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Lack of Transportation Tied to Array
of Health Measures in Aging US HIV Group
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11th International Workshop on HIV & Aging Virtual Meeting, September 30 to October 2, 2020
By Mark Mascolini for NATAP and Virology Education
Lack of reliable transportation proved a key factor in several measures of health status among middle-aged and older people with HIV living in the Deep South of the United States [1]. These measures included general health perception, health distress, pain, and quality of life.
Researchers from the University of Kentucky and the University of Alabama at Birmingham noted that barriers to transportation correlate with race/ethnicity, socioeconomic status, and rural or resource-poor environments. These barriers can contribute to overall health disparities between people who face such barriers and those who do not.
This study aimed to determine whether transportation barriers contribute to both objective and self-reported health outcomes in people with HIV living in the Deep South, an epicenter of the US HIV epidemic. The region accounted for 19,422 new HIV diagnoses in 2018, or 51% of all new cases in the United States.
Researchers recruited middle-aged and older people with HIV from the University of Alabama at Birmingham HIV clinic. Participants answered questions about lack of transportation to access care, other barriers to care, missed healthcare appointments, medication adherence, depressive symptoms, and self-reported health components via the Medical Outcome Studies HIV Health Survey (MOS-HIV).
The investigators collected relevant HIV characteristics. They used Spearman rho correlations to explore associations between all variables. A linear regression model adjusted for HIV characteristics, race, socioeconomic status, and depressive symptoms determined associations between lack of transportation and each MOS-HIV component.*
The study included 261 people, 80% of them African American and 64% men. Everyone was at least 40 years old, and age averaged 51.1 years (standard deviation 6.78 years). The group averaged 12.5 years in education, but 78% were not employed and 51% had an annual household income of $10,000 or less before taxes. Median CD4 count stood at 636 and HIV duration at 18 years. About one quarter (27.6%) had a detectable viral load.
Spearman correlation identified three demographic factors associated with greater lack of transportation: nonwhite race (rs = 0.172, P = 0.005), lower annual household income (rs = -0.179, P = 0.004), and fewer years of education (rs = -0.131, P = 0.035). Greater lack of transportation was also associated with four care-related outcomes--a cancelled or missed healthcare appointment (rs = 0.391, P < 0.001), greater medication nonadherence (rs = -0.175, P = 0.006), higher viral load (rs = 0.165, P = 0.016), and more depressive symptoms (rs = 0.246, P < 0.001).
Linear regression adjusted for HIV duration, CD4 count, viral load, race, socioeconomic status, and depressive symptoms linked reporting more transportation problems to worse general health perceptions (beta = -0.212, P = 0.003), worse pain in the past 4 weeks (beta = -0.185, P = 0.016), worse social functioning in the past 4 weeks (beta = -0.138, P = 0.059), worse health distress in the past 4 weeks (beta = -0.152, P = 0.017), and worse quality of life in the past 4 weeks (beta = -0.125, P = 0.056).
The researchers concluded that reliable transportation is critical to “promoting health equity and quality of life for people with HIV.” They proposed that these associations may most affect people who cannot drive because of poor health or economic constraints and people who live in areas with poor public transportation. The authors encouraged colleagues to assess barriers to transportation in at-risk people with HIV infection.
*MOS-HIV components were general health perceptions, pain, physical functioning, role functioning, social functioning, cognitive functioning, energy/fatigue, mental health, health distress, health transitions, and quality of life.
Reference
1. Fazeli P, Pope C, Stavrinos D, Vance D. The association between transportation barriers and health status in middle-aged and older adults living with HIV in the deep South. 11th International Workshop on HIV & Aging Virtual Meeting, September 30 to October 2, 2020. Abstract 5.
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