Public transport use cessation and accelerated health declines – a quasi-causal analysis

Background

Mobility is a hallmark of healthy ageing, linked to older adults’ independence, health and wellbeing, and depends on access to suitable transport. As people age, they often stop using public transport. However, little is known regarding the health outcomes of this cessation. A key difficulty in investigating this link is bidirectionality: declining health both causes and results from cessation. To address this, this study utilised a quasi-experimental approach focussing on cessation caused by structural, non-health-related factors, aiming to quantify impacts on two major markers of ageing: gait speed and cognitive function.

Methods

Participants from waves 3-10 of the English Longitudinal Study of Ageing (ELSA) were classified according to their public transport use status. Ceasers were then divided to subgroups according to cessation reason. Linear mixed-effects models were used to examine the links between public transport use cessation and gait speed and cognitive function, testing for changes in the rate of decline following cessation, adjusting for age, sex, and relevant covariates.

Results

The sample consisted of 18,292 unique participants, of which 3,400 (18.6%) ceased using public transport, 794 of them for structural reasons. Structural public transport use cessation was significantly associated with acclerated gait speed and cognitive decline (β=-0.001 m/s /year, p = 0.008; β=-0.012/year, p = 0.002 respectively), compared with pre-cessation trajectories. In contrast, health-related ceasers exhibited sharp declines at cessation, with no significant change in rate.

Conclusions

Public transport use cessation is relatively common among older adults. While it is often caused by health-related reasons, cessation might also independently lead to adverse health outcomes. This underscores the importance of maintaining accessible and adequate public transport to support independent mobility and potentially delay age-related functional decline.

Key messages

• Older adults who cease using public transport for structural reasons show significantly faster gait speed and cognitive function declines, suggesting cessation contributes to health declines.

• Maintaining accessible public transport may support healthy ageing, as some cessation appears preventable and linked to modifiable barriers, rather than unavoidable age-related health declines.