Medical Accessibility and Under-reporting of Occupational Diseases: Effect of Travel Distance and Travel Time

Ping Hui Chen ^1* Po-Ching Chu ² Ching-Chun Huang ¹ Chi-Hsien Chen ² Yue Leon Guo ² Ta-Chen Su ² Pau-Chung Chen ^2,3,4,5

• ¹ Department of Environmental and Occupational Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
• ² Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
• ³ Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
• ⁴ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
• ⁵ National Institute of Environmental Medicine, National Health Research Institutes (Taiwan), Zhunan, Miaoli County, Taiwan

Under-reporting of occupational diseases (ODs) could be attributed to poor medical accessibility, which is rarely discussed previously. The aim of our cross-sectional study is to evaluate how ODs reporting is impeded by long travel distance/time (TD/TT) to nearest major occupational medicine clinics. Methods Using data from NODIS, Taiwan's ODs surveillance system, and annual Manpower Survey from 2008 to 2018, we calculate each district's incidence rate of ODs (IROD) and expected IROD based on industries and job titles. Each town's TD/TT to nearest major occupation medicine clinics is estimated by Google Maps' Distance Matrix API. Quasi-Poisson regression model is used to investigate effect of TD and TT on IROD, while industries and job titles are adjusted by offsetting expected IROD. Subgroup analysis is then carried out to check the effect of employment status, sickness absence, and reporting years. Results 3420 cases of definite ODs are included in our study. Using quasi-Poisson regression model, after adjusting industry types and job titles, TD and TT have significant effect on IROD. As TD/TT increase by 10 km/10 mins, IROD decreases by 10.90%/10.73%. It is estimated that around 200 OD cases per year or 40% ODs are therefore under-reported. In subgroup analysis, only mildly-sicked workers are still significantly affected by TD and TT.Our study shows how poor medical accessibility leads to under-reporting, especially for mildly-sicked cases, and up to 40% ODs could be under-reported. Using this method, we can evaluate cost-effectiveness of adding reporting hospital in areas with poor medical accessibility.