Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 1;7(10):e2439499.
doi: 10.1001/jamanetworkopen.2024.39499.

Patterns of Migration Following Dementia Diagnosis

Momotazur Rahman  1 , Bishnu Bahadur Thapa  1 , Christopher Santostefano  1 , Pedro Gozalo  1 , Ulrike Muench  2 , Cyrus M Kosar  1 , Hyesung Oh  1 , Elizabeth White  1   3 , Vincent Mor  1
Affiliations

Patterns of Migration Following Dementia Diagnosis

Momotazur Rahman et al. JAMA Netw Open. .

Abstract

Importance: Diseases have historically prompted individual relocations to mitigate the risk of disease acquisition or improve access to care. As dementia prevalence increases, comprehending the migration patterns of affected individuals is vital for public policy.

Objective: To quantify the association of dementia diagnosis with migration patterns by examining the proportion of individuals with dementia who relocate, the timing of their moves relative to diagnosis, and the nature of their new living arrangements, whether in institutional settings or different households.

Design, setting, and participants: This cohort study leveraged a comprehensive dataset of national Medicare claims and assessments spanning from 2012 to 2020, including Medicare Beneficiary Summary File and nursing home administrative datasets. The study focused on beneficiaries who received diagnoses in 2016 of dementia, myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Analyses were performed from March 2023 to August 2024.

Main outcomes and measures: The primary outcome was migration, defined as change in county or state. The analysis distinguished between migrations with and without a nursing home stay. By tracking patients' residential county for 4 years before and after diagnosis, a difference-in-differences approach was used to contrast migration tendencies associated with dementia against the other 3 conditions.

Results: The sample included 1 626 127 Medicare beneficiaries (mean [SD] age, 80.1 [8.0] years; 922 194 women [56.7%]) who received diagnoses of the 4 conditions in 2016. In total, 818 862 had a new dementia diagnosis (age, 82.0 [7.8] years; 492 146 women [60.1%]). Comparing between the prediagnosis and postdiagnosis months, the proportion migrating to a different county increased by 8.5 percentage points (95% CI, 7.6-9.4 percentage points) for individuals with dementia and between 4.2 to 5.8 percentage points among those with myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. The difference-in-difference estimates indicated a 3.9 percentage point (95% CI, 3.7-4.0 percentage points) increase in intercounty migration and a 1.9 percentage point (95% CI, 1.8-2.0 percentage points) increase in interstate migration for patients with dementia, effectively doubling the likelihood of migration compared with the other conditions. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings.

Conclusions and relevance: In this retrospective cohort study of Medicare fee-for-service beneficiaries, dementia was associated with a marked increase in migration rates over other major illnesses. This finding underscores the need to understand the factors associated with these distinct migration behaviors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gozalo reported receiving grants from the National Institute on Aging outside the submitted work. Dr Muench reported receiving personal fees from Brown University for research consulting during the conduct of the study and grants from the National Institute on Aging outside the submitted work. Dr White reported receiving grants from the Centers for Disease Control and Prevention outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Any Migration Relative to Time of Diagnosis
Graphs show proportions of patients in a community setting migrating to another county (A), patients in a nursing home migrating to another county (B), patients in a community setting migrating to another state (C), and patients in a nursing home migrating to another state (D). COPD indicates chronic obstructive pulmonary disease; and MI, myocardial infarction.
Figure 2.
Figure 2.. Cumulative Likelihood of Migration Relative to Time of Diagnosis
Graphs show cumulative likelihood of migration among patients in a community setting migrating to another county (A), patients in a nursing home migrating to another county (B), patients in a community setting migrating to another state (C), and patients in a nursing home migrating to another state (D). COPD indicates chronic obstructive pulmonary disease; and MI, myocardial infarction.
Figure 3.
Figure 3.. Difference in the Cumulative Likelihood of Migration Between Persons With Dementia and Other Conditions
This plot is based on the regression coefficients and associated 95% CIs (error bars) of the dynamic difference in the difference model.
See this image and copyright information in PMC

References

    1. Koyama M, Jedwab R, Johnson N. Pandemics, places, and populations: evidence from the Black Death (discussion paper DP13523). Center for Economic Policy Research. February 12, 2019. Accessed September 9, 2024. https://economics.yale.edu/sites/default/files/cepr-dp13523_adans.pdf
    1. Alirol E, Getaz L, Stoll B, Chappuis F, Loutan L. Urbanisation and infectious diseases in a globalised world. Lancet Infect Dis. 2011;11(2):131-141. doi:10.1016/S1473-3099(10)70223-1 - DOI - PMC - PubMed
    1. Gardner RC, Valcour V, Yaffe K. Dementia in the oldest old: a multi-factorial and growing public health issue. Alzheimers Res Ther. 2013;5(4):27. doi:10.1186/alzrt181 - DOI - PMC - PubMed
    1. Global Burden of Disease 2019 Dementia Forecasting Collaborators . Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022;7(2):e105-e125. doi:10.1016/S2468-2667(21)00249-8 - DOI - PMC - PubMed
    1. Rahman M, White EM, Mills C, Thomas KS, Jutkowitz E. Rural-urban differences in diagnostic incidence and prevalence of Alzheimer’s disease and related dementias. Alzheimers Dement. 2021;17(7):1213-1230. doi:10.1002/alz.12285 - DOI - PMC - PubMed

Publication types