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Am J Perinatol 2020; 37(11): 1146-1154
DOI: 10.1055/s-0039-1692455
Original Article

The Association between Travel Time and Prenatal Care Attendance

Lauren Y. Maldonado 
1   Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
,
Kimberly E. Fryer
2   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Christine M. Tucker
1   Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
,
Alison M. Stuebe
1   Department of Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
3   Divsion of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
› Author Affiliations Funding This report is made possible by the generous support of the North Carolina Translational and Clinical Sciences (NC TraCS) Institute (NIH grant number UL1TR002489) and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) (grant number R40MC29455 Care4Moms for $897,986). The content presented is that of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by NC TraCS, HRSA, HHS, or the U.S. Government. Sponsors were not involved in study design, data collection, analysis, writing, or submission of this report.
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Abstract

Objective This study aimed to evaluate the association between a patient's travel time to clinic and her prenatal care attendance.

Study Design We conducted a retrospective cohort study of women (≥18 years) who received prenatal care and delivered at North Carolina Women's Hospital between July 1, 2014, and June 30, 2016 (n = 2,808 women, 24,021 appointments). We queried demographic data from the electronic medical record and calculated travel time with ArcGIS. Multinomial logistic regression models estimated the association between travel time and attendance, adjusted for sociodemographic covariates.

Results For every 10 minutes of additional travel time, women were 1.05 (95% confidence interval [CI]: 1.02–1.08, p < 0.001) times as likely to arrive late and 1.03 (95% CI: 1.01–1.04, p < 0.001) times as likely to cancel appointments than arrive on time. Travel time did not significantly affect a patient's likelihood of not showing for appointments. Non-Hispanic black patients were 71% more likely to arrive late and 51% more likely to not show for appointments than non-Hispanic white patients (p < 0.05). Publicly insured women were 28% more likely to arrive late to appointments and 82% more likely to not show for appointments than privately insured women (p < 0.05).

Conclusion Changes to transportation availability alone may only modestly affect outcomes compared with strategically improving access for sociodemographically marginalized women.

Keywords

prenatal care - transportation - travel time - structural barrier - attendance - health disparities


Publication History

Received: 06 February 2019

Accepted: 06 May 2019

Article published online:
12 June 2019

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