Multi-use physical activity trails in an urban setting and cardiovascular disease: a difference-in-differences analysis of a natural experiment in Winnipeg, Manitoba, Canada.
Int J Behav Nutr Phys Act
; 19(1): 34, 2022 03 28.
Article
in En
| MEDLINE
| ID: mdl-35346244
ABSTRACT
OBJECTIVE:
To determine if expansion of multi-use physical activity trails in an urban centre is associated with reduced rates of cardiovascular disease (CVD).METHODS:
This was a natural experiment with a difference in differences analysis using administrative health records and trail-based cycling data in Winnipeg, Canada. Prior to the intervention, each year, 314,595 (IQR 309,044 to 319,860) persons over 30 years without CVD were in the comparison group and 37,901 residents (IQR 37,213 to 38,488) were in the intervention group. Following the intervention, each year, 303,853 (IQR 302,843 to 304,465) persons were in the comparison group and 35,778 (IQR 35,551 to 36,053) in the intervention group. The natural experiment was the construction of four multi-use trails, 4-7 km in length, between 2010 and 2012. Intervention and comparison areas were based on buffers of 400 m, 800 m and 1200 m from a new multi-use trail. Bicycle counts were obtained from electromagnetic counters embedded in the trail. The primary outcome was a composite of incident CVD events CVD-related mortality, ischemic heart disease, cerebrovascular events and congestive heart failure. The secondary outcome was a composite of incident CVD risk factors hypertension, diabetes and dyslipidemia.RESULTS:
Between 2014 and 2018, 1,681,125 cyclists were recorded on the trails, which varied ~ 2.0-fold across the four trails (2358 vs 4264 counts/week in summer months). Between 2000 and 2018, there were 82,632 CVD events and 201,058 CVD risk events. In propensity score matched Poisson regression models, the incident rate ratio (IRR) was 1.06 (95% CI 0.90 to 1.24) for CVD events and 0.95 (95%CI 0.88 to 1.02) for CVD risk factors for areas within 400 m of a trail, relative to comparison areas. Sensitivity analyses indicated this effect was greatest among households adjacent to the trail with highest cycling counts (IRR = 0.85; 95% CI 0.75 to 0.96).CONCLUSIONS:
The addition of multi-use trails was not associated with differences in CVD events or CVD risk factors, however the differences in CVD risk may depend on the level of trail use. TRIAL REGISTRATION Trial registration number NCT04057417 .Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cardiovascular Diseases
/
Hypertension
Type of study:
Prognostic_studies
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Int J Behav Nutr Phys Act
Year:
2022
Document type:
Article
Affiliation country:
Canada