Public transportation and transmission of viral respiratory disease: Evidence from influenza deaths in 121 cities in the United States.

Renata E Howland,Scarlett S Wang,Mitchell L Moss,Nicholas R Cowan,Sherry Glied,Kin On Kwok

doi:10.1371/journal.pone.0242990

Renata E Howland, Scarlett S Wang + Show 4 more

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https://doi.org/10.1371/journal.pone.0242990

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Abstract

One important concern around the spread of respiratory infectious diseases has been the contribution of public transportation, a space where people are in close contact with one another and with high-use surfaces. While disease clearly spreads along transportation routes, there is limited evidence about whether public transportation use itself is associated with the overall prevalence of contagious respiratory illnesses at the local level. We examine the extent of the association between public transportation and influenza mortality, a proxy for disease prevalence, using city-level data on influenza and pneumonia mortality and public transit use from 121 large cities in the United States (US) between 2006 and 2015. We find no evidence of a positive relationship between city-level transit ridership and influenza/pneumonia mortality rates, suggesting that population level rates of transit use are not a singularly important factor in the transmission of influenza.

Highlights

Concern about the role of public transit use in the spread of contagious respiratory diseases is long-standing, widespread, and very timely
Using historical influenza/pneumonia and transit data in the United States (US), we did not find any evidence supporting the hypothesis that greater use of public transit at the city level is associated with local influenza and pneumonia mortality rates
These findings are consistent with prior studies of the relationship between transit use and influenza [8,9,10], but they do go against convention wisdom

Summary

Introduction

Concern about the role of public transit use in the spread of contagious respiratory diseases is long-standing, widespread, and very timely. It points to sociodemographic characteristics, including income, race and ethnicity, as possible risk factors potentially because these characteristics are correlated with underlying health conditions or with increases in the probability of exposure to disease [3]. One source of such increased exposure is hypothesized to be the use of public transit [4]. In an analysis of the severe acute respiratory syndrome (SARS) outbreak in 2003, Sadique et a. In an analysis of the severe acute respiratory syndrome (SARS) outbreak in 2003, Sadique et a. (2007) found that 75% of respondents reported

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