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.
abstract: To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this.
  
  
  
  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.
  
  
  
  A wide range of settings within primary and secondary care (these were not restricted in the search).
  
  
  
  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' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies.
  
  
  
  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.
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.|Institute for Transport Studies, University of Leeds, Leeds, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kelly
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hulme
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Farragher
authors.affiliation: School of Geography, University of Leeds, Leeds, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Clarke
mesh_terms: D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D013997:Time Factors; D014195:Travel / Q000706:statistics & numerical data*
keywords: Access to Healthcare; Health Outcomes; Systematic Review