Health and Economic Effects of Light Rail Lines: A Natural Experiment

轻轨线路的健康和经济影响：一个自然实验

• 批准号: 9262217
• 负责人: Stephen Paul Fortmann
• 金额: $ 65.65万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9262217
• 关键词: Accelerometer; Address; Affect; Area; Behavior; Biological Markers; Blood Pressure; Body mass index; Censuses; Characteristics; Cholesterol; Chronic Disease; Clinical; Collaborations; Communities; Computerized Medical Record; Control Groups; Cost Measures; Cost Savings; Costs and Benefits; Crime; Data; Decision Making; Destinations; Development; Diet; Environment; Equation; Evaluation; Future; Glucose; Glycosylated Hemoglobin; Green space; Health; Health Care Costs; Health Planning; Health Policy; Health Status; Healthcare; Home environment; Individual; Interdisciplinary Study; Investments; Leisures; Light; Link; Longitudinal Studies; Low income; Measures; Mediating; Modeling; Natural experiment; Neighborhoods; Obesity; Oregon; Outcome; Ownership; Pathway interactions; Patient Self-Report; Pattern; Physical activity; Policies; Policy Making; Politics; Population Density; Positioning Attribute; Prevalence; Process; Public Health; Recreation; Recruitment Activity; Research; Research Infrastructure; Resistance; Resolution; Resources; Safety; Socioeconomic Status; System; Transportation; Travel; Walking; Work; aged; behavior measurement; blood lipid; built environment; cost; demographics; design; experience; follow-up; group intervention; health economics; improved; interest; land use; light effects; member; physical conditioning; population health; prospective; public health relevance; walkability

DESCRIPTION (provided by applicant): Decisions about whether to build new public transportation projects need to consider how these major investments impact public health. However, to date, research on these impacts has been scarce. To inform future policy making, we propose to evaluate the effects of a new light rail line on health outcomes and health care costs among members of an integrated health plan in Portland, Oregon. We will examine longitudinal data on health biomarkers and health care costs among 4,000 health plan members and matched controls before and after the opening of a new light rail line in 2015. By linking individual behavior, health, and health care costs to parcel-level data on retail outlets, street characteristics, and active transportation infrastructure, we propose to conduct the most comprehensive, robust evaluation of a large-scale community infrastructure improvement to date. We will determine, prospectively, the effect of opening a new light rail line on changes in clinical health measures and health care costs between baseline and three years after the line opens. We will recruit Kaiser Permanente Northwest members aged 18-74 years living within 1.5 km of the new rail line stations; these "cases" (N=4000) will be compared to a control group (N=4000) matched at the census block group level on demographics, walkability, and transit accessibility. Health measures will include body mass index (BMI), blood pressure, blood lipids, and glycosylated hemoglobin from the electronic medical record (EMR). We will also determine the degree to which any observed changes in health status and costs in the intervention group are mediated by changes in transportation-associated and total physical activity (PA), controlling for walkability (local accessibility), crime and safety measures, pedestrian, bike, recreational infrastructure, and socioeconomic status. This will be done by objectively assessing at baseline and two-year follow up total PA (using accelerometry data) and transportation PA (GPS data), in a randomly selected subsample of 500 exposed and 500 control group members. This study could have a substantial impact on public health policy. Considerable political resistance to increasing public transportation still exists; establishing the health effects and costs of such infrastructure will inform cost-benefit models used to prioritize transportation investments. The rich health and environmental data that our study will yield will enhance public understanding of the ways in which transit investment impacts physical activity and health care costs. This critical information is currently lacking from decision- making about major public transportation investments.

描述（由申请人提供）：有关是否建立新公共交通项目的决定需要考虑这些主要投资如何影响公共卫生。但是，迄今为止，对这些影响的研究很少。为了告知未来的政策制定，我们建议评估新的轻轨线对俄勒冈州波特兰综合健康计划成员的健康结果和医疗保健费用的影响。我们将检查有关4,000名健康计划成员中健康生物标志物和医疗保健的纵向数据，并在2015年开放新轻轨线之前和之后匹配控制。在零售店，街道特征和积极的运输基础设施上，我们建议对迄今为止大规模的社区基础设施改善进行最全面，最强的评估。我们将前瞻性地确定开设新的轻轨线对临床健康措施和基线临床保健成本的变化的影响。我们将招募居住在新铁路线站1.5公里以内的Kaiser Permanente Northwest成员；这些“案例”（n = 4000）将与在人口统计学，步行性和过境可访问性上匹配的对照组（n = 4000）进行比较。健康措施将包括体重指数（BMI），血压，血脂和电子病历（EMR）的糖基化血红蛋白。我们还将确定干预组中任何观察到的健康状况和成本变化的程度都由交通相关和全部体育锻炼（PA）的变化介导，自行车，娱乐基础设施和社会经济地位。这将在基线时客观地评估总PA（使用加速度计数据）和运输PA（GPS数据），在500个曝光和500个对照组成员中随机选择的子样本中完成。这项研究可能会对公共卫生政策产生重大影响。仍然存在对增加公共交通的极大政治抵抗；建立此类基础设施的健康效果和成本将为使用用于优先运输投资的成本效益模型提供信息。我们的研究将产生的丰富健康和环境数据将增强公众对运输投资影响体育锻炼和医疗保健成本的方式的理解。这个批评 目前缺乏有关大型公共交通投资的决策。