In recent years, researchers have identified transportation insecurity as an important but understudied form of material hardship. Transportation insecurity refers to the condition in which people are unable to regularly move from place to place in a safe or timely manner due to the absence of needed resources. Because the ability to get around is consequential for seeking health care, accessing nutritious food, and making social connections, transportation is considered an important social determinant of health.

Objectives

This study examines how transportation insecurity is associated with an individual’s self-rated physical and mental health, their ability to cover medical costs, and if they have a typical place for medical care.

Methods

Drawing on representative samples of residents in four Michigan communities (N=5007), we use multiple regression to test the hypothesis that transportation insecurity–measured by the validated 6-item Transportation Security Index (TSI)–is a significant, negative predictor of health, net of individual and neighborhood characteristics.

Results

Within our sample, 29% of residents report some level of transportation insecurity. Transportation insecure individuals are significantly more likely to be in fair or poor health and report more frequent mental health struggles compared to transportation secure individuals. For example, high transportation insecure individuals are 25% more likely to report severe mental health struggles. While transportation insecure individuals are equally as likely to have a primary place of medical care as transportation secure residents, they are significantly more likely to defer medical care because of cost. Low and high transportation insecure individuals, respectively, were 28% and 51% more likely to have deferred medical care in the past year, even after controlling for individual and neighborhood characteristics.

Conclusion(s)

Transportation insecurity is a common issue and is strongly associated with poor health quality and access. Transportation insecure individuals report worse physical and mental health and are more likely to defer medical care due to cost.

Public health implications

Incorporating the TSI into the social determinants of health toolbox can clarify the influence of transportation insecurity on health and help create interventions to address health disparities and barriers to care.