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Primary Submission Category: Place/Communities

Transportation access and forgoing healthcare due to lack of transportation: Evidence from the Detroit Research on Cancer Survivors (ROCS) study

Authors:  Nora Akcasu, Jamaica Robinson, Julie Ruterbusch, Ann Schwartz, Theresa Hastert,

Presenting Author: Nora Akcasu*

Background

Transportation insecurity is an important determinant of cancer outcomes. This study evaluates associations between transportation access and forgoing care among cancer survivors.

Methods

Results included data from 3938 participants in the Detroit Research on Cancer Survivors cohort, a population-based study of Black cancer survivors. Transportation insecurity was measured by a dichotomous item asking if survivors had gone without healthcare due to a lack of transportation in the last year. Transportation access measures included self-reported car ownership and census tract public transit availability at study enrollment. We summarized associations of transportation access with transportation insecurity using unadjusted prevalence ratios (PR) and 95% confidence intervals (CI).

Results

10.1% of survivors reported forgoing healthcare due to a lack of transportation. A higher proportion of these survivors were unmarried, on Medicaid and had low incomes compared to transportation secure survivors. Overall, 63% of survivors reported owning a car. Prevalence of transportation insecurity was 5.5 times higher among survivors without compared to those with a car (CI:4.4-6.9). On average there were 22 public transit stops per square mile in survivors’ census tracts; however, 38% of survivors lived in tracts with no public transit stops. Transportation insecurity was more common among survivors living in high transit stop density areas compared to those living in areas with no public transit, both overall and among survivors without a car (PRoverall:1.9, CI:1.5-2.4; PRnocar:1.4, CI:1.1-1.9).

Conclusions

Forgoing healthcare due to lack of transportation varied by survivor characteristics. Car ownership reduced risk of transportation insecurity while living in high density public transit areas was associated with transportation insecurity regardless of car ownership. Further investigation is needed to understand contributors to transportation insecurity in cancer survivors.