Public transport use cessation and age-related functional decline: a quasi-causal analysis using the English longitudinal study of ageing

Mobility is crucial for older adults’ independence, health and wellbeing, and depends on access to suitable transport. As people age, they often stop using public transport, yet this cessation’s health consequences are poorly understood. A key challenge is bidirectionality: declining health both cause and result from cessation. To address this, a quasi-experimental approach was utilised, 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. Participants from waves 3–10 of the English Longitudinal Study of Ageing (ELSA) were classified according to their public transport use status, with ceasers further classified by cessation reason. Linear mixed-effects models were used to examine associations between public transport use cessation and health outcomes, testing for changes in the rate of decline following cessation, adjusting for age, sex, and relevant covariates. Out of 18,292 unique participants 3,400 ceased using public transport, 794 of them for structural reasons. Structural cessation was significantly associated with accelerated gait speed and cognitive declines (β=-0.001 m/s /year, p = 0.008; β=-0.012/year, p = 0.002 respectively), compared to pre-cessation. In contrast, health-related ceasers exhibited sharp declines at cessation, with insignificant subsequent changes in rate. Public transport use cessation is a relatively common phenomenon, affecting almost a fifth of participants. While often caused by health-related reasons, cessation also independently leads to adverse health outcomes, specifically accelerated physical and cognitive declines. Policy for maintaining accessible and adequate public transport is essential for preserving mobility and might delay these declines.