The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment
The Health and economic effects of light rail lines: design, methods, and protocol for a natural experiment
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DOI：
10.1186/s12889-019-6518-6
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发表时间：
2019-02-15
影响因子：
4.5
通讯作者：
Fortmann, Stephen P.
中科院分区：
文献类型：
--
作者：
Frank, Lawrence D.;Kuntz, Jennifer L.;Fortmann, Stephen P.
在过去的二十年里，社区设计对健康的影响已经得到了广泛的研究。特别是，公共交通的使用与公交车站和商店，工作，家庭和其他目的地之间的更多步行有关。过境准入的变化与体育活动和肥胖有关，但很少与健康结果和相关费用有关，特别是在因果框架内。健康相关的财政影响的过境投资应主要考虑过境investment decisions.MethodsThe Rails & Health研究是一个自然的实验，评估临床措施，医疗保健利用率和医疗保健费用之间的变化凯萨永久西北（KPNW）成员开放后，一个新的轻轨交通（LRT）线在波特兰，俄勒冈州。该研究前瞻性地跟踪了3036名暴露于新LRT线的成年人和4386名不居住在新线附近的成年人。从KPNW的电子病历中提取个人水平的结局和协变量，包括成员人口统计学和合并症、血压、体重指数、血脂、糖化血红蛋白以及医疗保健利用和成本。此外，还对参与者进行了关于其他人口统计数据、旅行模式、身体活动（PA）和感知的社区步行能力的调查。在研究人群的子样本中，我们正在收集旅行相关行为的直接测量结果-身体活动（加速度计），全球定位系统（GPS）跟踪和旅行日记，以记录负责观察到的健康结果和成本变化的机制。此外，亦收集了在基线及铁路施工后的建筑环境的综合测量数据。统计分析将（1）检查开通一条新的LRT线对慢性病指标，卫生保健利用和卫生保健费用的影响，（2）评估LRT线对健康措施和费用的观察影响在多大程度上由总PA和交通相关PA的变化介导。卫生从业人员、开发人员和决策者，掌握记录过境投资如何影响人口健康和相关成本所需的关键信息。
BackgroundThe 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.MethodsThe 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 behaviorphysical activity (accelerometry), global positioning system (GPS) tracking, and travel diariesto 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.DiscussionThe 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.