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

描述（由申请人提供）：关于是否建立新的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卫生。然而，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，我们建议评估一个新的轻轨线对健康的结果和医疗保健费用的综合健康计划在波特兰，俄勒冈州的成员之间的影响。我们将检查2015年新轻轨线开通前后4,000名健康计划成员和匹配对照组的健康生物标志物和医疗保健费用的纵向数据。通过将个人行为，健康和医疗保健成本与零售店，街道特征和活跃的交通基础设施的包裹级数据联系起来，我们建议对大规模社区基础设施改善进行最全面，最可靠的评估。我们将前瞻性地确定开通新的轻轨线路对基线和线路开通后三年之间临床健康措施和医疗保健成本变化的影响。我们将招募Kaiser Permanente Northwest成员，年龄在18-74岁之间，居住在距离新铁路线车站1.5公里的范围内;这些“病例”（N= 4000）将与人口统计学、步行能力和交通可达性方面在人口普查区块组水平匹配的对照组（N=4000）进行比较。健康指标将包括电子病历（EMR）中的体重指数（BMI）、血压、血脂和糖化血红蛋白。我们还将确定在干预组中观察到的健康状况和成本变化在多大程度上受到交通相关和总体力活动（PA）变化的影响，控制步行性（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状况。这将通过在基线和2年随访时客观评估500名暴露组成员和500名对照组成员的随机子样本中的总PA（使用加速度计数据）和运输PA（GPS数据）来完成。这项研究可能对公共卫生政策产生重大影响。增加公共交通仍然存在相当大的政治阻力;确定这种基础设施的健康影响和成本将为用于确定交通投资优先次序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，这将提高公众对交通投资影响身体活动和医疗保健成本的方式的理解。这一关键 目前缺乏有关重大公共交通投资决策的信息。

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.