Association Between Bike-Sharing Systems and the Blood Pressure of Local Citizens: A Cross-Sectional Study in China

Abstract

Objective: To estimate whether and to what extent city-level introduction of bikesharing systems is associated with local citizens' blood pressure in China.

Design: Quasi-experimental difference-indifferences analysis.

Setting: The introduction of bike-sharing systems into a city, with different cities facing different event timing.

Participants: 8,107,363 physical examination visits to one of the largest medical examination centers in China during the period of June 2016 to August 2017.

Exposures: The exposure was the city-level entry events of bike-sharing systems. Main outcome measures: The main outcome was the blood pressure among adult participants who were likely to adopt shared bikes (age<45), measured by (i) systolic blood pressure (SBP), (ii) diastolic blood pressure (DBP), and (iii) a binary indicator of hypertension status (SBP ≥130 or DBP ≥80 mm Hg).

Results: Blood pressure showed a decreasing trend after a bike-sharing platform entered the local city. After six months post an entry event, SBP reduced by 0.67 mm Hg (β [SE],-0.672 [0.245]; 95% CI,-1.154 to-0.191); the prevalence of hypertension reduced by 1.4 percentage points (β [SE],-0.014 [0.007]; 95% CI,-0.027 to-0.000); the reduction in DBP was statistically insignificant (β [SE],-0.193 [0.193]; 95% CI,-0.572 to 0.187). Participants less likely to adopt shared bikes (age>45) showed no significant response. The number of visits and the age of participants were also unaffected by the entry events. Reduction in blood pressure was more pronounced in male, younger, and non-obese participants.

Conclusion: The findings of this study suggest that bike-sharing systems in China may be associated with lowered blood pressure, and thus may serve as a supplemental instrument to combat the increasing prevalence of hypertension, especially among young adults.

Keywords: bike-sharing, blood pressure, public health, sharing economy, physical activity