title: Estimating proximity to care: are straight line and zipcode centroid distances acceptable proxy measures?
abstract: BACKGROUND
  Spatial accessibility of healthcare may be measured by proximity of patient residence to health services, typically in driving distance or driving time. Precise driving distances and times are rarely available. Although straight line distances between zipcode centroids and between precise address locations are used as proxy measures for distance to care, the accuracy of these measures has received little study.
  
  
  METHODS
  Among a cohort of Medicare beneficiaries, actual driving distances and times between patient residence and clinic were obtained from commercial software (MapQuest). We used a split-sample design to build and validate linear regression models that predict actual driving distances and times from estimated distances between zipcode centroids and between precise residential and hospital locations, adjusting for urban/suburban/rural residential status.
  
  
  RESULTS
  On average, predicted driving distances and times were larger than actual values. Zipcode centroid distances alone predicted longer driving distances than observed values: rural +19% (3.2 miles), suburban +23% (3.7 miles), and urban +27% (2.0 miles). Predicted time was 36% (9.4 min) longer in rural, 32% (6.8 min) longer in suburban, and 38% (4.7 min) longer in urban areas than observed values. Including urban/suburban/rural categorization of residence improved the accuracy of predicted driving distance and time for suburban and urban areas but diminished accuracy for rural areas. Similar trends were observed for distance estimates from precise locations.
  
  
  CONCLUSIONS
  Distances between zipcode centroids and precise residential/hospital locations provide reasonable estimates of driving distance and time for epidemiologic research. Estimates are improved for suburban and urban residences when data are augmented by urban categorization.
authors.affiliation: Department of Orthopedic Surgery, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. rbliss@partners.org
authors.forename: Robin L
authors.initials: RL
authors.lastname: Bliss
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wright
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
mesh_terms: D001334:Automobile Driving; D015331:Cohort Studies; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D006278:Medicare; D012111:Residence Characteristics; D013997:Time Factors; D014481:United States