Transit use and health care costs: A cross-sectional analysis. (March 2022)

• Record Type: Journal Article
• Authors: Saelens, Brian E.; Meenan, Richard T.; Keast, Erin M.; Frank, Lawrence D.; Young, Deborah R.; Kuntz, Jennifer L.; Dickerson, John F.; Fortmann, Stephen P.
• Is Part Of: Journal of transport & health. Volume 24(2022)
• Publication Date: 2022-03
• Subjects: Transit -- Health care costs -- Public transportation -- Medical expenditures; Transportation -- Health aspects -- Periodicals; Transportation -- Periodicals; Public Health -- Periodicals; Noise, Transportation -- Periodicals; Air Pollutants -- Periodicals; 388
• DOI: 10.1016/j.jth.2021.101294
• Languages: English
• ISSNs: 2214-1405

Abstract

Abstract: Introduction: Greater transit use is associated with higher levels of physical activity, which is associated with lower health risks and better health outcomes. However, there is scant evidence about whether health care costs differ based on level of transit ridership. Methods: A sample (n = 947) of members of Kaiser Permanente in the Portland, Oregon area were surveyed in 2015 about their typical use of various modes of travel including transit. Electronic medical record-derived health care costs were obtained among these members for the prior three years. Analysis examined proportional costs between High transit users (3+ days/week), Low transit users (1–2 days/week), and Non-users adjusting for age and sex, and then individually (base models) and together for demographic and health status variables. Results: In separate base models across individual covariates, High transit users had lower total health care costs (59–69% of Non-user's costs) and medication costs (31–37% of Non-users' costs) than Non-users. Low transit users also had lower total health care (69%–76% of Non-users' costs) and medication costs (43–57% transit of Non-user's costs) than Non-users. High transit users' outpatient costs were also lower (77–82% of Non-users). In fully-adjusted models, total health care and medication costs were lower among High transit users' (67% and 39%) and Low transit users' (75% and 48%) compared to Non-users, but outpatient costs did not differ by transit use. Conclusions: Findings have implications for the potential cost benefit of encouraging and supporting more transit use, although controlled longitudinal and experimental evidence is needed to confirm findings and understand mechanisms. Highlights: Transit users had lower health care costs than those not using transit. Health care costs were lowest among high transit users (3+ days/week typically). Lower costs for transit users remained after demographic & health status adjustment.