Evaluating Causal Relationships between Built Environment Characteristics, Health Care Utilization Patterns, and Costs in British Columbia

Project number: 
16-148
Approval date: 
Sunday, October 16, 2016
Principal Investigator: 
Frank,Lawrence
Institution: 
University of British Columbia (UBC)
Funding Agency: 
Canadian Institutes of Health Research(CIHR)
Datasets requested: 
PharmaNet
Deaths (BC Vital Statistics Agency)
consolidation - census geocodes
Income band (Statistics Canada)
Medical Services Plan (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
MSP Registration & Premium Billing(BC Ministry of Health)
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
Research objective: 

AIM I. [Cross-sectional] To evaluate relationships between environmental features (walkability, bikeability, and regional accessibility) and physical activity behaviours when controlling for sociodemographic factors.
Hypothesis: Built environment features are positively associated with physical activity participation when adjusting for individual and neighbourhood-level sociodemographic factors.

AIM II. [Cross-sectional] To evaluate relationships between built environment features (walkability, bikeability, and regional accessibility) and physical activity-related morbidities (obesity and obesity-related chronic diseases including diabetes), both direct and as mediated by physical activity and BMI.
Hypothesis: Built environment features are negatively associated with obesity and obesity-related chronic diseases including diabetes when adjusting for individual and neighbourhood-level sociodemographic factors, with physical activity and BMI partially mediating the associations.

AIM III. [Cross-sectional] To evaluate relationships between built environment features (walkability, bikeability, and regional accessibility) and health care utilization costs, both direct and as mediated by physical activity, obesity, and obesity-related chronic diseases.
Hypothesis: Built environment features (local walkability, bikeability, and regional accessibility) are negatively associated with current health care utilization costs and increase in health care utilization costs over time when adjusting for individual and neighbourhood-level sociodemographic factors, with physical activity, obesity, and obesity-related chronic diseases partially mediating the associations.

AIM IV. [Longitudinal] To evaluate if there is a significant change in health care utilization and costs before and after moving due to a change in built environment features (walkability, bikeability, and regional accessibility) when adjusting for sociodemographics and pre-existing conditions.
Hypothesis: Moving from a less to a more walkable and bikeable environment with equal or improved regional accessibility will result in a reduction in health care utilization and costs.


Page last revised: July 11, 2017