Importance The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.

中文翻译：

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不受控制的慢性病患病率的地域差异与个体不受控制的慢性病可能性变化的关联

重要性 在美国，发病率和死亡率的主要危险因素的流行程度因地区、州和社区而异，但这些差异与一个人的居住地与居住在不同地方的人的特征的相关程度仍不清楚. 目的 通过比较搬到不同地区或未搬家的个人的健康结果趋势，估计主要风险因素的地理差异与一个人的居住地相关的程度。设计、设置和参与者 这项回顾性队列研究估计了不同迁徙者目的地和始发地邮政编码之间不受控制的慢性病患病率差异与个人健康状况变化之间的关联。搬家后出现不受控制的慢性病的可能性，根据个人特定的固定效应、搬家后的持续时间以及搬家和不搬家的长期趋势进行调整。分析了退伍军人健康管理局的电子健康记录。主要分析包括 5 342 207 名在 2008 年至 2018 年期间至少移动过一次或从未移动过邮政编码的退伍军人健康管理局门诊患者。暴露 一个人的始发地邮政编码和目的地邮政编码之间不受控制的慢性病患病率的差异（不包括个体搬家者的结果）。主要结果和措施 不受控制的血压（收缩压水平 >140 毫米汞柱或舒张压水平 >90 毫米汞柱）的患病率，在个人搬家前 3 年和搬家后 3 年期间，每季度未控制的糖尿病（血红蛋白 A1c 水平 >8%）、肥胖（体重指数 >30）和抑郁症状（2 项患者健康问卷评分≥2） . 结果 研究人群包括 5 342 207 人（平均年龄，57.6 [SD，17.4] 岁，男性占 93.9%，白人占 72.5%，黑人占 12.7%），其中 1 095 608 人只移动过一次，4 246 599 人从未移动学习期间搬家。在搬家者中，搬家后血压不受控制流行率的变化为血压不受控制流行率地区间差异的27.5%（95% CI，23.8%-31.3%）。同样，不受控制的糖尿病患病率移动后的变化为 5.0%（95% CI，2.7%-7. 2%）未控制的糖尿病患病率地区间差异；肥胖患病率移动后的变化为肥胖患病率地区间差异的 3.1%（95% CI，2.0%-4.2%）；抑郁症状患病率移动后的变化为抑郁症状患病率地区间差异的15.2%（95% CI，13.1%-17.2%）。结论和相关性 在这项针对在退伍军人健康管理局机构接受护理的个人的回顾性队列研究中，患病率的地域差异与个人血压控制不佳或抑郁症状的可能性变化的很大百分比有关，而在个体糖尿病控制不佳和肥胖的可能性的变化。