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: 9470868
• 负责人: Stephen Paul Fortmann
• 金额: $ 65.01万
• 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 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9470868
• 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; Data Reporting; Decision Making; Destinations; Development; Diet; Environment; Equation; Evaluation; Future; Glucose; Glycosylated Hemoglobin; Green space; Health; Health Care Costs; 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; 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; health plan; improved; interest; land use; light effects; member; physical conditioning; population health; prospective; public health relevance; recruit; 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）：关于是否建设新公共交通项目的决定需要考虑这些重大投资如何影响公共健康。然而，迄今为止，对这些影响的研究还很少。为了为未来的政策制定提供信息，我们建议评估一条新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 4,000 名健康计划成员的健康生物标志物和医疗保健费用的纵向数据，以及 2015 年新轻轨线路开通前后的匹配控制。通过将个人行为、健康和医疗保健费用与地块级数据联系起来针对零售店、街道特征和活跃的交通基础设施，我们建议对大规模社区基础设施改善进行迄今为止最全面、最稳健的评估。我们将前瞻性地确定一条新轻轨线路的开通对基线和开通后三年内临床健康措施和医疗保健成本变化的影响。我们将招募居住在新铁路线车站1.5公里范围内的18-74岁的Kaiser Permanente Northwest会员；这些“案例”（N=4000）将与在人口普查区块组层面上匹配的对照组（N=4000）在人口统计、步行能力和交通可达性方面进行比较。健康指标将包括体重指数 (BMI)、血压、血脂和电子病历 (EMR) 中的糖化血红蛋白。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在多大程度上是由交通相关和总体力活动 (PA) 的变化所介导的，控制步行能力（当地可达性）、犯罪和安全措施、行人、自行车、娱乐基础设施和社会经济地位。这将通过在随机选择的 500 名暴露组成员和 500 名对照组成员的子样本中客观评估基线和两年随访的总 PA（使用加速测量数据）和交通 PA（GPS 数据）来完成。这项研究可能会对公共卫生政策产生重大影响。增加公共交通的政治阻力仍然存在；确定此类基础设施对健康的影响和成本将为用于优先考虑交通投资的成本效益模型提供信息。我们的研究将产生丰富的健康和环境数据，将增强公众对交通投资影响体育活动和医疗保健成本的方式的理解。这个关键的 目前，重大公共交通投资的决策缺乏信息。

项目成果

Transit Use and Health Care Costs: A Cross-sectional Analysis.

交通使用和医疗保健成本：横断面分析。

• DOI: 10.1016/j.jth.2021.101294
• 发表时间: 2022
• 期刊: Journal of transport & health
• 影响因子: 3.6
• 作者: Saelens,BE;Meenan,RT;Keast,EM;Frank,LD;Young,DR;Kuntz,JL;Dickerson,JF;Fortmann,SP
• 通讯作者: Fortmann,SP

Causal evaluation of the health effects of light rail line: A Natural Experiment.

• DOI: 10.1016/j.jth.2021.101292
• 发表时间: 2022-03
• 期刊: Journal of transport & health
• 影响因子: 3.6
• 作者: Behram Wali;L. Frank;D. Young;R. Meenan;B. Saelens;J. Dickerson;S. Fortmann

Validity of the Exercise Vital Sign Tool to Assess Physical Activity.

• DOI: 10.1016/j.amepre.2021.01.012
• 发表时间: 2021-06
• 期刊: American journal of preventive medicine
• 影响因子: 5.5
• 作者: Kuntz JL;Young DR;Saelens BE;Frank LD;Meenan RT;Dickerson JF;Keast EM;Fortmann SP
• 通讯作者: Fortmann SP