Who benefits from shifting metal-to-pedal? Equity in the health tradeoffs of cycling

Health impact assessments (HIAs) have been used to evaluate the benefits and risks of cycling and other transportation interventions. Most HIAs use aggregate, city-level data rather than considering how impacts might vary across neighborhoods. To address this limitation, we developed a novel HIA framework for evaluating intra-city spatial variation and equity in the health tradeoffs of cycling. We illustrated the utility of this framework by applying it to Los Angeles, CA, estimating changes in mortality risk that might be expected from shifting a 2.5-mile daily car trip to cycling for five years. This shift was associated on average with a 12.4% net reduction in mortality risk, and a 50% increase in cycling could prevent approximately 600 deaths over five years. However, benefits were significantly lower in places with higher percentages of Black and Hispanic residents and lower socioeconomic status. To avoid widening health disparities, cycling promotion should be coupled with mitigation strategies in marginalized communities where risks are currently highest.