Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study.
Vamos, Eszter P
Laverty, Anthony A
The Lancet. Planetary health
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Patterson, R., Panter, J., Vamos, E. P., Cummins, S., Millett, C., & Laverty, A. A. (2020). Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study.. The Lancet. Planetary health, 4 (5), e186-e194. https://doi.org/10.1016/s2542-5196(20)30079-6
Background Active travel is increasingly recognised as an important source of physical activity. We aimed to describe associations between commute mode and cardiovascular disease (CVD), cancer and all-cause mortality. Methods Cohort analyses were of 394,746 participants from the Office for National Statistics Longitudinal Study, which linked census data from 1991, 2001 and 2011 to mortality and cancer registrations. Commuting by private motorised transport, public transport, walking and cycling were compared in terms of these outcomes using Cox proportional hazards models with time-varying covariates. Models were additionally stratified by socio-economic group. Findings During the study period, 13,983 participants died, 3,172 from CVD, 6,509 from cancer and there were 20,980 incident cancer cases. In adjusted models, cycle commuting was associated with 20% lower all-cause mortality (Hazard Ratio = 0.80, 95% Confidence Interval = 0.73-0.89), 24% lower CVD mortality (0.76, 0.61-0.94), 16% lower cancer mortality (0.84, 0.73-0.98) and 11% lower cancer incidence (0.89, 0.82-0.97) than those commuting by private motorised vehicle. Rail commuters had a 10% lower all-cause (0.90, 0.83-0.97) and 20% lower CVD mortality (0.80, 0.67-0.95) in addition to 12% lower cancer incidence (0.88, 0.83-0.94), and walk commuting was associated with 7% lower cancer incidence (0.93 (0.89-0.97)). Stratified analyses did not reveal differences in associations between socio-economic groups. Interpretation This large cohort study adds to existing evidence for the beneficial health impacts of more physically active commute modes, especially cycling and train use, and suggests that all socio-economic groups could benefit.
Humans, Neoplasms, Cardiovascular Diseases, Incidence, Mortality, Socioeconomic Factors, Transportation, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, England, Wales, Female, Male, Young Adult
Funded by National Institute for Health Research Professorship award to Professor Millett (NIHR RP 2014-04-032). The Public Health Policy Evaluation Unit at Imperial College London is grateful for the support of the NIHR School of Public Health Research (SPHR). This work formed part of RP’s PhD which he undertook at Imperial College London, funded by CM’s professorship until January 2019. Since June 2019 he has been funded by an MRC intramural programme grant [MC_UU_12015/6], as is JP. The work was also supported under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence at the University of Cambridge, for which funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the United Kingdom Clinical Research Collaboration, is gratefully acknowledged.
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External DOI: https://doi.org/10.1016/s2542-5196(20)30079-6
This record's URL: https://www.repository.cam.ac.uk/handle/1810/303965
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