Health care–related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease

Abstract

Background: Health care–related transportation insecurity (delayed or forgone medical care due to transportation barriers) is being increasingly recognized as a social risk factor affecting health outcomes. We estimated the national burden and adverse outcomes of health care–related transportation insecurity among US adults with chronic liver disease (CLD). Methods: Using the U.S. National Health Interview Survey from 2014 to 2018, we identified adults with self-reported CLD. We used complex weighted survey analysis to obtain national estimates of health care–related transportation insecurity. We examined the associations between health care–related transportation insecurity and health care–related financial insecurity, food insecurity, self-reported health status, work productivity, health care use, and mortality. Results: Of the 3643 (representing 5.2 million) US adults with CLD, 267 [representing 307,628 (6%; 95% CI: 5%–7%)] reported health care–related transportation insecurity. Adults with CLD experiencing health care–related transportation insecurity had 3.5 times higher odds of cost-related medication nonadherence [aOR, 3.5; (2.4–5.0)], 3.5 times higher odds of food insecurity [aOR, 3.5; (2.4–5.3)], 2.5 times higher odds of worsening self-reported health status over the past year [aOR, 2.5; (1.7–3.7)], 3.1 times higher odds of being unable to work due to poor health over the past year [aOR, 3.1; (2.0–4.9)], and 1.7 times higher odds of being in a higher-risk category group for number of hospitalizations annually [aOR, 1.7; (1.2–2.5)]. Health care–related transportation insecurity was independently associated with mortality after controlling for age, income, insurance status, comorbidity burden, financial insecurity, and food insecurity [aHR, 1.7; (1.4–2.0)]. Conclusions: Health care–related transportation insecurity is a critical social risk factor that is associated with health care–related financial insecurity, food insecurity, poorer self-reported health status and work productivity, and increased health care use and mortality among US adults with CLD. Efforts to screen for and reduce health care–related transportation insecurity are warranted.