United States bicycle commuting rates are low compared to similarly developed countries like the Netherlands and Denmark. However, bicycle commuting shows promise for positive health outcomes, especially those related to chronic diseases like obesity, diabetes, and heart disease. Little research has been conducted in the U.S. to study the association between bicycle commuting and heart disease. Furthermore, U.S. cities need guidance on how to increase bicycle commuting rates.

The purpose of this study was to evaluate the association between U.S. bicycle commuting rates and heart disease prevalence and to identify infrastructure and policy factors most significantly associated with bicycle commuting rates in large U.S. cities. This research quantitatively defined infrastructure and policy factors and analyzed ecologic associations across the 50 most populous U.S. cities.

The results of this study are based on an ecologic analysis that evaluated associations at the census tract and city levels. Secondary data from nine sources as used to conduct the analysis. Data sources include the League of American Bicyclists Benchmarking Report, PeopleForBikes bicycle network analysis, the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, the U.S. Census Bureau American Community Survey, and more. A principal components analysis was conducted to identify relevant infrastructure factors for research question one; ordinary least squares regression models were derived to compare associations between infrastructure and policy factors for research question two, and latent class cluster analysis was conducted to calculate the prevalence odds ratios of the association between bicycle commuting rate and heart disease for research question three.

Three factors accounted for 70% of the variation in bicycle commuting rates. Those three factors include the average number of cyclist fatalities, the number of city employees working on bicycle projects, and bicycle network connections to public transit. The results also show that the association between bicycle commuting rate and heart disease prevalence was only statistically significant in census tract populations with predominantly high socioeconomic status, low health risk factors, and white race. The ecologic study design likely masked any positive health outcomes in populations with low socioeconomic status. The findings of this study provide valuable insights for transportation and public health practitioners, and the conclusions set the stage for future research on cycling and chronic disease outcomes in the United States.