Abstract
Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant's address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271) were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m) in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.