Citation

McDonald-Lopez K, Murphy AK, Gould-Werth A, Griffin J, Bader MDM, Kovski N. Am. J. Epidemiol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Oxford University Press)

DOI

10.1093/aje/kwad145

PMID

37365831

Abstract

Research suggests that transportation is an important social determinant of health because the ability to get around is consequential for accessing healthcare and nutritious food and for making social connections. We use an inductive mixed-methods approach and a quantitative k-means clustering approach to identify five categories of transportation insecurity using the validated 16-item Transportation Security Index. The resulting five-category measure distinguishes among respondents with qualitatively different experiences of transportation insecurity. Analyzing data from 2018 that is representative of the U.S. adult population aged 25 and older, we demonstrate a non-parametric association between transportation insecurity and two different health measures. Self-rated health had a threshold relationship between self-rated health and any level of transportation insecurity. High transportation insecurity had a very strong relationship to depressive symptoms. The categorical TSI will be useful for clinicians who wish to screen for transportation barriers to care. It will also facilitate research investigating the influence of transportation insecurity on health outcomes and provide the basis for interventions to address health disparities.

Language: en

Keywords

social determinants of health; categorical measure; healthy equity; screener; transportation insecurity; Transportation Security Index