Security in public spaces and access to health centres for older adults with disabilities in vulnerable neighbourhoods of Latin America: a study in Hermosillo, Mexico

Objective: This study examines how perceived safety in public spaces is associated with the use of health centres among older adults with disabilities in Hermosillo, Mexico, a city with high crime rates and an ageing population. Methods: Using a cross-sectional approach, 381 individuals aged 60 or older with disabilities from seven neighbourhoods in central Hermosillo were surveyed. Logistic regression models were employed to assess associations between perceived safety and health service utilisation (cancellation of medical appointments), controlling for sociodemographic, health, and urban environment variables (safety, accessibility, mobility, and comfort). Results: 23.6% of participants cancelled or postponed medical appointments, and appointment cancellation was associated with individual, social, and environmental factors, including scarce police presence. Living alone and psychological problems were significantly associated with appointment cancellation. In neighbourhoods with higher perceived insecurity and low accessibility, older adults showed reduced health service use, increased social isolation, and deteriorating health. Conclusion: Insecurity in public spaces is a critical barrier to healthcare access for this population. These findings underscore the need for urban and health policies focused on creating safe and age-friendly environments through urban and psychosocial interventions in vulnerable neighbourhoods across Latin America, where ageing, urban violence, and inequality intersect.