How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India

ABSTRACT Accessibility determines health care utilization among individuals with noncommunicable diseases as they need to visit health facilities frequently. Hence, we aimed to assess the road distance and travel time to the diabetes clinic of Persons with Diabetes (PWDs) seeking care at a public tertiary care facility in South India. PWDs house locations were geocoded using ArcGIS World Geocoding Services, and ArcGIS Pro Business Analyst Geoprocessing extension was used to conduct network analysis. A simple median regression analysis was done to compare the association of sociodemographic variables with distance and time. Of the total 2261 PWDs included, the mean (SD) age was 53.7 (11.5) years, and 49.4% were males and about 66.0% of the PWDs resided in rural areas. The median (IQR) travel distance of PWDs from their home to the diabetes clinic was 30.5 (7.6–78.5) km and the median (IQR) time spent in travelling was 77.9 (16.4–194.7) minutes. About 76% travelled more than 5 km to the diabetes clinic. About 85% of PWDs travelled farther than the nearest available public health facility to avail care from the diabetes clinic. Younger age group, male gender, PWDs from rural areas and the state of Tamil Nadu travelled significantly longer distance compared to their counterparts. To conclude, about three-fourth of the PWDs travelled more than 5 km for care at the diabetes clinic. Also, about 9 out of 10 travelled farther than the nearest available public health facility where diabetes care was available.