ABSTRACT
Background:
Promoting active modes of
transportation such as cycling may generate important
public health, economic, and
climate mitigation benefits. We aim to assess the
mortality and
morbidity impacts of cycling in a country with relatively low levels of cycling,
France, along with associated monetary benefits. We further assess the potential additional benefits of shifting a portion of short trips from
cars to bikes, including projected
greenhouse gas emissions
savings.
Methods:
Using individual data from a nationally representative mobility
survey, we described the French 2019 cycling levels by age and
sex. We conducted a
burden of disease analysis to assess the
incidence of five
chronic diseases (
breast cancer,
colon cancer,
cardiovascular diseases,
dementia, and type-2 diabetes) and the number of deaths prevented by cycling, based on national
incidence and
mortality data and
dose-response relationships from meta-analyses. We assessed the corresponding direct medical
cost savings and the intangible
costs prevented based on the value of a statistical
life year. Lastly, based on individual simulations, we assessed the likely additional benefits of shifting 25% of short (<5 km)
car trips to cycling.
Findings:
The French
adult (20-89 years)
population was estimated to cycle on average 1 min 17 sec pers-1 day-1 in 2019, with important heterogeneity across
sex and age. This yielded benefits of 1,919 (
uncertainty interval, UI 1,101-2,736)
premature deaths and 5,963 (UI 3,178-8,749)
chronic disease cases prevented, with
males reaping nearly 75% of these benefits. Direct medical
costs prevented were estimated at 191 million (UI 98-285) annually, while the corresponding intangible
costs were nearly 25 times higher (4.8 billion, UI 3.0-6.5). We estimated that on average, 1.02 (UI 0.59-1.62) of intangible
costs were prevented for every km cycled. Shifting 25% of short
car trips to cycling would yield approximatively a 2-fold increase in deaths prevented, while also generating important CO2 emissions reductions (0.257 MtCO2e, UI 0.231-0.288).
Interpretation:
In a country with a low- to moderate-cycling
culture, cycling already generates important
public health and
health-related economic benefits. Further development of active
transportation would increase these benefits while also contributing to
climate change mitigation targets.
Funding:
This
research received no specific
grant from any funding agency in the public, commercial, or not-for-profit sectors.
