Predictors of early life residential mobility in urban and rural pennsylvania children with acute lymphoblastic leukemia and implications for environmental exposure assessment

ABSTRACT BACKGROUND Residential mobility can introduce exposure misclassification in pediatric epidemiology studies using birth address only. OBJECTIVE We examined whether residential

mobility varies by sociodemographic factors and urbanicity/rurality among children with cancer. METHODS Our study included 400 children born in Pennsylvania during 2002–2015 and diagnosed

with leukemia at ages 2–7 years. Addresses were obtained from state registries at birth and diagnosis. We considered three aspects of mobility between birth and diagnosis: whether a child

moved, whether a mover changed census tract, and distance moved. We evaluated predictors of these aspects in urban- and rural-born children using chi-square, _t_-tests, and regression

analyses. RESULTS Overall, 58% of children moved between birth and diagnosis; suburban/rural-born children were more likely to move than urban-born children (67% versus 57%). The mean

distance moved was 16.7 km in suburban/rural-born and 14.8 km in urban-born movers. In urban-born children, moving between birth and diagnosis was associated with race, education,

participation in the Nutrition Program for Women, Infants and Children (WIC), and census tract-level income (all χ2 _p_ < 0.01). Urban-born movers tended to be born in a census tract with

a higher Social Vulnerability Index than non-movers (_t_-test _p_ < 0.01). No factors were statistically significantly associated with any of the residential mobility metrics in

suburban/rural-born children, although the sample size was small. IMPACT STATEMENT In this study of a vulnerable population of children with cancer, we found that rural-born children were

more likely to move than urban-born children, however, the frequency of movers changing census tracts was equivalent. Mobility in urban-born children, but not rural-born, was associated with

several social factors, although the sample size for rural-born children was small. Mobility could be an important source of misclassification depending on the spatial heterogeneity and

resolution of the exposure data and whether the social factors are related to exposures or health outcomes. Our results highlight the importance of considering differences in mobility

between urban and rural populations in spatial research. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS

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SWITZERLAND Article Open access 02 December 2021 GEOGRAPHICAL VARIATION OF COMMON CHILDHOOD ILLNESS AND ITS ASSOCIATED FACTORS AMONG UNDER-FIVE CHILDREN IN ETHIOPIA: SPATIAL AND MULTILEVEL

ANALYSIS Article Open access 17 January 2023 INEQUITIES IN SPATIAL ACCESS TO CHILDBIRTH CARE IN THE GRAND CONAKRY CONURBATION, GUINEA Article Open access 23 April 2025 DATA AVAILABILITY Data

for this study were obtained from the Pennsylvania Cancer Registry and the Pennsylvania Department of Health Bureau of Health Statistics and Registries. The authors do not own these data

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Heidelberg: Springer Berlin Heidelberg; 2011. p. 23-6. Download references ACKNOWLEDGEMENTS This research was supported in part by National Priority Research Project under Assistance

Agreement No. CR839249 awarded by the U.S. Environmental Protection Agency (EPA) to Yale University. The publication has not been formally reviewed by EPA. The views expressed in this

document are solely those of the authors and do not reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. Research reported in

this publication was supported in part by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number R01MD016054. CJC was

supported by a T32 training grant from the National Cancer Institute (T32 CA250803). The content is solely the responsibility of the authors and does not represent the official views of the

National Institutes of Health. Some data were supplied by the Bureau of Health Statistics & Registries, Pennsylvania Department of Health, Harrisburg, Pennsylvania. The Pennsylvania

Department of Health specifically disclaims responsibility for any analyses, interpretations or conclusions. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Yale School of Public Health,

Department of Environmental Health Sciences, 60 College St., New Haven, CT, 06510, USA Cassandra J. Clark & Nicole C. Deziel * Yale School of Public Health, Department of Biostatistics,

60 College St., New Haven, CT, 06510, USA Joshua L. Warren * Yale School of the Environment, 195 Prospect Street, New Haven, CT, 06511, USA James E. Saiers & Michelle L. Bell * Yale

School of Public Health, Department of Chronic Disease Epidemiology, 60 College St., New Haven, CT, 06510, USA Xiaomei Ma Authors * Cassandra J. Clark View author publications You can also

search for this author inPubMed Google Scholar * Joshua L. Warren View author publications You can also search for this author inPubMed Google Scholar * James E. Saiers View author

publications You can also search for this author inPubMed Google Scholar * Xiaomei Ma View author publications You can also search for this author inPubMed Google Scholar * Michelle L. Bell

View author publications You can also search for this author inPubMed Google Scholar * Nicole C. Deziel View author publications You can also search for this author inPubMed Google Scholar

CONTRIBUTIONS CJC: Conceptualization, funding acquisition, formal analysis, visualization, writing—original draft and review and editing; JLW: Conceptualization, methodology, writing: review

and editing, MLB: Methodology, writing: review and editing, JES: Writing: review and editing, funding acquisition, XM: Supervision, writing: review and editing, funding acquisition, and

NCD: Conceptualization, supervision, writing—review and editing, funding acquisition. CORRESPONDING AUTHOR Correspondence to Cassandra J. Clark. ETHICS DECLARATIONS COMPETING INTERESTS The

authors declare no competing interests. ETHICAL APPROVAL The study protocol was approved by the Institutional Review Board of Yale University (HIC #2000021809) and the Pennsylvania

Department of Health (IF-0430) and reviewed and approved by the US Environmental Protection Agency (HSR-001162). ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with

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manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Clark, C.J.,

Warren, J.L., Saiers, J.E. _et al._ Predictors of early life residential mobility in urban and rural Pennsylvania children with acute lymphoblastic leukemia and implications for

environmental exposure assessment. _J Expo Sci Environ Epidemiol_ 34, 990–999 (2024). https://doi.org/10.1038/s41370-023-00636-9 Download citation * Received: 04 May 2023 * Revised: 08

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