Association between transportation barriers and healthcare access among people experiencing homelessness in Detroit

Homelessness is rising in the U.S., disproportionately impacting healthcare access. This is evident in Detroit, MI, where social determinants of health (SDoH), especially transportation, exacerbate chronic illness outcomes for people experiencing homelessness (PEH) by contributing to delayed or missed care. This cross-sectional observational study, conducted via Detroit Street Care (DSC), a student-led street medicine program, explored the role of transportation in healthcare access among 48 PEH (age > 21) interviewed at DSC’s clinics at soup kitchens. Surveys assessed demographics, transportation access, health status, and patient perspectives, analyzed with chi-square tests and ordinal regression. Participants were predominantly African American (77%), male (75%), with an average age of 47; 88% lacked a bachelor’s degree. Common transportation included buses and walking. Modes of transportation to the healthcare services were not associated with missed appointments ( p > 0.05). Chronic conditions were reported by 75% of participants, with musculoskeletal (38%) and cardiovascular/metabolic conditions (33%) most common, and 38% reporting multiple conditions. A discrepancy in the reporting of chronic conditions was observed across survey items, suggesting limitations in health literacy. 90% of participants indicated that transportation support would increase clinic attendance, and all participants were willing to return to DSC for care, reflecting trust in the organization. These findings suggest that transportation barriers and chronic disease burden may influence healthcare access among PEH in Detroit, supporting the need for street medicine in Detroit and the need for further investigation in larger studies.