Published: 2022-01-28

The impacts of internet and transportation access on patients’ health conditions: a cross-sectional study

Qinglin Hu, Xiaobing Li, Gregg Bell, Lea G. Yerby


Background: Use of internet and transportation to access to healthcare resources are 2 essential and effective ways to promote health outcomes and ameliorate health disparities. Despite general widespread availability of internet and transportation, disparities still exist among specific groups and regions. Little is known about the spatial patterns of extents of 2 access determinants on healthcare resources, nor for their compound effects on patient’s health outcomes.

Methods: The study uses 2018 health information national trends survey (HINTS) data, geographic information techniques and multiple ordered logistic regression model were applied.

Results: The results show that States in West and Midwest tend to have higher proportions on both perspectives, where states in South and Mideast had a relatively low percentage on the healthcare access determinants. Those states had similar socio-economic patterns with underserved population and low development progress in public healthcare system. Another finding is urban people had outstripped its rural neighbors on both internet (79% vs 57%) and transport (74% vs 62%) access to healthcare resources. Furthermore, our study suggests that, when considering compound effects of internet access for healthcare information and transport access to healthcare service, people who had greater barriers tend to have decreased likelihood (-21.30%) towards their health conditions, compare to those with sufficient accesses.

Conclusions: Additional work and policy are needed to ensure that internet and public transportation resources and services are prioritized for underserved populations and areas.


Use of internet, Transport access, Health conditions, Health disparities, Geographical variation

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Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: findings from a national probability sample. Journal of Medical Internet Research 2009;11(1):e4

Rutten LJ, Squiers L, Hesse B. Cancer-related information seeking: hints from the 2003 Health Information National Trends Survey (HINTS). J Health Communication. 2006;11(1):147-56.

Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R et al. What does 'access to health care' mean? J Health Services Res Policy. 2002;7:186-88.

Goddard M, Smith P. Equity of access to health care services: theory and evidence from the UK. Social Sci Med. 2001;53:1149-62.

Marmot MG, Wilkinson RG. Social determinants of health, Oxford University Press, Oxford. 2006.

Healthy People 2030. US Department of Health and Human Services. 2020. Health Communication and Health Information Technology. Available at: Accessed July 26, 2021.

Social Determinants of Health Series. The American Hospital Association. 2017. “Transportation and the Role of Hospitals. Available at: Accessed on July 26, 2019.

Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38:976-93.

Rask KJ, Williams MV, Parker RM, McNagny SE. Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. J Am Med Asso. 1994;271(24):1931-3.

Probst JC, Laditka SB, Wang JY, Johnson AO. Effects of residence and race on burden of travel for care: Cross sectional analysis of the 2001 US national household travel survey. BMC Health Services Res. 2007;7:40.

Wallace R, Hughes-Cromwick P, Mull H, Khasnabis S. Access to health care and nonemergency medical transportation: Two missing links. Transportation Res Record J Transportation Res Board. 1924;76-84.

Lamont EB, Hayreh D, Pickett KE, Dignam JJ, List MA, Stenson KM et al. Is patient travel distance associated with survival on phase II clinical trials in oncology? J National Cancer Institute. 2003;95(18):1370-5.

Guidry JJ, Aday LA, Zhang D, Winn RJ. Transportation as a barrier to cancer treatment. Cancer Practice. 1997;5(6), 361-6.

Lake JP, Ortega A, Vukasin P, Kaiser AM, Kaufman HS, Beart RW. Internet use by colorectal surgery patients: a surgeon's tool for education and marketing. Am Surgeon. 2004;70(6):553-8.

Salo D, Perez C, Lavery R, Malankar A, Borenstein M, Bernstein S. Patient education and the Internet: do patients want us to provide them with medical web sites to learn more about their medical problems? J Emergency Med. 2004;26(3):293-300.

Kalichman SC, Benotsch EG, Weinhardt L, Austin J, Luke W, Cherry C. Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey. Health Psychol. 2003;22(1):111-6.

Anderson M, Perrin A, Jiang JJ, Kumar M. Pew Research Center. 10% of Americans don’t use the internet. Who are they? 2019. Available at: Accessed on August 28, 2019.

Shim M, Kelly B, Hornik R. Cancer information scanning and seeking behavior is associated with knowledge, lifestyle choices, and screening. J Health Commun. 2006;11(1):157-72.

Czaja R, Manfredi C, Price J. The determinants and consequences of information seeking among cancer patients. J Health Communication 2003;8(6):529-62.

Viswanath K. Public communications and its role in reducing and eliminating health disparities. In: Thomson GE, Mitchell F, Williams MB, editors: Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business. Washington, DC: National Academy Press. 2006;215-53.

Rice RE. Influences, usage, and outcomes of Internet health information searching: multivariate results from the Pew surveys. Int J Med Informatics. 2006;75(1):8-28.

Tan SSL, Goonawardene N. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. J Med Internet Res. 2002;19(1):e9.

Nordin C, Michaelson P, Eriksson MK, Gard G. It's about me: patients' experiences of patient participation in the web behavior change program for activity in combination with multimodal pain rehabilitation. J Med Internet Res. 2017;19(1):e22.

Woolf SH, Chan EC, Harris R, Sheridan SL, Braddock CH, Kaplan RM. Promoting informed choice: transforming health care to dispense knowledge for decision making. Ann Internal Med. 2005;143:293-300.

Atkinson NL, Saperstein SL, Pleis J. Using the internet for health-related activities: findings from a national probability sample. Journal of Medical Internet Research 2009;11(1):e4

Jacobs W, Amuta AO, Jeon KC, Alvares C. Health information seeking in the digital age: An analysis of health information seeking behavior among US adults. Cogent Social Sci. 2017;3(1):1302785.

Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129(6):611-20.

Health Information National Trends Survey. HINTS Methodology Report. National Cancer Institute. Available at: Accessed Aug 7, 2019.

Dye C. Health and urban living. Science. 2008;319:766-9.

Vlahov D, Galea S, Freudenberg N. Urban health: Toward an urban health advantage. J Public Health Management Practice. 2005;11(3):256-8.

Sangrajrang S, Chokvanitphong V, Sumetchotimaytha W, Khuhaprema T. Evaluation of health status of a population underwent routine medical checkup at the high-risk screening clinic in National Cancer Institute. Asian Pacific J cancer Prevention. 2012;13(11):5759-62.

Hunter JB, De Zapien JG, Denman C, Moncada E, Papenfuss M, Wallace D et al. Healthcare access and utilization among women 40 and older at the U.S.-Mexico border: predictors of a routine check-up. J Community Health. 2003;28(5):317-33.

Yancik R, Ries LA. Cancer in older persons: An international issue in an ageing world. Seminars Oncol. 2004;31:128-36.

Wang JY, Bennett K, Probst J. Subdividing the Digital Divide: Differences in Internet Access and Use among Rural Residents with Medical Limitations. J Med Internet Res. 2011;13(1):e25.

Kaufert P, Boggs P, Ettinger B, Woods F, Utian W. Women and menopause: beliefs, attitudes and behaviors. The North American Menopause Society 1997 menopause survey. Menopause. 1998;5(4):197-202.

Powers BW, Rinefort S, Jain SH. Nonemergency medical transportation: delivering care in the era of Lyft and Uber. J Am Med Asso. 2016;316:921-2.