Medical accessibility and underreporting of occupational diseases: effect of travel distance and travel time.
Ping Hui Chen, Po-Ching Chu, Ching-Chun Huang and 4 others
PMID 40260201WHAT IT FOUND
Reported occupational disease rates in Taiwan fell with distance and travel time to major occupational reporting hospitals.
Districts more than 45 km or 45 minutes away had 31.92% and 30.12% of nearby rates. The authors treat the gap as underreporting.
Key findings
01Reported occupational disease incidence declined progressively as travel distance and travel time to the nearest major reporting hospital increased.
02Reported incidence was 31.92% of the nearest district rate for districts more than 45 km away, and 30.12% for districts taking more than 45 minutes.
03The distance and travel-time effect was significant for workers without sickness absence or who kept jobs, but not for workers with sickness absence or who lost jobs.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study analysed district-level reported cases and worker-years, not individual patient records, so it cannot show whether a particular worker's travel distance caused underreporting. It measured reported occupational diseases, not true occupational disease occurrence, so lower reported rates in remote areas cannot be read as lower disease rates. The occupational disease database may contain misclassified workplace, job title, industry, sick leave, and employment information, and the authors noted limited validation of reporters. The workforce composition adjustment covered job titles and industries, but age, gender, tenure, and corporation size were not adjusted. Travel distance and time were estimated from district offices, not workers' homes or exact workplace addresses, and assumed driving rather than public transport. Travel estimates were made in 2019 to 2020 for districts and hospitals during 2008 to 2018, so they may not match the actual study period. The estimates of underreported cases and the effect of adding a hospital are model-based projections, not observed outcomes.
The easy way to misread this
Do not conclude that occupational disease is less common in remote areas. The study found lower reported rates and interpreted them as underreporting. It did not measure actual disease occurrence.