The relationship between residential mobility and mortality following acute myocardial infarction

Background — The extent to which residential mobility is associated with declining health among disease-specific populations, such as survivors of acute myocardial infarction (AMI), remains unknown.

Methods — This prospective cohort study consisted of 3,377 patients followed from index AMI (Dec 1, 1999-March 30, 2003) until death or until the last available follow-up date (March 30, 2020) in Ontario, Canada. Each residential postal code move from a patient’s sentinel AMI event was tracked. Time-varying Cox proportional hazards examined the associated impact of each residential postal code move on mortality after adjusting for age, sex, baseline socioeconomic, psychosocial factors, changes in neighbourhood income level from each residential move, pre-existing cardiovascular and non-cardiovascular illnesses, and rural residence. All models evaluated death and long-term care institutionalization as competing risks to distinguish mortality from other end-of-life destination outcomes among community-dwelling populations.

Results — The study sample included 3,369 patients with 1,828 (54.3%) having at least one residential move throughout the study. 86.5% of patients either died in the community or transitioned from a community dwelling into a long-term care facility as an end-of-life destination. When adjusted for baseline factors and changing neighbourhood socioeconomic status over time, each residential move was associated with a 12% higher rate of death (Adjusted HR: 1.12; 95% CI: 1.05-1.19, p<.001) and a 26% higher rate of long-term care end-of-life institutionalization (Adjusted HR: 1.26; 95% CI: 1.14-1.58, p < 0.001).

Conclusions — Residential mobility was associated with higher mortality following AMI. Further research is needed to better evaluate intermediary causal pathways that may explain why residential mobility is associated with end-of-life outcomes.