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Original research article
Using alternatives to the car and risk of all-cause, cardiovascular and cancer mortality
  1. Jenna Panter1,2,
  2. Oliver Mytton1,2,
  3. Stephen Sharp1,
  4. Søren Brage1,
  5. Steven Cummins3,
  6. Anthony A Laverty4,
  7. Katrien Wijndaele1,
  8. David Ogilvie1,2
  1. 1 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  2. 2 UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
  3. 3 Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  1. Correspondence to Dr Jenna Panter, MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge CB2 0QQ, UK; jrp63{at}


Objective To investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and morbidity and mortality.

Methods We conducted a prospective study using data from 3 58 799 participants, aged 37–73 years, from UK Biobank. Commute and non-commute travel were assessed at baseline in 2006–2010. We classified participants according to whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time. The main outcome measures were incident cardiovascular disease (CVD) and cancer, and CVD, cancer and all-cause mortality. We excluded events in the first 2 years and conducted analyses separately for those who regularly commuted and those who did not.

Results In maximally adjusted models, regular commuters with more active patterns of travel on the commute had a lower risk of incident (HR 0.89, 95% CI 0.79 to 1.00) and fatal (HR 0.70, 95% CI 0.51 to 0.95) CVD. Those regular commuters who also had more active patterns of non-commute travel had an even lower risk of fatal CVD (HR 0.57, 95% CI 0.39 to 0.85). Among those who were not regular commuters, more active patterns of travel were associated with a lower risk of all-cause mortality (HR 0.92, 95% CI 0.86 to 0.99).

Conclusions More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease.

  • cardiac risk factors and prevention
  • hypertension
  • coronary artery disease
  • epidemiology
  • stroke

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors JP, OM and DO designed the analysis in collaboration with SS, SB, KW, AAL and SC. SS conducted the analysis. JP and OM drafted the manuscript, with SB, KW, AAL, SC and DO revising it for important intellectual content. All authors read and approved the final manuscript.

  • Funding JP, DO, SB and SS are supported by the Medical Research Council (Unit Programme Nos MC_UU_12015/1, MC_UU_12015/3 and MC_UU_12015/6) and KW is also supported by the British Heart Foundation (Intermediate Basic Science Research Fellowship grant No FS/12/58/29709). AAL is funded by the NIHR (RP 014-04-032), and the Public Health Policy Evaluation Unit are grateful for the support of the NIHR School of Public Health Research. This research was conducted using the UK Biobank resource (application No 20684). The work was also supported under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence at the University of Cambridge, for which funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the United Kingdom Clinical Research Collaboration, is gratefully acknowledged.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the North West Multi-centre Research Ethics Committee, the Patient Information Advisory Group, and the Community Health Index Advisory Group.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data for this study were accessed through the UK Biobank. UK Biobank welcome applications from researchers to use the data. Further information on the process is available from:

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