increases in relative deprivation in a municipality are related to higher emigration from the municipality. Allowing for heterogeneous effects across income, education and age groups reveals that the effect is stronger among those with comparably low levels of income and among low-skilled and young individuals.Originality/valueThe unique spatially disaggregated perspective is based on novel data from Austrian administrative registers, which comprehensively capture the economic situation and geographic movements of the whole Austrian population. Most importantly, this approach allows for measuring income inequality within local communities and for a direct identification of social groups that are more sensitive to inequality.