Direct healthcare costs associated with device assessed and self-reported physical activity: results from a cross-sectional population-based study

Abstract

BackgroundPhysical inactivity (PIA) is an important risk factor for many chronic conditions and therefore might increase healthcare utilization and costs. This study aimed to analyze the association of PIA using device assessed and self-reported physical activity (PA) data with direct healthcare costs.MethodsCross-sectional data was retrieved from the population based KORA FF4 study (Cooperative Health Research in the Region of Augsburg) that was conducted in southern Germany from 2013 to 2014 (n = 2279). Self-reported PA was assessed with two questions regarding sports related PA in summer and winter and categorized into “high activity”, “moderate activity”, “low activity” and “no activity”. In a subsample (n = 477), PA was assessed with accelerometers and participants were categorized into activity quartiles (“very high”, “high”, “low” and “very low”) according to their mean minutes per day spent in light intensity, or in moderate-vigorous PA (MVPA). Self-reported healthcare utilization was used to estimate direct healthcare costs. We regressed direct healthcare costs on PA using a two-part gamma regression, adjusted for age, sex and socio-demographic variables. Additional models, including and excluding potential additional confounders and effect mediators were used to check the robustness of the results.ResultsAnnual direct healthcare costs of individuals who reported no sports PA did not differ from those who reported high sports PA [+€189, 95% CI: -188, 598]. In the subsample with accelerometer data, participants with very low MVPA had significantly higher annual costs than participants with very high MVPA [+€986, 95% CI: 15, 1982].ConclusionDevice assessed but not self-reported PIA was associated with higher direct healthcare costs. The magnitude and significance of the association depended on the choice of covariates in the regression models. Larger studies with device assessed PA and longitudinal design are needed to be able to better quantify the impact of PIA on direct healthcare costs.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5906-7) contains supplementary material, which is available to authorized users.

Inpatient care utilisation and expenditure associated with objective physical activity: econometric analysis of the UK Biobank

“…Our results are in line with other econometric studies, which also found that higher levels of physical activity were associated with lower healthcare use or costs in population based samples [15,16,21,22]. Ku et al and Carlson et al also reported similar percentage differences in healthcare expenditure.…”

“…The models adjusted for the following covariates based on previous analyses: [15,16] gender (male or female); age (continuous); self-assigned ethnic background (white British, Irish, or other ethnicity); household income (< £18,000, £18,000 to £30,999, £31,000 to £51,999, £52,000 to £100,000, > £100,000); body mass index (BMI) (< 18.5 kg/ m2, 18.5-25 kg/m2, 25 to 30 kg/m2, > 30 kg/m2); waist-tohip ratio (continuous); Townsend deprivation index (quintiles); long-standing illness, disability or infirmity (yes or no); smoking status (never, previous, or current); marital status (married/cohabiting or not); and education (university level or not). The covariates were recorded at time of recruitment in 2006-2010.…”

Domain-specific effects of physical activity on the demand for physician visits

“…The detailed assessment of physical activity in different domains however requires comparably long questionnaires (for the Konstanz Life-Study the GPAQ administered encompasses 16 questions) and might be too cumbersome for large household surveys. This is probably the reason why several studies are restricted to LTPA only (Arem et al 2015 ; Carlson et al 2015 ; Karl et al 2018 ). Therefore, it might be interesting what our results would have looked like, if Specification 2 had been estimated with only including LTPA, but not TTPA and WTPA.…”

“…In fact, evidence on this association is less clear. Although a recent review suggests that a negative relationship between PA and health care expenditures is found in the majority of studies (Ding et al 2017 ), no significant association (Chevan and Roberts 2014 ; Karl et al 2018 ) or a positive relationship (Kang and Xiang 2017 ; Lynch et al 2019 ) is reported in some cases. Ding et al ( 2017 ) argue that it is problematic to compare the estimates of the effect of PA, partially because of methodological differences between studies.…”

Bone marrow fat fraction assessment in regard to physical activity: KORA FF4–3-T MR imaging in a population-based cohort

“…"-≥ 2 h per week, regularly;~1 h per week, regularly;~1 h per week, irregularly; no or nearly no workout. Initial division into summer and winter exercise was combined into one variable as described before [43]. & Non-exercise walking: "How long do you usually walk on a work day?…”