Variations in geographical accessibility: a cross-sectional nationwide study of travel times in Swedish primary care.

Abstract

To examine geographical accessibility to primary care in Sweden by estimating driving distances and travel times to primary care centres, assessing the availability of alternative providers within predefined travel-time thresholds and describing variation by municipality type. Descriptive cross-sectional nationwide study. Primary care in Sweden, including all primary care centres operating nationally during 2019-2020. Individual-level residential grid coordinates for all residents of Sweden as of 31 December 2019 were obtained. After exclusion of observations with missing coordinate data, the final analytical sample comprised 9 946 509 individuals. A total of 1167 primary care centres were included after merging duplicate administrative units at the same physical location. Outcomes were driving distance and driving travel time by car from place of residence to the nearest primary care centre. Furthermore, driving distance and travel time to the second- to fifth-nearest centres, and the number of centres reachable within 5, 10, 20 and 30 min by car were used as outcomes. Nationally, the mean travel distance and time to the nearest primary care centre were 3.84 km (SD=5.8) and 5.6 min (SD 6.3), respectively (median distance 1.63 km, IQR 0.90-3.67; median time 3.3 min, IQR 2.0-6.2). Overall, 15.8% of residents could not reach a primary care centre within 10 min by car while 0.9% had travel times exceeding 30 min. Mean travel time to the nearest centre was 15.1 min (SD 18.9) in very rural municipalities compared with 3.0 min (SD 2.5) in large cities. Geographical accessibility to Swedish primary care is high on average but substantial urban-rural disparities remain. Residents of sparsely populated areas face markedly longer travel times and more limited practical provider choice. Future studies should complement geographical measures with indicators of staffing, waiting times and multimodal transport to better assess medical deserts and effective access.