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
. 2023 Jul 3;6(7):e2325291.
doi: 10.1001/jamanetworkopen.2023.25291.

Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

Muhieddine Labban  1   2 , Chang-Rong Chen  3 , Nicola Frego  1   2   4 , David-Dan Nguyen  5 , Stuart R Lipsitz  2 , Amanda J Reich  2 , Timothy R Rebbeck  6   7 , Toni K Choueiri  8 , Adam S Kibel  1 , Hari S Iyer  6   9 , Quoc-Dien Trinh  1   2
Affiliations

Disparities in Travel-Related Barriers to Accessing Health Care From the 2017 National Household Travel Survey

Muhieddine Labban et al. JAMA Netw Open. .

Abstract

Importance: Geographic access, including mode of transportation, to health care facilities remains understudied.

Objective: To identify sociodemographic factors associated with public vs private transportation use to access health care and identify the respondent, trip, and community factors associated with longer distance and time traveled for health care visits.

Design, setting, and participants: This cross-sectional study used data from the 2017 National Household Travel Survey, including 16 760 trips or a nationally weighted estimate of 5 550 527 364 trips to seek care in the United States. Households that completed the recruitment and retrieval survey for all members aged 5 years and older were included. Data were analyzed between June and August 2022.

Exposures: Mode of transportation (private vs public transportation) used to seek care.

Main outcomes and measures: Survey-weighted multivariable logistic regression models were used to identify factors associated with public vs private transportation and self-reported distance and travel time. Then, for each income category, an interaction term of race and ethnicity with type of transportation was used to estimate the specific increase in travel burden associated with using public transportation compared a private vehicle for each race category.

Results: The sample included 12 092 households and 15 063 respondents (8500 respondents [56.4%] aged 51-75 years; 8930 [59.3%] females) who had trips for medical care, of whom 1028 respondents (6.9%) were Hispanic, 1164 respondents (7.8%) were non-Hispanic Black, and 11 957 respondents (79.7%) were non-Hispanic White. Factors associated with public transportation use included non-Hispanic Black race (compared with non-Hispanic White: adjusted odds ratio [aOR], 3.54 [95% CI, 1.90-6.61]; P < .001) and household income less than $25 000 (compared with ≥$100 000: aOR, 7.16 [95% CI, 3.50-14.68]; P < .001). The additional travel time associated with use of public transportation compared with private vehicle use varied by race and household income, with non-Hispanic Black respondents with income of $25 000 to $49 999 experiencing higher burden associated with public transportation (mean difference, 81.9 [95% CI, 48.5-115.3] minutes) than non-Hispanic White respondents with similar income (mean difference, 25.5 [95% CI, 17.5-33.5] minutes; P < .001).

Conclusions and relevance: These findings suggest that certain racial, ethnic, and socioeconomically disadvantaged populations rely on public transportation to seek health care and that reducing delays associated with public transportation could improve care for these patients.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Choueiri reported receiving personal fees from Alkermes, AstraZeneca, Aravive, Aveo, Bayer, Bristol Myers-Squibb, Calithera, Circle Pharma, Eisai, EMD Serono, Exelixis, GlaxoSmithKline, Gilead, IQVA, Infinity, Ipsen, Jansen, Kanaph, Lilly, Merck, Nikang, Nuscan, Novartis, Oncohost, Pfizer, Roche, Sanofi/Aventis, Scholar Rock, Surface Oncology, Takeda, Tempest, Up-To-Date, Peerview, OncLive, and MJH Life Sciences; having patents filed on molecular alterations and immunotherapy response and toxiceffects, and ctDNA; owning stock in Tempest, Pionyr, Osel, Precede Bio, and CureResponse; serving on committees for the National Comprehensive Cancer Network, Genitourinary Steering Committee of the American Society of Clinical Oncology/European Society for Medical Oncology, Academic and Community Cancer Research United, and KidneyCan; and salary support from the Dana-Farber–Harvard Cancer Center Kidney SPORE, Kohlberg Chair at Harvard Medical School, and the Trust Family, Michael Brigham, Pan Mass Challenge, Hinda and Arthur Marcus Fund, and Loker Pinard Funds for Kidney Cancer Research at Dana-Farber Cancer Institute outside the submitted work. Dr Trinh reported receiving personal fees from Astellas, Bayer, and Janssen and grants from Pfizer outside the submitted work. No other disclosures were reported.

References

    1. Nabi J, Tully KH, Cole AP, et al. . Access denied: the relationship between patient insurance status and access to high-volume hospitals. Cancer. 2021;127(4):577-585. doi:10.1002/cncr.33237 - DOI - PubMed
    1. Krimphove MJ, Cole AP, Fletcher SA, et al. . Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis. 2019;22(1):125-136. doi:10.1038/s41391-018-0083-4 - DOI - PubMed
    1. Purnell TS, Calhoun EA, Golden SH, et al. . Achieving health equity: closing the gaps in health care disparities, interventions, and research. Health Aff (Millwood). 2016;35(8):1410-1415. doi:10.1377/hlthaff.2016.0158 - DOI - PubMed
    1. Krieger N, Van Wye G, Huynh M, et al. . Structural racism, historical redlining, and risk of preterm birth in New York City, 2013-2017. Am J Public Health. 2020;110(7):1046-1053. doi:10.2105/AJPH.2020.305656 - DOI - PMC - PubMed
    1. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127-140. doi:10.1097/00005650-198102000-00001 - DOI - PubMed

Publication types