Physical activity trails in an urban setting and cardiovascular disease morbidity and mortality in Winnipeg, Manitoba, Canada: a study protocol for a natural experiment

Erin Hobin, Anders Swanson, Gillian Booth, Kelly Russell, Laura C Rosella, Brendan T Smith, Ed Manley, Wanrudee Isaranuwatchai, Stephanie Whitehouse, Nicole Brunton, Jonathan McGavock, Erin Hobin, Anders Swanson, Gillian Booth, Kelly Russell, Laura C Rosella, Brendan T Smith, Ed Manley, Wanrudee Isaranuwatchai, Stephanie Whitehouse, Nicole Brunton, Jonathan McGavock

Abstract

Introduction: Aspects of the built environment that support physical activity are associated with better population health outcomes. Few experimental data exist to support these observations. This protocol describes the study of the creation of urban trials on cardiovascular disease (CVD)-related morbidity and mortality in a large urban centre.

Methods and analysis: Between 2008 and 2010, the city of Winnipeg, Canada, built four, paved, multiuse (eg, cycling, walking and running), two-lane trails that are 5-8 km long and span ~60 neighbourhoods. Linking a population-based health data with census and environmental data, we will perform an interrupted time series analysis to assess the impact of this natural experiment on CVD-related morbidity and mortality among individuals 30-65 years of age residing within 400-1200 m of the trail. The primary outcome of interest is a composite measure of incident major adverse CVD events (ie, CVD-related mortality, ischaemic heart disease, stroke and congestive heart failure). The secondary outcome of interest is a composite measure of incident CVD-related risk factors (ie, diabetes, hypertension and dyslipidaemia). Outcomes will be assessed quarterly in the 10 years before the intervention and 5 years following the intervention, with a 4-year interruption. We will adjust analyses for differences in age, sex, ethnicity, immigration status, income, gentrification and other aspects of the built environment (ie, greenspace, fitness/recreation centres and walkability). We will also assess trail use and trail user profiles using field data collection methods.

Ethics and dissemination: Ethical approvals for the study have been granted by the Health Research Ethics Board at the University of Manitoba and the Health Information Privacy Committee within the Winnipeg Regional Health Authority. We have adopted an integrated knowledge translation approach. Information will be disseminated with public and government partners.

Trial registration number: NCT04057417.

Keywords: epidemiology; general diabetes; ischaemic heart disease; public health; sports medicine.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Map of trail locations within Winnipeg, Manitoba, Canada, as of 2016.

References

    1. Sallis JF, Bull F, Guthold R, et al. . Progress in physical activity over the Olympic quadrennium. Lancet 2016;388:1325–36. 10.1016/S0140-6736(16)30581-5
    1. Sallis JF, Floyd MF, Rodríguez DA, et al. . Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation 2012;125:729–37. 10.1161/CIRCULATIONAHA.110.969022
    1. Meijer M, Röhl J, Bloomfield K, et al. . Do neighborhoods affect individual mortality? A systematic review and meta-analysis of multilevel studies. Soc Sci Med 2012;74:1204–12. 10.1016/j.socscimed.2011.11.034
    1. Frank LD, Kavage S, Devlin A. Health and the built environment: a review, 2012.
    1. McCormack GR, Shiell A. In search of causality: a systematic review of the relationship between the built environment and physical activity among adults. Int J Behav Nutr Phys Act 2011;8:125 10.1186/1479-5868-8-125
    1. Ferdinand AO, Sen B, Rahurkar S, et al. . The relationship between built environments and physical activity: a systematic review. Am J Public Health 2012;102:e7–13. 10.2105/AJPH.2012.300740
    1. Io M. Bringing public health into urban Revitalization: workshop summary. bringing public health into urban Revitalization: workshop summary. Washington (DC), 2015.
    1. Gascon M, Vrijheid M, Nieuwenhuijsen MJ. The built environment and child health: an overview of current evidence. Curr Environ Health Rep 2016;3:250–7. 10.1007/s40572-016-0094-z
    1. Mayne SL, Auchincloss AH, Michael YL. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments. Obes Rev 2015;16:362–75. 10.1111/obr.12269
    1. Sallis JF, Cerin E, Conway TL, et al. . Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet 2016;387:2207–17. 10.1016/S0140-6736(15)01284-2
    1. Floyd MF, Spengler JO, Maddock JE, et al. . Park-based physical activity in diverse communities of two U.S. cities. An observational study. Am J Prev Med 2008;34:299–305. 10.1016/j.amepre.2008.01.009
    1. Li F, Harmer P, Cardinal BJ, et al. . Obesity and the built environment: does the density of neighborhood fast-food outlets matter? Am J Health Promot 2009;23:203–9. 10.4278/ajhp.071214133
    1. Polsky JY, Moineddin R, Glazier RH, et al. . Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: a population-based cohort study. Can J Public Health 2016;107:eS27–33. 10.17269/CJPH.107.5312
    1. Beale SJ, Bending MW, Trueman P, et al. . Should we invest in environmental interventions to encourage physical activity in England? an economic appraisal. Eur J Public Health 2012;22:869–73. 10.1093/eurpub/ckr151
    1. Guo JY, Gandavarapu S. An economic evaluation of health-promotive built environment changes. Prev Med 2010;50:S44–9. 10.1016/j.ypmed.2009.08.019
    1. Ding D, Gebel K. Built environment, physical activity, and obesity: what have we learned from reviewing the literature? Health Place 2012;18:100–5. 10.1016/j.healthplace.2011.08.021
    1. Abadie A, Diamond A, Hainmueller J. Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program. J Am Stat Assoc 2010;105:493–505. 10.1198/jasa.2009.ap08746
    1. Amatya A, Bhaumik D, Gibbons RD. Sample size determination for clustered count data. Stat Med 2013;32:4162–79. 10.1002/sim.5819
    1. Bancroft C, Joshi S, Rundle A, et al. . Association of proximity and density of parks and objectively measured physical activity in the United States: a systematic review. Soc Sci Med 2015;138:22–30. 10.1016/j.socscimed.2015.05.034
    1. Clark S, Bungum T, Shan G, et al. . The effect of a TRAIL use intervention on urban TRAIL use in southern Nevada. Prev Med 2014;67:S17–20. 10.1016/j.ypmed.2014.04.027
    1. Creatore MI, Glazier RH, Moineddin R, et al. . Association of neighborhood Walkability with change in overweight, obesity, and diabetes. JAMA 2016;315:2211–20. 10.1001/jama.2016.5898
    1. Finlayson GS, Lix LM, Roos LL. The whole is greater than the sum of the parts: using data linkage and cohort designs to create data synergy at MCHP. Health Policy 2011;6:83–5.
    1. Fransoo RR, Martens PJ, Prior HJ, et al. . The rising prevalence of asthma: true increase, diagnostic exchange or diagnostic accuracy? Healthc Policy 2013;8:27–34. 10.12927/hcpol.2013.23398
    1. Martens PJ. Straw into gold: lessons learned (and still being learned) at the Manitoba centre for health policy. Healthc Policy 2011;6:44–54. 10.12927/hcpol.2011.22118
    1. Nickel NC, Chateau DG, Martens PJ, et al. . Data resource profile: pathways to health and social equity for children (paths equity for children). Int J Epidemiol 2014;43:1438–49. 10.1093/ije/dyu190
    1. Roos LL, Soodeen R-A, Bond R, et al. . Working more productively: tools for administrative data. Health Serv Res 2003;38:1339–58. 10.1111/1475-6773.00180
    1. Smith M, Roos LL, Burchill C. Expanding the data Repository: new technology and resources for the 21st century. Healthc Policy 2011;6:104–6. 10.12927/hcpol.2011.22130
    1. Kontopantelis E, Doran T, Springate DA, et al. . Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ 2015;350:h2750 10.1136/bmj.h2750
    1. Sims M, Maxwell R, Bauld L, et al. . Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction. BMJ 2010;340:c2161 10.1136/bmj.c2161
    1. Jandoc R, Burden AM, Mamdani M, et al. . Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations. J Clin Epidemiol 2015;68:950–6. 10.1016/j.jclinepi.2014.12.018
    1. Clancy L, Goodman P, Sinclair H, et al. . Effect of air-pollution control on death rates in Dublin, ireland: an intervention study. Lancet 2002;360:1210–4. 10.1016/S0140-6736(02)11281-5
    1. Law MR, Soumerai SB, Adams AS, et al. . Costs and consequences of direct-to-consumer advertising for clopidogrel in Medicaid. Arch Intern Med 2009;169:1969–74. 10.1001/archinternmed.2009.320
    1. McAlister FA, Bakal JA, Majumdar SR, et al. . Safely and effectively reducing inpatient length of stay: a controlled study of the general internal medicine care transformation initiative. BMJ Qual Saf 2014;23:446–56. 10.1136/bmjqs-2013-002289
    1. Serumaga B, Ross-Degnan D, Avery AJ, et al. . Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ 2011;342:d108 10.1136/bmj.d108
    1. EPOC-Cochrane EPOC- criteria for including interrupted time series analyses, 1998. Available:
    1. Ramsay CR, Matowe L, Grilli R, et al. . Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care 2003;19:613–23. 10.1017/S0266462303000576
    1. Wagner AK, Soumerai SB, Zhang F, et al. . Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309. 10.1046/j.1365-2710.2002.00430.x
    1. von Hippel P, Benson R. Obesity and the natural environment across us counties. Am J Public Health 2014;104:1287–93. 10.2105/AJPH.2013.301838
    1. EPOC EPaOoC. interrupted time series (its) analyses. Oslo: Norwegian Knowledge Centre for the Health Services, 2013.
    1. Linden A, Adams JL. Applying a propensity score-based weighting model to interrupted time series data: improving causal inference in programme evaluation. J Eval Clin Pract 2011;17:1231–8. 10.1111/j.1365-2753.2010.01504.x
    1. Distasio J, Kaufman A. The divided Priarie City: income inequality among Winnipeg's neighbourhoods. Institute for Urban Studies, University of Winnipeg, 2015.
    1. Fransoo R, Martens P, Prior H, et al. . The 2013 RHA health indicators atlas, University of Manitoba, 2013. Available:
    1. Lix LM, Yogendran MS, Shaw SY, et al. . Population-Based data sources for chronic disease surveillance. Chronic Dis Can 2008;29:31–8.
    1. Marrie RA, Fisk J, Tremlett H, et al. . Differing trends in the incidence of vascular comorbidity in MS and the general population. Neurol Clin Pract 2016;6:120–8. 10.1212/CPJ.0000000000000230
    1. Ermagun A, Lindsey G, Loh TH. Urban trails and demand response to weather variations. Transp Res D Transp Environ 2018;63:404–20. 10.1016/j.trd.2018.05.016
    1. Lix LM, Kuwornu JP, Kroeker K, et al. . Estimating the completeness of physician billing claims for diabetes case ascertainment using population-based prescription drug data. Health Promot Chronic Dis Prev Can 2016;36:55–60. 10.24095/hpcdp.36.3.02
    1. Lindsey GPM, Hankey S. The Minnesota Bicycle and Pedestrian Counting Initiative: Implementation Study : Management MDoT-OoTS. St. Paul, Minnesota: University of Minnesota, 2015.
    1. Budowski A. Developing expansion factors to estimate cyclist seasonal average daily traffic in Winnipeg, MB. Winnipeg, Manitoba: University of Manitoba, 2015.
    1. Chateau D, Metge C, Prior H, et al. . Learning from the census: the socio-economic factor index (SEFI) and health outcomes in Manitoba. Can J Public Health 2012;103:S23–7.
    1. Lees L, Slater T, Wyly E. The birth of Gentrification : Gentrification. New York, NY: Taylor and Francis Group, LLC, 2013: 3–38.
    1. Kavanagh A, Bentley RJ, Turrell G, et al. . Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Soc Sci Med 2010;71:1150–60. 10.1016/j.socscimed.2010.05.038
    1. Mackenbach JP, Cavelaars AE, Kunst AE, et al. . Socioeconomic inequalities in cardiovascular disease mortality; an international study. Eur Heart J 2000;21:1141–51. 10.1053/euhj.1999.1990
    1. Winkleby MA, Jatulis DE, Frank E, et al. . Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health 1992;82:816–20. 10.2105/AJPH.82.6.816
    1. Lysy Z, Booth GL, Shah BR, et al. . The impact of income on the incidence of diabetes: a population-based study. Diabetes Res Clin Pract 2013;99:372–9. 10.1016/j.diabres.2012.12.005
    1. Lipscombe LL, Austin PC, Manuel DG, et al. . Income-Related differences in mortality among people with diabetes mellitus. CMAJ 2010;182:E1–17. 10.1503/cmaj.090495
    1. Brook JR, Setton EM, Seed E, et al. . The Canadian Urban Environmental Health Research Consortium - a protocol for building a national environmental exposure data platform for integrated analyses of urban form and health. BMC Public Health 2018;18:114 10.1186/s12889-017-5001-5
    1. Pattanayak CW, Rubin DB, Zell ER. [Propensity score methods for creating covariate balance in observational studies]. Rev Esp Cardiol 2011;64:897–903. 10.1016/j.recesp.2011.06.008
    1. Donner A, Klar N. Design and analysis of cluster randomization trials in health research. London, ON: Arnold, 2000.
    1. Fransoo R, Martens P, Burland E. The need to know team. Manitoba RHA indicators atlas 2009. EInnipeg, MB: University of Manitoba, 2009.
    1. Pell JP, Haw S, Cobbe S, et al. . Smoke-Free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008;359:482–91. 10.1056/NEJMsa0706740
    1. MacDonald JM, Stokes RJ, Cohen DA, et al. . The effect of light rail transit on body mass index and physical activity. Am J Prev Med 2010;39:105–12. 10.1016/j.amepre.2010.03.016
    1. Schaefer L, Plotnikoff RC, Majumdar SR, et al. . Outdoor time is associated with physical activity, sedentary time, and cardiorespiratory fitness in youth. J Pediatr 2014;165:516–21. 10.1016/j.jpeds.2014.05.029
    1. Shephard RJ, Aoyagi Y. Seasonal variations in physical activity and implications for human health. Eur J Appl Physiol 2009;107:251–71. 10.1007/s00421-009-1127-1
    1. Danet S, Richard F, Montaye M, et al. . Unhealthy effects of atmospheric temperature and pressure on the occurrence of myocardial infarction and coronary deaths. A 10-year survey: the Lille-World health organization MONICA Project (monitoring trends and determinants in cardiovascular disease). Circulation 1999;100:E1–7. 10.1161/01.cir.100.1.e1
    1. Group TE Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter group. Lancet 1997;349:1341–6. 10.1016/S0140-6736(96)12338-2
    1. DR BPJ. Introduction to time series and forecasting. 2nd ed New York, NY: Springer, 2001.
    1. Tricco AC, Cogo E, Isaranuwatchai W, et al. . A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types. BMC Med 2015;13:90 10.1186/s12916-015-0326-3
    1. Marsh JD, Birmingham TB, Giffin JR, et al. . Cost-Effectiveness analysis of arthroscopic surgery compared with non-operative management for osteoarthritis of the knee. BMJ Open 2016;6:e009949 10.1136/bmjopen-2015-009949
    1. Tricco AC, Ashoor HM, Antony J, et al. . Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ 2014;349:g5459 10.1136/bmj.g5459
    1. Hoch JS, Briggs AH, Willan AR. Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Econ 2002;11:415–30. 10.1002/hec.678
    1. Willan AR, Briggs AH, Hoch JS. Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ 2004;13:461–75. 10.1002/hec.843
    1. Drummond MF, Sculpher MJ, Claxton K, et al. . Methods for the economic evaluation of health care programmes. Oxford, UK: Oxford university press, 2015.
    1. Cui Y, Doupe M, Katz A, et al. . Economic evaluation of Manitoba health lines in the management of congestive heart failure. Healthc Policy 2013;9:36–50. 10.12927/hcpol.2013.23620
    1. Forget EL. New questions, new data, old interventions: the health effects of a guaranteed annual income. Prev Med 2013;57:925–8. 10.1016/j.ypmed.2013.05.029

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