Travel time to hospitals and mortality patterns: A multidimensional analysis by age, sex and cause of death

Geographical access to medical services is a key determinant of population health, yet evidence on how hospital travel time affects mortality remains limited, particularly in countries with universal health coverage. Using Spain as a case study, this research explores a generalizable framework to quantify the association between hospital travel time and mortality. In particular, it examines the 2010–2019 period, assessing differences by age, sex, and cause of death (CoD), and discussing implications for healthy ageing and equitable healthcare access. We combine population and mortality microdata with a detailed measure of residential hospital accessibility, based on car travel time from census-section centroids to the average of the five nearest hospitals. Analyses are conducted for all-cause mortality and major cause-of-death groups, including circulatory, neoplasm, respiratory, and external causes. Longer travel times are associated with higher mortality, with the strongest effects observed among older adults—particularly those aged 65 years and over, for whom residential location is expected to provide a more informative geographical reference—and for time-sensitive conditions. Circulatory diseases show measurable associations even at relatively short travel times, whereas external causes exhibit steeper gradients at longer distances. Results are robust to sensitivity analyses using the nearest hospital alone. Overall, territorial disparities in residential proximity to hospital services persist in Spain and are associated with inequalities in mortality.