Saucy Apolline, Gehring Ulrike, Olmos Sergio, Delpierre Cyrille, de Bont Jeroen, Gruzieva Olena, de Hoogh Kees, Huss Anke, Ljungman Petter, Melén Erik, Persson Åsa, Pieterson Inka, Tewis Marjan, Yu Zhebin, Vermeulen Roel, Vlaanderen Jelle, Tonne Cathryn
Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain.
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Environ Int. 2023 Mar;173:107849. doi: 10.1016/j.envint.2023.107849. Epub 2023 Feb 26.
Residential relocation is increasingly used as a natural experiment in epidemiological studies to assess the health impact of changes in environmental exposures. Since the likelihood of relocation can be influenced by individual characteristics that also influence health, studies may be biased if the predictors of relocation are not appropriately accounted for. Using data from Swedish and Dutch adults (SDPP, AMIGO), and birth cohorts (BAMSE, PIAMA), we investigated factors associated with relocation and changes in multiple environmental exposures across life stages. We used logistic regression to identify baseline predictors of moving, including sociodemographic and household characteristics, health behaviors and health. We identified exposure clusters reflecting three domains of the urban exposome (air pollution, grey surface, and socioeconomic deprivation) and conducted multinomial logistic regression to identify predictors of exposome trajectories among movers. On average, 7 % of the participants relocated each year. Before relocating, movers were consistently exposed to higher levels of air pollution than non-movers. Predictors of moving differed between the adult and birth cohorts, highlighting the importance of life stages. In the adult cohorts, moving was associated with younger age, smoking, and lower education and was independent of cardio-respiratory health indicators (hypertension, BMI, asthma, COPD). Contrary to adult cohorts, higher parental education and household socioeconomic position were associated with a higher probability of relocation in birth cohorts, alongside being the first child and living in a multi-unit dwelling. Among movers in all cohorts, those with a higher socioeconomic position at baseline were more likely to move towards healthier levels of the urban exposome. We provide new insights into predictors of relocation and subsequent changes in multiple aspects of the urban exposome in four cohorts covering different life stages in Sweden and the Netherlands. These results inform strategies to limit bias due to residential self-selection in epidemiological studies using relocation as a natural experiment.
在流行病学研究中，居住迁移越来越多地被用作一种自然实验，以评估环境暴露变化对健康的影响。由于迁移的可能性可能受到也会影响健康的个体特征的影响，如果没有适当地考虑迁移的预测因素，研究可能会产生偏差。我们使用来自瑞典和荷兰成年人（SDPP、AMIGO）以及出生队列（BAMSE、PIAMA）的数据，调查了与迁移以及不同生命阶段多种环境暴露变化相关的因素。我们使用逻辑回归来确定迁移的基线预测因素，包括社会人口学和家庭特征、健康行为和健康状况。我们确定了反映城市暴露组三个领域（空气污染、灰色表面和社会经济剥夺）的暴露集群，并进行多项逻辑回归以确定迁移者中暴露组轨迹的预测因素。平均而言，每年有7%的参与者迁移。在迁移之前，迁移者始终比未迁移者暴露于更高水平的空气污染中。成人队列和出生队列中迁移的预测因素有所不同，这突出了生命阶段的重要性。在成人队列中，迁移与较年轻的年龄、吸烟以及较低的教育程度相关，并且与心肺健康指标（高血压、体重指数、哮喘、慢性阻塞性肺疾病）无关。与成人队列相反，在出生队列中，较高的父母教育程度和家庭社会经济地位与迁移的可能性较高相关，同时还包括是第一个孩子以及居住在多单元住宅中。在所有队列的迁移者中，基线时社会经济地位较高的人更有可能朝着城市暴露组更健康的水平迁移。我们为瑞典和荷兰四个涵盖不同生命阶段的队列中迁移的预测因素以及城市暴露组多个方面的后续变化提供了新的见解。这些结果为在使用迁移作为自然实验的流行病学研究中限制因居住自我选择导致的偏差的策略提供了信息。
