Using the data from the 500 Cities project, Michigan State University (MSU) conducted a census tract–level analysis in 16 Michigan cities to investigate the relationship between transit services for the elderly and preventive healthcare attainment. The results indicate that the provision of transit services for the elderly has significant effects on the attainment of preventive health care services.

HOW THEY USED 500 CITIES DATA

Many elderly citizens are advised to stop driving because of their changing physical and mental conditions. However, the current transit system may not be a good substitute for private vehicles because the elderly find walking and waiting at bus stops increasingly challenging. The elderly would benefit more from “door-to-door” service, which most transit agencies lack, rather than the existing curb-to-curb transit service. Previous research suggests that the elderly population has an increasing need for healthcare and visits to doctors' offices as they age. However, without consistent, reliable, and affordable transportation services, they must depend on friends and/or family for rides or risk missing their medical appointments altogether.

Michigan State Uuniversity conducted a study to investigate the relationship between transportation and preventive health attainment, examining 16 Michigan cities.

Michigan State University has conducted multiple levels of data analyses with the 500 Cities data, centering their analysis on the share of older adults attaining preventive health care. The MSU team compared 500 Cities data with (1) public transit agency data, investigating the current parameters for transportation that specifically serves the elderly population, and (2) US census data, to control for socioeconomic factors (i.e., car ownership, poverty rates, race, and disability) in their analysis.

These analyses have found that the provision of transportation does not have much variation in general, meaning transportation for older adults is available in most Michigan cities. 

When digging deeper into the available transportation services, MSU found that several factors determine whether elderly people qualify for services, including age-specific criteria, proximity to existing transportation routes, and slight variations in the levels of service offered (e.g., door-to-door, curb-to-curb, fees, and wheelchair-accessible services) that have been accounted for in the data collection and analysis. It is these variations that are yielding the results expected through the analyses. 

After incorporating these variations into the dataset, MSU found significant relationships between transportation services and health outcomes. Main findings from their results include the following:

• Door-to-door services and economic status have significant effects on elderly persons' preventive health care attainments.
• The share of the elderly who attain preventive health care services in the census tracts where door-to-door services are provided is 2.77 percent higher than in those where door-to-door services are not.
• The share of the elderly who attain preventive health care services decreases by 2.91 percent as the poverty rate among the elderly increases by 1 percent.
• Car ownership, race, and disability rates among the elderly are negatively related to their preventive health care attainment. For example, a 1-percent increase in the share of the population that does not own a car is associated with a 0.12-percent decrease in the share that attains preventive health care services.

The MSU team shared insights from their analysis via research posters and presentations at strategic conferences, including the American Association of Geographers' annual meeting and the Urban Affairs Association's annual conference.

Among other results, the MSU team solidified these takeaways to shed further light on the relationship between transportation access and health outcomes for older adults:

• Transit needs vary by age group.
• The provision of door-to-door services for the elderly significantly improves their health care attainments.
• Transit services for the elderly need to be improved, especially for the low-income elderly population.
• The fixed-route public transit system is limited and unsuitable for the elderly to attain preventive health care because of fixed schedules, walking distances, and poorly provided waiting spots.
• The complicated document-filing process and in-advance reservation requirements in the current on-demand transit system are huge barriers for the elderly to attain preventive health care.

The MSU team has released a preprint version of their findings to share while awaiting publication of their completed manuscript.

WHAT THEY LEARNED

The 500 Cities data has provided MSU with the necessary information to transform research theories to actionable interventions. Until recently, health-specific data at geographic levels smaller than the city was hard to obtain for research within the social sciences, making similar studies burdensome by relying on disparate local data or community interviews. The 500 Cities dataset has helped substitute the need for conducting health surveys in the surrounding local areas; census tract–level data was previously unavailable to MSU.

The MSU team learned that there are plenty of opportunities to use this dataset, given the extensive list of variables included in 500 Cities data. However, the team noted that there are fewer variables available for older adults specifically, as most information is for all adults ages 18 and older.

WHAT THEY RECOMMEND FOR SIMILAR PROJECTS

Michigan State University has identified the following recommendations for organizations interested in pursuing similar approaches to using the 500 Cities data in their communities:

• Use the 500 Cities data to advance the field. All these deliverables emphasize the fact that research in the social sciences can benefit by using the 500 Cities database to access health information at geographic levels that enhance our research. Presenting research with data on health factors gives meaning to the research and can help policymakers understand the change we are actively seeking for the betterment of society.
• Be intentional in creating your dataset. Take the time and go through multiple data sources to gather a dataset for you to use. This dataset opens many windows to combine data and make meaningful research projects.
• Use the City Health Dashboard. This resource (which incorporates the 500 Cities dataset) offers census and other information for your secondary data needs.

To learn more about Michigan State University’s work, follow @MSUPlanningSPDC and @MSUSPDC. If you are interested in learning more about this team’s project approach or have specific questions regarding replicating their work in your community, please feel free to contact the Principal Investigator of this project, Zeenat Kotval-Karamchandani.