Research Spotlight: Transportation Insecurity and Adverse Health Outcomes Among Adults with Chronic Liver Disease

Nneka Ufere, MD, MSCE, a physician-investigator in the Division of Gastroenterology and Hepatology at Massachusetts General Hospital and an assistant professor of Medicine at Harvard Medical School, is lead author of a new paper in Hepatology Communications, Health Care-related Transportation Insecurity is Associated with Adverse Health Outcomes Among Adults with Chronic Liver Disease.

Summary:

In a national survey study of U.S. adults, patients with chronic liver disease who answered "Yes" to the question, “Have you delayed getting care in the past 12 months because you did not have transportation?” had a higher likelihood of having increased acute health care use and mortality.

Health care-related transportation insecurity is a critical social risk factor for U.S. adults with chronic liver disease, and there is an urgent need for feasible and scalable interventions, clinical programs, and policy reform to address transportation barriers and improve their clinical outcomes.

What Methods or Approach Did You Use?

Using the U.S. National Health Interview Survey from 2014 to 2018, we identified adults with self-reported chronic liver disease (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.

What Were Your Findings?

In a nationally representative of US adults with self-reported chronic liver disease (CLD), approximately 308,000 (6%) identified delaying medical care due to transportation barriers.

The 6% rate of health care–related transportation insecurity among U.S. adults with CLD is higher than that reported in the U.S. general population (1.8%) or among patients with cancer (3.1%) or cardiac disease (4.5%).

Health care–related transportation insecurity was independently associated with poorer self-reported health status, work productivity loss, reduced access to outpatient care, and increased acute health care utilization among adults with CLD.

Notably, adults with CLD experiencing health care–related transportation insecurity were found to have an ~2-fold higher risk of mortality after controlling for income and the presence of social risk factors such as financial and food insecurity.

Our findings establish transportation insecurity as a critical social risk factor for U.S. adults with CLD.

What Are the Clinical Implications?

Health care–related transportation insecurity is a critical social risk factor in chronic liver disease that is independently associated with mortality.

There is an urgent need for feasible and scalable interventions, clinical programs, and policy reform to address transportation barriers for U.S. adults with chronic liver disease to improve their clinical outcomes.

Paper Cited:

Ufere, N. N., Lago-Hernandez, C., Alejandro-Soto, A., Walker, T., Li, L., Schoener, K., Keegan, E., Gonzalez, C., Bethea, E., Singh, S., El-Jawahri, A., Nephew, L., Jones, P., & Serper, M. (2024). Health care-related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease. Hepatology communications, 8(1), e0358. https://doi.org/10.1097/HC9.0000000000000358