Project Title:

Understanding the health benefits of active commuting in a Scottish context

Project Number:

2019_003

Researchers:

David Walsh, Glasgow Centre for Population Health (GCPH)
Welcome Wami , University of Glasgow/GCPH
Bruce Whyte, Glasgow Centre for Population Health (GCPH)
Graham Baker, University of Edinburgh
Chris Dibben, University of Edinburgh
Ruth Dundas, University of Glasgow
Zhiqiang Feng, University of Edinburgh
Paul Kelly, University of Edinburgh

Start Date:

01/11/19

Summary:

The overall aim is to assess the health benefits, and resulting policy implications, of active commuting in Scotland. There are eight associated research questions (RQs) which are listed below. SLS data will be analysed directly in seeking to answer RQs 3-6, with the results of those analyses additionally used in answering RQs 7-8.

Research questions:

1. What is already known about the benefits of active commuting, and how does this evidence fit with current Scottish Government policy?

2. How have patterns of commuting (active and non-active) in Scotland changed since 1991?

3. What are the principal differences in the profiles (e.g. age, gender, socio-economic status) of active vs. non-active commuters?

4. How do risks of different health outcomes (including all-cause and cause-specific mortality and hospitalisation) differ between active and non-active commuters?

5. What is the impact of change in mode of commuting on risks of the above outcomes?

6. How do risks of outcomes compare across different socioeconomic groups (and other characteristics of the sample e.g. age, gender)?

7. What are the estimated cost savings to the NHS in Scotland of increased levels of active commuting?

8. What are the policy implications of all the above?

There is a considerable amount of research evidence of the health benefits (and associated cost savings) of active commuting. This has included a recent UK study which demonstrated an association between cycling commuting and notably lower risks of all-cause and cause-specific mortality, while controlling for the effects of a broad range of other risk factors [1]. In addition, a 2014 systematic review and meta-analysis showed evidence of significant reductions in all-cause mortality associated with both walking (-11%) and cycling (-10%) [2], and a 2008 meta-analytic review confirmed the ‘robust’ protective effects of active commuting on cardiovascular incidence and mortality [3]. Other evidence has pointed to reductions in BMI for commuters who transitioned from car commuting to active commuting or public transport [4], while in terms of cost savings, a 2012 modelling-based analysis predicted savings of £20 billion to the NHS in England & Wales of increased levels of active travel in urban areas [5]. Although the most recent UK study [1] had a number of strengths, it was also associated with a number of important weaknesses: a limited follow-up period, a narrow age range of participants, and the established lack of representativeness of the data source [6]. This study seeks to both address some of those limitations (e.g. in terms of incorporating a much longer follow-up period, using a broader age group, and examining different outcomes) and, importantly, to produce new evidence based on a specifically Scottish context – using a large representative Scottish sample – with which to make specific recommendations aimed at Scottish Government policy-makers

References:

1. Celis-Morales C. A., Lyall D. M., Welsh P. et al. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ. 2017; 357: j1456
2. Kelly P., Kahlmeier S., Gotschi T. et al. Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship. International Journal of Behavioral Nutrition and Physical Activity. 2014 11:132.
3. Hamer M., Chida Y. Active commuting and cardiovascular risk: a meta-analytic review. Prev Med. 2008; 46(1): 9-13
4. Flint E., Webb E., Cummins S. Change in commute mode and body-mass index: prospective longitudinal evidence from the UK Biobank. The Lancet. 2016; 1:e46-55.
5. Jarrett J., Woodcock J., Griffiths U.K. et al. Effect of increasing active travel in urban England and Wales on costs to the National Health Service. Lancet. 2012; 379(9832): 2198-205
6. Fry A., Littlejohns T.J., Sudlow C. et al. Comparison of Sociodemographic and Health-Related Characteristics of UK Biobank Participants With Those of the General Population. Am J Epidemiol. 2017; 186(9): 1026-1034

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