Transportation barriers, emergency department use, and mortality risk among us adults: a national health interview survey analysis

To estimate the prevalence of transportation barriers to care among patients with common chronic health conditions and examine associations between transportation barriers with the outcomes of emergency department use and all-cause mortality risk using a large, nationally representative cohort in the United States. We used weighted logistic and Cox regression to assess the association of transportation barriers, ED use and all-cause mortality, in 440,249 US adults aged 18–79 from the 2002–2018 National Health Interview Survey (NHIS) and linked mortality data. Transportation barrier was higher in adults with chronic health conditions (history of hypertension, cardiac diseases, chronic obstructive pulmonary disease (COPD)/asthma, class III obesity, diabetes, and cancer). It was also associated with increased risk of emergency department use (age 18–64: odds ratio (OR) = 1.45, 95% confidence interval (CI):1.41–1.50; age 65+: OR = 1.34, 95%CI:1.26–1.42), and all-cause mortality (age 18–64: hazard ratio (HR) = 1.36, 95%CI:1.24–1.49; age 65+: HR = 1.30, 95%CI:1.15–1.47). These associations also hold in subgroups with all chronic health conditions, except older adults with cancer history. Transportation barriers disproportionally burdened adults with chronic health conditions, which warrant effective screening for and interventions against transportation barriers for individuals with chronic diseases.