Quality of life is a matter of distance? A study investigating the association between transport accessibility to healthcare and health inequalities for patients with Rheumatoid Arthritis and Osteoarthritis

This study explored the association between transport accessibility to healthcare facilities and health outcomes for patients in England with Arthritis. The aim was to provide evidence on the impacts on patient health from changing where patients attend hospital and a method for evaluating who would be affected under a range of scenarios. The study had three main stages: 1. Systematic review to consider the current evidence. This review focused on studies that had considered the associations between travel time/ distance and health outcomes in global north countries. Out of 108 identified studies 77% reported evidence that patients who live further from where their healthcare is provided have poorer health outcomes. 2. Exploring the association. The study used two datasets to explore the association between transport accessibility and health outcomes. These were the linked Hospital Episode Statistics and Patient Reported Outcomes Measures dataset (using West Yorkshire patient data) and the English Longitudinal Study of Ageing (using a national sample). These were used to assess whether travelling further to the hospital or the GP was associated with poorer health. The results include some evidence of a decline for those travelling the furthest, but importantly that the key association with health outcomes was ease of travel. The burden of travel to healthcare was exacerbated for individuals without access to a car, living alone and with mobility issues. 3. Assessing the impact of changes to healthcare provision. Using mapping techniques (including location-allocation methods), the study has assessed the impact on patient travel and inequalities within groups for a number of service provision scenarios. Modelling was used to predict changes in health outcomes from these changes. These findings can help inform future planning decisions concerning where patients attend healthcare services to minimise the impact on patient travel and health inequalities.