<Original article>Travel Time to Hospital/clinic and Risk of Death or Nursing Care in Japanese Community-dwelling Elderly Adults: Y-HALE Cohort Study

In a cohort of Japanese aged adults, we estimated the hazard ratios (HRs) (95% confidence intervals) of travel time to the nearest hospital/clinic for mortality/nursing care and calculated coefficients of travel time for decline in the instrumental activities of daily living (IADL) score (range, 0– 13). At baseline 2003 year, the mean (standard deviation) age, IADL score, and travel time to a hospital/clinic were 73.2 (5.6) years, 11.2 (2.8) points, and 18.0 (12.8)/13.1(10.1) minutes, respectively, among the 283 participating women, and 76.2 (6.7) years, 11.2 (2.2) points, and 18.0 (13.3)/10.3 (7.1) minutes, respectively, among the 304 participating men. HRs for travel times of 20+ minutes and 10– 19 minutes to a hospital as compared with 0–9 minutes were 1.50 (0.87– 2.58) and 1.96 (1.23 –3.13), respectively. The travel time to the nearest clinic was not significantly associated with the health outcomes. However, our results suggested that poor accessibility to a hospital increases the risk of mortality or nursing care. Optimizing the roll allotment of medical facilities and medical doctor specialities, networking of hospitals and clinics, and town planning may improve the health outcomes of aged adults.