Geographic Differences in Uncontrolled Chronic Medical Conditions—Reply

Abstract

In Reply Dr Tompkins and colleagues suggest additional analyses to clarify the relationship between moving and chronic medical conditions in reference to our recent publication.¹ We would first emphasize that our study does not argue that there is a relationship between moving itself and the prevalence of uncontrolled chronic conditions. Rather, our study sought to estimate the association between changes in individuals’ likelihood of an uncontrolled chronic condition after moving and the difference in the prevalence of the uncontrolled chronic condition between movers’ destination vs origin zip code. Conceptually, we compared changes in chronic condition control among people from the same zip code who subsequently moved to separate zip codes with different rates of chronic condition control, after adjusting for secular trends in outcomes among nonmovers from their zip code (eFigure 2 in the Supplement). The primary analysis accounted for baseline differences in chronic condition control associated with moving itself by including patient-specific fixed effects. The primary analysis also accounted for changes in chronic condition control over time associated with the time since each person moved by including quarter-years since moving as fixed effects.