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



Residential mobility can introduce exposure misclassification in pediatric epidemiology studies using birth address only.


We examined whether residential mobility varies by sociodemographic factors and urbanicity/rurality among children with cancer.


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.


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.

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Fig. 1: Movement between and within urban and rural areas in 224 Pennsylvania children who moved between birth and diagnosis with ALL.

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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 and are not permitted to share them.


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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.

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Authors and Affiliations



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.

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Correspondence to Cassandra J. Clark.

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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).

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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 (2023).

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