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

说明(申请人提供)：决定是否建设新的公共交通项目需要考虑这些重大投资对公众健康的影响。然而，到目前为止，关于这些影响的研究还很少。为了给未来的政策制定提供参考，我们建议评估一条新的轻轨线路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成本的影响。我们将检查4000名健康计划成员和2015年一条新的轻轨线路开通前后的配对对照的健康生物标志物和医疗费用的纵向数据。通过将个人行为、健康和医疗保健成本与零售网点、街道特征和活跃的交通基础设施的地块级别数据联系起来，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的轻铁线开通后对临床健康措施和医疗成本在基线至开通三年后的变化的影响。我们将招募18-74岁的Kaiser Permanente Northwest成员居住在新铁路线车站1.5公里范围内；这些“案例”(N=4000)将与在人口普查区组水平匹配的对照组(N=4000)在人口统计、步行和交通便利方面进行比较。健康措施将包括体重指数(BMI)、血压、血脂和电子病历(EMR)中的糖化血红蛋白。我们还将确定干预组中观察到的健康状况和成本的任何变化在多大程度上受到与交通相关的变化和总体力活动(PA)、控制步行能力(当地可访问性)、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的影响。这将通过在基线和两年的随访中客观地评估500名暴露组和500名对照组成员中的总PA(使用加速度计数据)和运输PA(GPS数据)来实现。这项研究可能会对公共卫生政策产生重大影响。增加公共交通仍然存在相当大的政治阻力；确定此类基础设施对健康的影响和成本将为用于确定交通投资优先顺序的成本效益模型提供依据。我们的研究将产生丰富的健康和环境数据，这将增强公众对交通投资影响体力活动和医疗保健成本的方式的理解。这一点至关重要 目前，关于重大公共交通投资的决策缺乏信息。

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.