Abstract: SA-PO0960
Transportation Insecurity Associated with Adverse Health Outcomes in Adults with Kidney Diseases: A Retrospective Cohort Study of National Survey Data
Session Information
- Diversity and Equity in Kidney Health
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Liu, Annie, Mass General Brigham Inc, Boston, Massachusetts, United States
- Baek, Sally Eunchae, University of California San Diego, La Jolla, California, United States
- Vera Rodriguez, Renan A., Universidad Autonoma de Guadalajara, Zapopan, Jal., Mexico
- Kalim, Sahir, Mass General Brigham Inc, Boston, Massachusetts, United States
- Ufere, Nneka, Massachusetts General Hospital, Boston, Massachusetts, United States
- Lago Hernandez, Carlos, University of California San Diego, La Jolla, California, United States
Background
Transportation insecurity, defined as delayed medical care due to lack of transportation, is an increasingly recognized social risk factor that impedes access to care. While its impact has been described among people receiving dialysis, its prevalence and clinical significance across the kidney disease continuum remain poorly understood. We examined the prevalence of transportation insecurity among U.S. adults with self-reported kidney disease and its associations with health status, work productivity, healthcare utilization, and mortality.
Methods
We conducted a national retrospective cohort study using data from the National Health Interview Survey (2014-2018) of U.S. adults aged >18 years with self-reported kidney disease. Transportation insecurity was examined in relation to self-reported health status and work productivity, emergency department visits and hospitalizations, and all-cause mortality. Associations were evaluated using survey-weighted multivariable regression models with adjustment for sociodemographic and clinical characteristics.
Results
Overall, 3,824 respondents (representing 5.0 million U.S. adults) reported kidney disease, of whom 8% (n = 326; representing 384,882 individuals) experienced transportation insecurity. Transportation insecurity was associated with lower income, nonprivate or no insurance, and work limitations. Compared with those without transportation insecurity, affected individuals had higher odds of daily depressive symptoms (aOR 2.2; 95% CI 1.4-3.6) and work limitations (aOR 2.5; 95% CI 1.7-3.7). It was associated with higher risk of emergency department use (aOR 1.8; 95% CI 1.3-2.5) and hospitalizations (aOR 1.6; 95% CI 1.2-2.3) and was independently associated with all-cause mortality (aHR 1.8; 95% CI 1.5-2.1).
Conclusion
Transportation insecurity affects a notable proportion of U.S. adults with kidney disease and is associated with worse health status, reduced work productivity, higher healthcare utilization, and all-cause mortality. These findings support efforts to improve access to care across the kidney disease spectrum.