The Health and economic effects of light rail lines

design, methods, and protocol for a natural experiment

Lawrence D. Frank, Jennifer L. Kuntz, James E. Chapman, Eric H. Fox, John F. Dickerson, Richard T. Meenan, Brian E. Saelens, Deborah R. Young, Janne Heinonen, Stephen P. Fortmann

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Number of pages1
JournalBMC public health
Volume19
Issue number1
DOIs
StatePublished - Feb 15 2019

Fingerprint

Health Care Costs
Patient Acceptance of Health Care
Economics
Light
Health
Demography
Accelerometry
Geographic Information Systems
Electronic Health Records
Glycosylated Hemoglobin A
Population
Walking
Comorbidity
Body Mass Index
Chronic Disease
Obesity
Blood Pressure
Lipids
Costs and Cost Analysis

Keywords

  • Active travel
  • Built environment
  • Environmental measurement methods
  • Health care utilization
  • Light rail transit
  • Physical activity
  • Transportation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Frank, L. D., Kuntz, J. L., Chapman, J. E., Fox, E. H., Dickerson, J. F., Meenan, R. T., ... Fortmann, S. P. (2019). The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment. BMC public health, 19(1). https://doi.org/10.1186/s12889-019-6518-6

The Health and economic effects of light rail lines : design, methods, and protocol for a natural experiment. / Frank, Lawrence D.; Kuntz, Jennifer L.; Chapman, James E.; Fox, Eric H.; Dickerson, John F.; Meenan, Richard T.; Saelens, Brian E.; Young, Deborah R.; Heinonen, Janne; Fortmann, Stephen P.

In: BMC public health, Vol. 19, No. 1, 15.02.2019.

Research output: Contribution to journalArticle

Frank, LD, Kuntz, JL, Chapman, JE, Fox, EH, Dickerson, JF, Meenan, RT, Saelens, BE, Young, DR, Heinonen, J & Fortmann, SP 2019, 'The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment', BMC public health, vol. 19, no. 1. https://doi.org/10.1186/s12889-019-6518-6
Frank, Lawrence D. ; Kuntz, Jennifer L. ; Chapman, James E. ; Fox, Eric H. ; Dickerson, John F. ; Meenan, Richard T. ; Saelens, Brian E. ; Young, Deborah R. ; Heinonen, Janne ; Fortmann, Stephen P. / The Health and economic effects of light rail lines : design, methods, and protocol for a natural experiment. In: BMC public health. 2019 ; Vol. 19, No. 1.
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