Urban Design 4 Health, Inc., Rochester, NY, USA.
Health & Community Design Lab, Schools of Population and Public Health and Community and Regional Planning, University of British Columbia, Vancouver, BC, Canada.
BMC Public Health. 2019 Feb 15;19(1):200. doi: 10.1186/s12889-019-6518-6.
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.
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.
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.
在过去的二十年中，社区设计对健康的影响已经得到了广泛的研究。特别是，公共交通的使用与在过境站和商店、工作、家庭和其他目的地之间更多的步行有关。过境通道的变化与身体活动和肥胖有关，但很少与健康结果和相关成本有关，特别是在因果框架内。过境投资的与健康相关的财政影响应该是重大过境投资决策的关键考虑因素。
Rails & Health 研究是一项自然实验，评估了在俄勒冈州波特兰市新轻轨（LRT）线路开通后，Kaiser Permanente Northwest（KPNW）成员的临床指标、医疗保健利用和医疗保健成本的变化。该研究正在前瞻性地跟踪 3036 名接触新 LRT 线路的成年人和 4386 名不居住在新线路附近的类似成年人。个体水平的结果和协变量从 KPNW 的电子病历中提取，包括成员的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的利用和成本。此外，参与者还接受了有关其他人口统计学、出行模式、身体活动（PA）和感知邻里步行能力的调查。在研究人群的一个子样本中，我们正在收集与旅行相关行为的直接测量值-身体活动（加速度计）、全球定位系统（GPS）跟踪和旅行日记-以记录观察到的健康结果和成本变化的机制。基线和铁路建设后的建筑环境的综合测量值也在收集。统计分析将：（1）检查开通新 LRT 线路对慢性病指标、医疗保健利用和医疗保健成本的影响；（2）评估观察到的 LRT 线路对健康措施和成本的影响在多大程度上受到总身体活动和与交通相关的身体活动变化的影响。
Rails & Health 研究的结果将为城市规划者、交通工程师、医疗保健从业者、开发商和决策者提供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。
