What Association Do Inequalities in Travel Time to Healthcare Have on Health Status? a Case Study of West Yorkshire Hip and Knee Replacement Patients

Abstract

Background With ageing populations and healthcare policy moving towards centralisation of services a greater understanding is needed on the impact of patients travelling further to access healthcare. A growing number of studies have identified that patients living further from healthcare facilities have lower rates of use after adjustment for need than those living closer. However, it is not always clear what is the association between travel time to healthcare facilities and patients’ health. This study explored the association between travel time to the hospital and patients’ health status for hip/ knee replacement operations in West Yorkshire (UK). Methods The study used Hospital Episode Statistics, which includes data for patients of each National Health Service visit or stay in England, linked to patient reported outcomes for hip and knee replacement (2009/10-2011/2012). Health status was measured using the EuroQol 5 dimensions EQ-5D questionnaire completed pre and post-operation. Shortest travel time using the road network was calculated from the patient’s home postcode to the hospital attended using ArcGIS10.4. Regression models were used to examine the association between travel time to the hospital (both as a continuous variable and split into quintiles) and health status pre-operation and change post-operation and examine interaction effects between deprivation and travel time. Results A total of 10,991 patients undergoing hip and knee operations were included in the analyses. The highest pre-operation health status (0.41, SD 0.311) was achieved by those patients with the longest travel times (furthest quintile). A positive association between travel time and health status was identified when travel time was included as a continuous variable. For every 10 minute increase in travel time the health status score increased by 0.00626 (CI 0.0015 - 0.0111). However, when travel time was split into quintiles the results showed a significant negative association (increasing travel time reducing health status) with the exception of patients’ in the furthest two quintiles. Patients living in the most deprived quintile had lower average travel times to the hospital and lower average pre-operation health status scores (average 0.285, SD 0.32) compared to those living in the least deprived quintile (average 0.429, SD 0.31). Conclusions Inequalities in travel time to the hospital were associated with differences in health status. A detailed spatial analysis by hospital and geographical area is needed for policies such as centralisation, as it is not uniformly those with the longest travel times that are most affected by inequalities in travel time.