Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Jul 3;6(7):e2325291. doi: 10.1001/jamanetworkopen.2023.25291.
Geographic access, including mode of transportation, to health care facilities remains understudied.
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.
Mode of transportation (private vs public transportation) used to seek care.
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.
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).
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.
医疗保健设施的地理位置可达性，包括交通方式，仍研究不足。
确定与使用公共交通和私人交通来获得医疗保健相关的社会人口学因素，并确定与医疗保健就诊的距离和时间较长相关的受访者、行程和社区因素。
设计、设置和参与者：这项横断面研究使用了 2017 年全国家庭出行调查的数据，包括在美国寻求医疗保健的 16760 次旅行或全国加权估计的 5550527364 次旅行。包括完成所有 5 岁及以上成员的招募和检索调查的家庭。数据于 2022 年 6 月至 8 月进行分析。
用于寻求医疗保健的交通方式（私人交通与公共交通）。
使用调查加权多变量逻辑回归模型确定与公共交通和私人交通以及自我报告的距离和旅行时间相关的因素。然后，对于每个收入类别，种族和族裔与交通类型的交互项用于估计与使用公共交通相比，使用私人车辆与每个种族类别相关的旅行负担的具体增加。
样本包括 12092 户家庭和 15063 名受访者（8500 名受访者[56.4%]年龄在 51-75 岁；8930 名[59.3%]女性），他们有医疗旅行，其中 1028 名受访者（6.9%）是西班牙裔，1164 名受访者（7.8%）是非西班牙裔黑人，11957 名受访者（79.7%）是非西班牙裔白人。与公共交通使用相关的因素包括非西班牙裔黑人种族（与非西班牙裔白人相比：调整后的优势比[OR]，3.54[95%CI，1.90-6.61]；P<0.001）和家庭收入低于 25000 美元（与收入≥100000 美元相比：OR，7.16[95%CI，3.50-14.68]；P<0.001）。与使用私人车辆相比，使用公共交通工具所带来的额外旅行时间因种族和家庭收入而异，收入在 25000 美元至 49999 美元之间的非西班牙裔黑人受访者的公共交通相关负担较高（平均差异，81.9[95%CI，48.5-115.3]分钟）比收入相似的非西班牙裔白人受访者（平均差异，25.5[95%CI，17.5-33.5]分钟；P<0.001）。
这些发现表明，某些种族、民族和社会经济处于不利地位的人群依赖公共交通来寻求医疗保健，减少与公共交通相关的延误可能会改善这些患者的护理。
