TY - JOUR
T1 - The Health and economic effects of light rail lines
T2 - Design, methods, and protocol for a natural experiment
AU - Frank, Lawrence D.
AU - Kuntz, Jennifer L.
AU - Chapman, James E.
AU - Fox, Eric H.
AU - Dickerson, John F.
AU - Meenan, Richard T.
AU - Saelens, Brian E.
AU - Young, Deborah R.
AU - Boone-Heinonen, Janne
AU - Fortmann, Stephen P.
N1 - Funding Information:
This study is funded by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health to Dr. Fortmann (R01 DK103385). The funder does monitor study progress, but does not have a role in the conduct of the study and did not contribute to the preparation of this manuscript.
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/2/15
Y1 - 2019/2/15
N2 - Background: The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions. Methods: The Rails & Health study is a natural experiment evaluating changes in clinical measures, health care utilization and health care costs among Kaiser Permanente Northwest (KPNW) members following the opening of a new light rail transit (LRT) line in Portland, Oregon. The study is prospectively following 3036 adults exposed to the new LRT line and a similar cohort of 4386 adults who do not live close to the new line. Individual-level outcomes and covariates are extracted from the electronic medical record at KPNW, including member demographics and comorbidities, blood pressure, body mass index, lipids, glycosylated hemoglobin, and health care utilization and costs. In addition, participants are surveyed about additional demographics, travel patterns, physical activity (PA), and perceived neighborhood walkability. In a subsample of the study population, we are collecting direct measures of travel-related behavior - physical activity (accelerometry), global positioning system (GPS) tracking, and travel diaries - to document mechanisms responsible for observed changes in health outcomes and cost. Comprehensive measures of the built environment at baseline and after rail construction are also collected. Statistical analyses will (1) examine the effects of opening a new LRT line on chronic disease indicators, health care utilization, and health care costs and (2) evaluate the degree to which observed effects of the LRT line on health measures and costs are mediated by changes in total and transportation-associated PA. Discussion: The results of the Rails & Health study will provide urban planners, transportation engineers, health practitioners, developers, and decision makers with critical information needed to document how transit investments impact population health and related costs.
AB - Background: The health impacts of community design have been studied extensively over the past two decades. In particular, public transportation use is associated with more walking between transit stops and shops, work, home and other destinations. Change in transit access has been linked with physical activity and obesity but seldom to health outcomes and associated costs, especially within a causal framework. Health related fiscal impacts of transit investment should be a key consideration in major transit investment decisions. Methods: The Rails & Health study is a natural experiment evaluating changes in clinical measures, health care utilization and health care costs among Kaiser Permanente Northwest (KPNW) members following the opening of a new light rail transit (LRT) line in Portland, Oregon. The study is prospectively following 3036 adults exposed to the new LRT line and a similar cohort of 4386 adults who do not live close to the new line. Individual-level outcomes and covariates are extracted from the electronic medical record at KPNW, including member demographics and comorbidities, blood pressure, body mass index, lipids, glycosylated hemoglobin, and health care utilization and costs. In addition, participants are surveyed about additional demographics, travel patterns, physical activity (PA), and perceived neighborhood walkability. In a subsample of the study population, we are collecting direct measures of travel-related behavior - physical activity (accelerometry), global positioning system (GPS) tracking, and travel diaries - to document mechanisms responsible for observed changes in health outcomes and cost. Comprehensive measures of the built environment at baseline and after rail construction are also collected. Statistical analyses will (1) examine the effects of opening a new LRT line on chronic disease indicators, health care utilization, and health care costs and (2) evaluate the degree to which observed effects of the LRT line on health measures and costs are mediated by changes in total and transportation-associated PA. Discussion: The results of the Rails & Health study will provide urban planners, transportation engineers, health practitioners, developers, and decision makers with critical information needed to document how transit investments impact population health and related costs.
KW - Active travel
KW - Built environment
KW - Environmental measurement methods
KW - Health care utilization
KW - Light rail transit
KW - Physical activity
KW - Transportation
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UR - http://www.scopus.com/inward/citedby.url?scp=85061616160&partnerID=8YFLogxK
U2 - 10.1186/s12889-019-6518-6
DO - 10.1186/s12889-019-6518-6
M3 - Article
C2 - 30770737
AN - SCOPUS:85061616160
SN - 1471-2458
VL - 19
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 200
ER -