Metro and elderly health in Hong Kong: protocol for a natural experiment study in a high-density city

Abstract

Introduction: Public transport accessible to older people may offer a transformative solution to achieving healthy ageing. However, the evidence to support such transport infrastructure modifications is unclear. Previous studies on public transport use and elderly health were mostly observational studies using cross-sectional data. Few studies have examined the before-and-after effects of a new metro, for example, to see if it leads to improved elderly health.

Methods and analysis: We use a new metro line in Hong Kong as a natural experiment to examine the impact of the metro-led public transport intervention on elderly health. In Hong Kong, more than 90% of daily travels are made by public transport. The public transport modifications consist of the new metro line with eight stations and changes in the walking environment and bus services around the stations. We will look at the before-and-after differences in public transport use and health outcomes between elderly participants living in treatment neighbourhoods (400 m walking buffered areas of the new metro stations) and in control groups (living in comparable areas but unaffected by the new metro). Questionnaire-based baseline data were collected in 2019 before the COVID-19 pandemic, while some qualitative interviews are ongoing. Amid the pandemic, we conducted a quick telephone-based survey of COVID-19's potential impact on public transport use behaviours of our elderly cohort in September 2020. Note there is no lockdown in Hong Kong until the writing of the paper (January 2021). After the new metro opens, we will conduct a follow-up survey, tentatively in late 2022. We aim to investigate if the new metro and the associated changes in the built environment have any effects on public transport use behaviours, physical activity and wider health outcomes among the elderly (eg, social inclusion, quality of life, subjective well-being).

Ethics and dissemination: The Human Research Ethics Committee of the University of Hong Kong reviewed and approved the study procedures and materials (reference number: EA1710040). Results will be communicated through scientific papers and research reports.

Keywords: mental health; public health; statistics & research methods.

Figure 1

The new metro line from Tai Wai to Hung Hom stations. The line will open in two phases: the first phase was in February 2020 with four stations opened (Tai Wai, Hin Keng, Diamond Hill and Kai Tak); the second phase will be in 2021 (including Sung Wong Toi, To Kwa Wan, Ho Man Tin and Hung Hom stations). The map was adapted under free art licence from Wikimedia. Retrieved from https://commons.wikimedia.org/wiki/File:SCL_ga_map.png.

Figure 2

Treatment–control groups represent pairing treatment–control groups for investigating the health impact of public transport among the elderly. Three treatment groups are selected from the new line (groups 1-T, 2-T and 3-T), compared with control groups (groups 1-C, 2-C and 3-C) from lines in operation for more than 5 years. Groups 1-E and 2-E are selected from two lines that entered into operation in March 2015 and December 2016, and their comparable groups are 4-C and 1-C. The background metro map was adapted under Creative Commons Attribution ShareAlike 3.0 from Wikimedia. Retrieved from https://upload.wikimedia.org/wikipedia/commons/f/f1/Shatin_to_Central_Link_proposal_final.svg.