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

Jonathan McGavock, Erin Hobin, Heather J Prior, Anders Swanson, Brendan T Smith, Gillian L Booth, Kelly Russell, Laura Rosella, Wanrudee Isaranuwatchai, Stephanie Whitehouse, Nicole Brunton, Charles Burchill, Jonathan McGavock, Erin Hobin, Heather J Prior, Anders Swanson, Brendan T Smith, Gillian L Booth, Kelly Russell, Laura Rosella, Wanrudee Isaranuwatchai, Stephanie Whitehouse, Nicole Brunton, Charles Burchill

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 .

Keywords: Active transportation; Build environment; Cycling; Exercise; Hypertension; Ischemic heart disease.

Conflict of interest statement

The authors declare that they have no competing interests to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Location of multi-use trails within the City of Winnipeg. Legend: Dark lines represent actual trails and light coloured areas represent 400 m buffer for each trail. Red lines represent major roads. Orange lines represent minor roads. Green areas represent parks/greenspace
Fig. 2
Fig. 2
Trail use following construction of multi-use trails. A-D. Weekly unidirectional cycling counts over 5 years for each of the four trails studied; E – Trail counts in summer and winter months for each trail. Bars = mean, error bars = 95% confident intervals
Fig. 3
Fig. 3
Crude quarterly incident rates for the composite measures of Cardiovascular Disease (CVD) Events and Risk Factors over time for intervention and comparison areas
Fig. 4
Fig. 4
Difference-in-differences for CVD events and CVD Risk Factors across different intervention buffers
Fig. 5
Fig. 5
Difference-in-differences for CVD events and CVD Risk Factors by trail. Legend: Numbers in brackets beside each trail reflect mean weekly cyclist counts during the summer months

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Source: PubMed

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