Exploring the Relationship Between Household Income and Healthcare Travel Patterns

Introduction Transportation is a social determinant of health which affects how easily individuals attend clinic appointments, obtain medications, or seek emergency care. Despite the importance of transportation, there are few large-scale studies characterizing typical transportation behaviors related to seeking healthcare. This study investigates demographic differences in travel times and transportation mode for healthcare/medical related trips using the National Household Travel Survey (NHTS) dataset and identifies potential access inequities. Methods Medical trip data was obtained from the 2017 NHTS dataset. All analysis was adjusted by survey weights. Multiple linear regression models were developed to investigate the relationships between demographic variables, transportation mode, and travel time. Additionally, a logistic regression model was used to investigate the relationship between demographics and transportation mode. Results Medical trips using public transportation were found to be significantly longer relative to personal automobile trips. Higher household income was found to be associated with shorter travel times, but the effect size decreased with the inclusion of transportation mode. Higher household income respondents were also likely to use public transportation. Respondent race was not significantly associated with any differences in travel times, but there were significant differences across races in public transportation use. Conclusions This study demonstrates that individuals with lower household incomes tended to have longer medical trips. Additionally, it identifies public transit to be a potential mediating factor for this difference, as lower-income residents were significantly more likely to use public transit. This analysis highlights the importance of maintaining accessible and efficient public transportation for access to healthcare, especially for populations which have traditionally been at-risk for health disparities. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any external funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: National Household Travel Survey NHTS 2017 Dataset: I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors and will be uploaded to a repository at a later date