Travel distance to tertiary healthcare reflects disease severity and medication access in Italian systemic sclerosis patients: a geographical study on adult-onset rare diseases from SPRING-SIR registry

Systemic sclerosis (SSc) is a rare, multiorgan disease in adults that requires specialized care. Commuting to tertiary medical centers poses a considerable burden and incurs significant costs, potentially affecting management choices. This study aims to describe the healthcare commuting burden and evaluate whether longer commuting distances are associated with disease severity and differences in medication access among Italian SSc patients. The driving distance from the city of residence to the care center was calculated using the Google Maps Distance Matrix API for patients from the Systemic Sclerosis Progression Investigation (SPRING) registry. These distances were categorized according to EUROSTAT classes. Travel distance was then correlated with clinical variables, medication access, and estimated annual pharmaceutical costs, based on standard doses and fares from the Italian Medicines Agency. The median commuting distance of the 1,795 enrolled patients was 59.4 (IQR 38.2–101.9) km, with 25.7% of them traveling more than 100 km to reach the tertiary center. Patients commuting more than 100 km to reach a tertiary center presented more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. The median annual drug cost was €4,407/patient, with 6.2% of patients accounting for half of the total medication budget. Drug costs reflect clinical manifestations, but correlated with commuting distances independently of disease severity. Commuting distances are correlated with disease severity and the need for advanced treatments. Public health strategies should aim to enhance accessibility to specialized care and advanced therapies for these patients, recognizing the impact of travel burden on healthcare access.

Authors

Institutions

Publication Details

Journal
BMC Public Health
Published
2026-10-09
DOI
https://doi.org/10.1186/s12889-026-28120-7
Primary Topic
Systemic Sclerosis and Related Diseases
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Travel distance to tertiary healthcare reflects disease severity and medication access in Italian systemic sclerosis patients: a geographical study on adult-onset rare diseases from SPRING-SIR registry

Alarico Ariani, Gerlando Natalello, Edoardo Rosato, Francesca Ingegnoli et al.
BMC Public Health
Systemic Sclerosis and Related Diseases
article

Travel distance to tertiary healthcare reflects disease severity and medication access in Italian systemic sclerosis patients: a geographical study on adult-onset rare diseases from SPRING-SIR registry

Alarico Ariani, Gerlando Natalello, Edoardo Rosato, Francesca Ingegnoli, Federica Lumetti, Amelia Spinella, Marco Di Battista, Rosario Foti, Elena Generali, Giuseppina Abignano, Greta Pellegrino, Fabio Cacciapaglia, Federica Furini, Gian Domenico Sebastiani, Franco Franceschini, Giorgio Pettiti, Simone Parisi, Silvia Laura Bosello, Lorenzo Dagna, Lucrezia Verardi, Carlo Salvarani, Martina Orlandi, Corrado Campochiaro, Enrico De Lorenzis, Simone Barsotti, Marco Fornaro, Alessandro Giollo, Francesco Girelli, Serena Guiducci, Giuseppa Pagano Mariano, Fabrizio Conti, Giuseppe Murdaca, Marcello Govoni, Salvatore D’Angelo, Cosimo Bruni, Ilaria Cavazzana, Gemma Lepri, Silvia Bellando-Randone, Elisa Visalli, Licia Vultaggio, Valeria Riccieri, Gianna Mennillo, Edoardo Cipolletta, Giacomo Davide De Luca, Annamaria Iuliano, Veronica Codullo, Carlo Iandoli, Gianluca Bagnato, Enrico Fusaro, Giovanni Zanframundo, Gerolamo Bianchi, Clara Lisa Peroni, Maria Grazia Lazzaroni, L. Magnani, Giovanni Ciano, Antonietta Gigante, Lorenzo Beretta, Erika Pigatto, Giovanna Cuomo, Ennio Lubrano, Alessandra Della Rossa, Gianluigi Bajocchi, Elisabetta Zanatta, Franco Cozzi, Cecilia Agnes, Clodoveo Ferri, Maria Antonietta D’Agostino, Maurizio Santi Caminiti, Marta Saracco, M Matucci Cerinic, Gabriella Alonzi, Rossella De Angelis, SPRING-SIR collaborators, Dilia Giuggioli, Andrea Doria, Maria Ilenia De Andres, Maria De Santis, Florenzo Iannone
article en

Abstract

Systemic sclerosis (SSc) is a rare, multiorgan disease in adults that requires specialized care. Commuting to tertiary medical centers poses a considerable burden and incurs significant costs, potentially affecting management choices. This study aims to describe the healthcare commuting burden and evaluate whether longer commuting distances are associated with disease severity and differences in medication access among Italian SSc patients. The driving distance from the city of residence to the care center was calculated using the Google Maps Distance Matrix API for patients from the Systemic Sclerosis Progression Investigation (SPRING) registry. These distances were categorized according to EUROSTAT classes. Travel distance was then correlated with clinical variables, medication access, and estimated annual pharmaceutical costs, based on standard doses and fares from the Italian Medicines Agency. The median commuting distance of the 1,795 enrolled patients was 59.4 (IQR 38.2–101.9) km, with 25.7% of them traveling more than 100 km to reach the tertiary center. Patients commuting more than 100 km to reach a tertiary center presented more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. The median annual drug cost was €4,407/patient, with 6.2% of patients accounting for half of the total medication budget. Drug costs reflect clinical manifestations, but correlated with commuting distances independently of disease severity. Commuting distances are correlated with disease severity and the need for advanced treatments. Public health strategies should aim to enhance accessibility to specialized care and advanced therapies for these patients, recognizing the impact of travel burden on healthcare access.

BMC Public Health
University of Pisa (IT), University of Messina (IT), University of Verona (IT), University of Modena and Reggio Emilia (IT), Marche Polytechnic University (IT), University of Molise (IT), Humanitas University (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Milan (IT), University of Ferrara (IT), University of Basilicata (IT), University of Pavia (IT), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), University of Catania (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Azienda Sanitaria Unità Locale di Reggio Emilia (IT), Azienda Ospedaliera San Camillo-Forlanini (IT), Ospedale San Carlo (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Azienda Unità Sanitaria Locale Della Romagna (IT), IRCCS Ospedale Galeazzi - Sant'Ambrogio (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale San Bassiano (IT), Arcispedale Sant'Anna (IT), University of Campania "Luigi Vanvitelli" (IT), IRCCS Ospedale San Raffaele (IT), Ospedale di Parma (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Ospedale Policlinico San Martino (IT), Policlinico San Matteo Fondazione (IT), University of the Sacred Heart (JP), Carlo Forlanini Hospital (IT), Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco" (IT), IRCCS Humanitas Research Hospital (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), University of Bari Aldo Moro (IT), University of Brescia (IT), University of Genoa (IT), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 13%
Systemic Sclerosis and Related Diseases
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.