A new study by researchers at Montefiore Health System published in the journal Preventive Medicine found that healthcare transportation challenges are strongly associated with chronic health conditions like depression, asthma and diabetes.

Additionally, people who reported healthcare transportation as a need were 84% more likely to have an alcohol/drug abuse diagnosis and 41% more likely to smoke, than people without healthcare transportation needs. People reporting transportation challenges were also associated with higher prevalence of diabetes. Those with asthma, were 37% more likely to report poor housing quality issues like having mold and pests.

Illnesses like depression, asthma, and diabetes, are the leading causes of death and disability in the United States. These illnesses are also the leading contributors of healthcare costs.

Social determinants of health (SDOH) are the conditions that people are born into, work and live in like housing, transportation and education, which impact health outcomes. For example, research has found that children who live near highways have a higher risk for asthma than those who do not. While research in the area continues to expand, the mechanism between specific social needs and chronic conditions is not well understood.

“These findings allow us to better understand the challenges our patients face, both at the individual and population level,” said Kevin Fiori MD, MPH, MSc, FAAP, Assistant Professor of Pediatrics and of Family and Social Medicine at Albert Einstein College of Medicine and Director, Social Determinants of Health, Community & Population Health at Montefiore Health System, and study senior author. “Our hope is that by demonstrating how our clinical teams use screening tools and clinical data to identify the issues our patients are struggling with—and help them resolve these problems—that more healthcare systems will invest in integrating social care interventions and tracking of these efforts.”

From April 2018 to December 2019, 33,550 adult patients at Montefiore Health System completed a 10-item social needs screening survey during primary care visits in the Bronx and Westchester. Questions touched on topics that ranged from housing quality, healthcare transportation, food insecurity, and the cost of utilities, to relationships with spouses and family members. Half of the patients (52.8%) were Hispanic and more than one-third (37.2%) were non-Hispanic Black. The median age was 51.9 years-old. Approximately half of respondents were insured through Medicaid or Medicare with one third having commercial insurance.

This research builds on previous findings from the same research team that found healthcare transportation is most strongly associated with no-show visits, and thus an important barrier to accessing healthcare.

“Inadequate healthcare transportation impacts nearly all chronic conditions, however more work needs to be done to understand why we saw more of an association among people with depression and diabetes,” said Dr. Fiori.

As a result of this research, Montefiore is evaluating pilot transportation programs for patients who live within 25 miles of its sites.

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About Montefiore Health System

Montefiore Health System is one of New York’s premier academic health systems and is a recognized leader in providing exceptional quality and personalized, accountable care to approximately three million people in communities across the Bronx, Westchester and the Hudson Valley. It is comprised of 11 hospitals, including the Children’s Hospital at Montefiore, Burke Rehabilitation Hospital and close to 200 outpatient care sites. The advanced clinical and translational research at its medical school, Albert Einstein College of Medicine, directly informs patient care and improves outcomes. From the Montefiore-Einstein Centers of Excellence in cancer, cardiology and vascular care, pediatrics, and transplantation, to its preeminent school-based health program, Montefiore is a fully integrated healthcare delivery system providing coordinated, comprehensive care to patients and their families. For more information please visit www.montefiore.org. Follow us on Twitter and view us on Facebook and YouTube.