Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review

Objectives: To investigate whether there is an association between differences in travel time/ travel distance to healthcare services and patients’ health outcomes and assimilate the methodologies used to measure this. Design: Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC, and EBM-Reviews for studies up to 7th September 2016. Studies were excluded that included children (including maternity), emergency medical travel, or countries classed as being in the global south. Settings: A wide range of settings within primary and secondary care (these were not restricted in the search) Results: One hundred and eight studies met the inclusion criteria. The results were mixed. Seventy seven percent of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (e.g. survival rates, length of stay in hospital, non-attendance at follow-up) than those that lived closer. Six of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients’ geographical locations and the healthcare facilities attended and the methods used to calculate travel times and distances were not consistent across studies. Conclusions: The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.