Pathways from Built Environment to Health Care Costs: Linking Objectively Measured Built Environment with Physical Activity and Health Care Expenditures

Abstract

Evidence connecting health care expenditures with physical activity and built environment is rare. We examined how detailed urban form relates to mode specific moderate-to-vigorous physical activity (MVPA) and health care costs—controlling for transit access, residential choices/preferences, sociodemographic factors. We harness high resolution data for 476 participants in the Rails and Health study on health care costs, mode specific MVPA, parcel-level built environment, and neighborhood perception surveys. To account for dependencies among outcomes, structural equation modeling framework is used. A 1% increase in bike, walk, and transit-related MVPA was associated with lower health care costs by −0.28%, −0.09%, and −0.27% respectively. A one-unit increase in neighborhood walkability index correlates with a 6.48% reduction in health care costs. Indirect associations between residential choices, attitudes, and health outcomes through MVPA were also observed. The results suggest the potential to alter behaviors and lower health care costs through retrofitting neighborhoods.