@article {Kellye013059, author = {Charlotte Kelly and Claire Hulme and Tracey Farragher and Graham Clarke}, title = {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}, volume = {6}, number = {11}, elocation-id = {e013059}, year = {2016}, doi = {10.1136/bmjopen-2016-013059}, publisher = {British Medical Journal Publishing Group}, abstract = {Objectives To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients{\textquoteright} 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{\textquoteright} 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.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/6/11/e013059}, eprint = {https://bmjopen.bmj.com/content/6/11/e013059.full.pdf}, journal = {BMJ Open} }