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Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review
  1. Charlotte Kelly1,2,
  2. Claire Hulme1,
  3. Tracey Farragher1,
  4. Graham Clarke3
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2Institute for Transport Studies, University of Leeds, Leeds, UK
  3. 3School of Geography, University of Leeds, Leeds, UK
  1. Correspondence to Dr Charlotte Kelly; c.e.kelly{at}


Objectives To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this.

Design Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south.

Settings A wide range of settings within primary and secondary care (these were not restricted in the search).

Results 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies.

Conclusions The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.

  • Systematic Review
  • Access to Healthcare
  • Health Outcomes

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors CK wrote the protocol with critical input from CH, GC, and TF. CK developed the search strategy and did the electronic searches. CK and CH screened the titles and abstracts and selected studies for inclusion. CK and CH carried out the data extraction and quality assessment. CK wrote the original draft, and CH, GC and TF revised the draft critically for important intellectual content and approved the final version of the paper.

  • Funding Charlotte Kelly is funded by a National Institute for Health Research Doctoral Fellowship DRF 2013-06-141.

  • Disclaimer This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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