inequalities in transport accessibility to healthcare facilities - PowerPoint PPT Presentation

Institute for Transport Studies FACULTY OF ENVIRONMENT Using health data to explore inequalities in transport accessibility to healthcare facilities Charlotte Kelly Institute for Transport Studies & Academic Unit Health Economics c.e.kelly@leeds.ac.uk

Health & Transport Complex interaction of many contributing factors between transport and health Barton and Grant (2006) A health map for the local human habitat http://dx.doi.org/10.1177/1466424006070466

Accessing Healthcare Majority of patients have to get to the appointment! • Some examples of remote testing/ tele-medicine Assumption that people can get there, BUT… • 31% of people without a car have difficulty travelling to their local hospital & 17% with a car (SEU, 2003) Growing body of research showing evidence of a distance decay effect (Kelly et al, 2016) • e.g. later stage cancer diagnosis of patients living further from GP • Some solutions – patients having to travel long distances for specialised care - associations with poorer health were reduced where follow up was local. A need for more joined up transport / healthcare planning • e.g. Context of centralisation/ relocation of healthcare services

Health Data available - examples • Hospital Episodes Statistics (HES) (NHS Digital) • 15.5 million NHS inpatient admissions & >100 million outpatient appointments (2013-2014) • Variables include – Diagnosis / treatment, age, gender, ethnicity, locations etc … • Linked to other databases STATS19, PROMS, Cancer registries etc … • English Longitudinal Study on Ageing (ELSA) (UK data Service) • Cohort of 12,000 individuals > 50 years old • Variables include - use of public transport, diagnosis, quality of life, walk speed, BMI, income, cars owned and type etc … • Examples of use Arthritis UK - prevalence by area. • ResearchOne - http://www.researchone.org/ • + Many Others

Example: Potential Relocation of Healthcare Services Using: • HES data - Patients with an LS postcode having a hip/knee operation between 2009/10 – 2011/12 • Data on individuals (diagnosis, age, gender, deprivation level of residence, postcode etc..) • Linked - patient reported outcome measures data (health data). • GIS (ESRI ArcGIS 10.4 and Visography TRACC) • Calculate distance/ travel times - home postcode to hospital attended • Investigate potential location of hospitals/ issues with access

Leeds Residents: Hip and Knee Replacements (2009/10 – 2011/12) RTRAT . 3, 213 patients with LS postcode Average distance 10km Minimum 0.35km Maximum 86km Travel further if: • Male RCD01 NT447 • NVC28 Live in less deprived locations RCB55 NT245 • No Comorbidities RCF22 • Higher self assessed quality of life NT332 RR819 RAE00 NT225 RR801 NT350 RWY02 NT349 RXF10 RXF05 RXF03 RXF05 RXF03 RP5DR RHQNG

Leeds Residents: Hip and Knee Replacements (2009/10 – 2011-12) RCD01 . NT447 NVC28 RCB55 Number of operations RCF22 (2009/10 - 2010/11) Hospitals F4 1 - 10 NT332 11 - 28 RR819 29 - 120 RAE00 NT225 121 - 860 RR801 861 - 1329 NT350 RWY02 NT349 RXF10 RXF05 RXF05 RXF03 RXF03 0 2 4 8 Miles Transverse Mercator & British National Grid Source: Edina Boundaries & NHS Digital Created by C Kelly

Optimal location ? RCD01 NT447 . NVC28 3, 213 patients with LS Number of operations postcode (2009/10 - 2010/11) " Mean Centre Mean Centre RCF22 Hospitals • Average distance F4 1 - 10 8.8km 11 - 28 29 - 120 NT332 " • 121 - 860 RR819 Minimum 0.25km 861 - 1329 RAE00 • NT225 Maximum 25km RR801 NT350 0 1.75 3.5 7 Miles RWY02 NT349 RXF10 RXF05 Transverse Mercator & British National Grid RXF05 RXF03 RXF03 Source: Edina Boundaries & NHS Digital Created by C Kelly

Optimal location? (weighted by residential deprivation) . Number of operations (2009/10 - 2010/11) ) " Mean Weighted by Deprivation " Mean Centre Hospitals F4 1 - 10 NT332 11 - 28 " RR819 29 - 120 ) " 121 - 860 RAE00 NT225 RR801 861 - 1329 NT350 0 1.5 3 6 Miles NT349 RWY02 RXF10 Transverse Mercator & British National Grid Source: Edina Boundaries & NHS Digital RXF05 RXF05 RXF03 RXF03 Created by C Kelly

Impact of everyone going to Harrogate Harrogate RCD01 . NT447 • Average 20km • Most deprived 21.8km (6.4km original) • Least deprived 18km (12.4km – original) NT332 RR819 RAE00 NT225 RR801 Chapel Allerton • Average 9km NT350 NT349 WY02 RXF10 RXF05 RXF05 RXF0 RXF03 0

Impact of everyone going to Harrogate: By Bus ~1/3 could not get to Harrogate hospital by bus for a 9am appointment. Average travel time = 78mins Min 12 mins Max 119 mins Knock on effect for patient transport services?

Conclusions • How, where and when patients access healthcare has a major impact on the NHS budget & patients health. • Ageing population and increasing demand – increasing problem • Large scope to use health and transport data in joint planning.