Sociodemographic and health characteristics of Anglophone Canadian and U.S. snowbirds

Prevalence of winter migration to warmer destinations among Ontarians ("snowbirds") and patterns of their use of health care services: a population-based analysis

BACKGROUND

Older Canadians frequently migrate to warmer destinations for the winter season (snowbirds). Our aim was to examine the prevalence of migration to warmer destinations among Ontarians, and to compare the characteristics and use of health care services of snowbirds to those of older Ontarians who did not migrate for the winter.

METHODS

We conducted a population-based analysis using health administrative databases from Ontario. We compiled 10 seasonal cohorts (2009/10 to 2018/19) of adults aged 65 or more who filled a travel supply of medications under the Ontario Drug Benefits program (snowbirds) between September and January (snowbird season). We calculated the seasonal prevalence of snowbirds per 100 Ontarians aged 65 or more. We matched each snowbird in the 2018/19 season to 2 nonsnowbirds on age and sex, and compared their characteristics and patterns of use of government-funded health care services.

RESULTS

Over the 10-year period, 53 431 to 70 863 Ontarians aged 65 or more were identified as snowbirds (seasonal prevalence 2.6%-3.3%). Compared to nonsnowbirds, snowbirds were more likely to be recent migrants, live in higher-income neighbourhoods, have fewer comorbidities and make more visits to primary care physicians. From January to March 2019, snowbirds accessed government-funded health care services for a median of 0 days (interquartile range [IQR] 0-1 d), compared to 4 days (IQR 2-8 d) among nonsnowbirds.

INTERPRETATION

About 3% of older Ontarians migrate to warmer destinations for the winter each season. Since few access health care services in Ontario from January to March, researchers are encouraged to consider the snowbird population and the impact of their absence on evaluations that assume continuous observation.

Snowbirds and infection--new phenomena in pneumonia and influenza hospitalizations from winter migration of older adults: a spatiotemporal analysis

BACKGROUND

Despite advances in surveillance and prevention, pneumonia and influenza (P&I) remain among the leading causes of mortality in the United States. Elderly adults experience the most severe morbidity from influenza-associated diseases, and have the highest rates of seasonal migration within the U.S. compared to other subpopulations. The objective of this study is to assess spatiotemporal patterns in influenza-associated hospitalizations in the elderly, by time, geography, and intensity of P&I. Given the high seasonal migration of individuals to Florida, this state was examined more closely using harmonic regression to assess spatial and temporal patterns of P&I hospitalizations by state of residence.

METHODS

Data containing all Medicare-eligible hospitalizations in the United States for 1991-2006 with P&I (ICD-9-CM codes 480-487) were abstracted for the 65+ population. Hospitalizations were classified by state of residence, provider state, and date of admissions, specifically comparing those admitted between October and March to those admitted between April and September. We then compared the hospitalization profile data of Florida residents with that of out-of-state residents by state of primary residence and time of year (in-season or out-of-season).

RESULTS

We observed distinct seasonal patterns of nonresident P&I hospitalizations, especially comparing typical winter destination states, such as California, Arizona, Texas, and Florida, to other states. Although most other states generally experienced a higher proportion of non-resident P&I during the summer months (April-September), these states had higher nonresident P&I during the traditional peak influenza season (October-March).

CONCLUSIONS

This study is among the first to quantify spatiotemporal P&I hospitalization patterns in the elderly, focusing on the change of patterns that are possibly due to seasonal population migration. Understanding migration and influenza-associated disease patterns in this vulnerable population is critical to prepare for and potentially prevent influenza outbreaks in this vulnerable population.

Change and Continuity

This qualitative study examined lifestyles of older adults who migrate south in the winter. Interviews were conducted with 25 older adults (aged 60+) from the upper Midwest. Analyses revealed the following themes, including (a) snowbirds were flexible and adaptable to change, (b) there was continuity in personality, activity, and lifestyle, (c) friendships were established and maintained, (d) lifestyles were diverse, (e) health and safety considerations affected lifestyle, (f) internal and external forces shaped the snowbird experience, and (g) seasonal migration was developmental. Seasonal migration had a major impact in promoting quality of life and providing added meaning to the lives of these older adults. This study lent support for the concept of seasonal migration as an alternative to permanent migration (e.g., Smith & House, 2006), as well as McHugh and Mings’ (1996) circular life-course trajectory and place attachment. The snowbird experience can be explained as involving developmental change and continuity, family resiliency and connectedness, and successful aging.

Seasonal migration and health care

This article examines health care use and issues among seasonal migrants in an urban setting in the Sunbelt. The study, based on a survey of 230 American and Canadian snowbirds in Phoenix, Arizona, complements previous research on health care use among Canadian snowbirds in Florida. Our results show that health care use among seasonal migrants in Phoenix is substantial, and it varies by citizenship (American vs. Canadian), age, number of winter visits, and length of winter stay. We argue that health care use is symptomatic of social and emotional attachments to the winter residence that develop and deepen over a period of years. Phoenix snowbirds view their lifestyles as healthy, they are adept in adjusting to health decrements, and the majority plan to continue spending time in both their summer and winter residences as long as their health permits.