Associations Between Sedentary Behavior, Physical Activity, and Out-of-Pocket Health Care Expenditure: Evidence From Chinese Older Adults

Economic cost of not meeting the 24-h movement guidelines in china: Research gaps and recommendations

It is well-known that not meeting the 24-hours (h) movement guidelines, including insufficient physical activity (PA), excessive sedentary behavior (SB), inadequate sleep duration, and their combinations, are independent risk factors for noncommunicable diseases (NCDs). The prevalence of not meeting the guidelines is high across the world, especially in China where has one of the largest population. Some studies have estimated the economic cost of insufficient PA in China, which is useful to guide policymakers to develop and implement effective health actions. However, several research gaps should be discussed and addressed for better evidence base and decision making. This commentary aims to provide a research insight into gaps and recommendations related to the analysis of economic cost of not meeting the 24-h movement guidelines. Some major research gaps can be indicated, including less research attention on excessive SB and inadequate sleep, limited evidence regarding NCDs associated with not meeting all 24-h movement guidelines considered in economic cost analysis, absence of evidence on estimated cost of not meeting the guidelines, and the adherence to methodological guide. Future research is required to address the gaps to guide effective health policy development in China. We hope that this commentary can play an important role in updating research evidence and advancing policy practice.

Sedentary behavior, abdominal obesity and healthcare costs in Brazilian adults with cardiovascular diseases: a cross-sectional study

BACKGROUND

Research on the economic burden of sedentary behavior and abdominal obesity on health expenses associated with cardiovascular diseases is scarce.

OBJECTIVE

The objective of this study was to verify whether sedentary behavior, isolated and combined with abdominal obesity, influences the medication expenditure among adults with cardiovascular diseases.

DESIGN AND SETTING

This cross-sectional study was conducted in the city of President Prudente, State of São Paulo, Brazil in 2018.

METHODS

The study included adults with cardiovascular diseases, aged 30-65 years, who were treated by the Brazilian National Health Services. Sedentary behavior was assessed using a questionnaire. Abdominal obesity was defined by waist circumference. Medication expenditures were verified using the medical records of each patient.

RESULTS

The study included a total of 307 adults. Individuals classified in the group with risk factor obesity combined (median [IQ] USD$ 29.39 [45.77]) or isolated (median [IQ] USD$ 27.17 [59.76]) to sedentary behavior had higher medication expenditures than those belonging to the non-obese with low sedentary behavior group (median [IQ] USD$ 13.51 [31.42]) (P = 0.01). The group with combined obesity and sedentary behavior was 2.4 (95%CI = 1.00; 5.79) times more likely to be hypertensive.

CONCLUSION

Abdominal obesity was a determining factor for medication expenses, regardless of sedentary behavior, among adults with cardiovascular diseases.

Economic burden of excessive sedentary behaviour in Canada

OBJECTIVE

To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults.

METHODS

Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive sedentary behaviour, gathered from meta-analyses of prospective cohort studies; (2) the prevalence of excessive sedentary behaviour in Canadian men and women, obtained using waist-worn accelerometry in a nationally representative sample of adults (Canadian Health Measures Survey 2018-2019); and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes, selected using the Economic Burden of Illness in Canada 2010 data. The 2010 costs were then adjusted to 2021 costs to account for inflation, population growth, and higher average earnings. A Monte Carlo simulation was conducted to account for uncertainty in the model.

RESULTS

The total costs of excessive sedentary behaviour in Canada were $2.2 billion (8 h/day cut-point) and $1.8 billion (9 h/day cut-point) in 2021, representing 1.6% and 1.3% of the overall burden of illness costs, respectively. The two most expensive chronic diseases attributable to excessive sedentary behaviour were cardiovascular disease and type 2 diabetes. A 10% decrease in excessive sedentary behaviour (from 87.7% to 77.7%) would save an estimated $219 million per year in costs.

CONCLUSION

Excessive sedentary behaviour significantly contributes to the economic burden of illness in Canada. There is a need for evidence-based and cost-effective strategies that reduce excessive sedentary behaviour in the population.

Influencing Factors Related to Female Sports Participation Under the Implementation of Chinese Government Interventions: An Analysis Based on the China Family Panel Studies

Objectives

Regular sports participation is a gendered phenomenon in China. Women have reported much higher constraints than men on time, partner, psychology, knowledge, and interest. This study explores personal, family, lifestyle, and health factors associated with sports participation.

Study Design

This study is a cross-sectional study.

Methods

Data were collected from the national reprehensive China Family Panel Studies (CFPS) database (2018) to analyze personal information, family background, lifestyle, and health in relation to women's sports participation. Multiple classification logistic regression was used to quantify the association between independent variables and sports time.

Results

Women with high personal income and education, who were unmarried, in faster economic development areas have more awareness and more time for sports participation. Women who were overweight and self-rated as unattractive spent less time on sports participation. Women with a small family population and no children have more time for sports participation. Less time on the internet and moderate sleep contribute to active sports participation. Women with chronic diseases and high medical costs are less likely to participate in sports.

Conclusions

Negative body aesthetic perception, the burden of family environment, modernization of lifestyle, and the normalization of sub-health are essential factors affecting women's sports participation. The government should understand the inner and outer barriers to women's participation in sports, develop policies and regulations to protect and support women's sports participation, and guide and monitor the effective implementation of women's sports activities.

Socioeconomic Disparities in Health Care Consumption: Using the 2018-China Family Panel Studies

The existing research on residents’ health care consumption mostly covers medical care consumption and seldom regards residents’ health care consumption as an independent research object. This article takes residents’ healthcare consumption as the research object and aims to explore the impact of socioeconomic status on healthcare consumption and its mechanisms. The data of this study came from the 2018-China Family Panel Studies (CFPS). The binary probit regression model and the Tobit model explored the impact mechanism of residents’ income, education, occupation, and physical activity on health care consumption decision-making and health care expenditure, respectively. The research results showed that, from the perspective of the direct influence mechanism, residents’ work income (0.029, p < 0.01) and education level (811.149, p < 0.01) had a significant positive impact on health care consumption. Residents whose occupations (−99.697, p < 0.01) tend to be more skilled and also have higher health care consumption. From the perspective of the mediating mechanism, residents’ physical exercise duration had a significant positive impact on their participation in healthcare consumption (0.005, p < 0.01) but had a weaker impact on healthcare consumption expenditure (21.678, p < 0.1). In general, socioeconomic status represented by income, education, and occupation had a significant positive impact on residents’ health care consumption. The duration of physical exercise also played an important mediating role.

Redevelopment and Examination of the Psychometric Properties of the Chinese Version of the Last 7-Day Sedentary Behaviour Questionnaire (SIT-Q-7d-Chi) in Hong Kong Older Adults

(1) Background: This study examined the psychometric properties of the Chinese version of the Last 7-Day Sedentary Behaviour Questionnaire (SIT-Q-7d-Chi) in Hong Kong older adults; (2) Methods: Study 1 assessed the questionnaire’s test–retest reliability, and Study 2 examined its validity. Place the question addressed in a broad context and highlight the purpose of the study; (3) Results: In Study 1, 84 older adults (aged 60–90) completed the SIT-Q-7d-Chi twice over a 2-week interval, and in Study 2, 38 older adults (i) completed the SIT-Q-7d-Chi and the Sedentary Behaviour Questionnaire for Older Adults (SBQOA) and (ii) wore a waist-mounted accelerometer for 7 consecutive days. In Study 1, the SIT-Q-7d-Chi’s test–retest reliability (ICC = 0.91–0.99) was satisfactory, and adequate internal consistency was found for most domains of the SIT-Q-7d-Chi (Cronbach’s alpha value being 0.7 or above). Study 2′s results showed that the SIT-Q-7d-Chi results were significantly correlated with the SBQOA results, but not with the accelerometer results; (4) Conclusions: This study revealed the prevalence of sedentary behavior among Hong Kong’s senior citizens, which can be used as a reference to plan or evaluate a future sedentary behavior intervention for older persons, including identifying the content and intensity of activities.

Economics of sedentary behaviour: A systematic review of cost of illness, cost-effectiveness, and return on investment studies

AIMS

METHODS: RESULTS: We identified nine articles (conducted in Australia (n = 5), Europe (n = 3) and China (n = 1)); three reported healthcare costs associated with excessive sedentary time, whilst six were economic evaluations of interventions targeting sedentary behaviour. Healthcare costs associated with excessive sedentary time as reported in cost of illness studies were substantial; however, none explored non-health sector costs. In contrast, all full economics evaluations adopted a societal perspective; however, costs included differed depending on the intervention context. One sedentary behaviour intervention in children was cost-saving. The five interventions targeting occupational sitting time of adults in office workplaces were cost-effective. Physical environmental changes such as sit-stand desks, active workstations etc., were the key cost driver.

CONCLUSIONS

Sedentary behaviour is likely associated with excess healthcare costs, although future research should also explore costs across other sectors. Cost-effectiveness evidence of sedentary behaviour reduction interventions in workplaces is limited but consistent. Key gaps relate to the economic credentials of interventions targeting children, and modelling of long-term health benefits of interventions.

Impact of the COVID-19 Pandemic on the Time of Utilitarian Walking and Walking as Exercise Among Brazilian Community-Dwelling Older Adults: The REMOBILIZE Study

This study aimed to investigate behavioral changes related to utilitarian walking and walking as exercise among Brazilian older adults before and during the COVID-19 pandemic. Baseline data from the longitudinal REMOBILIZE study were used. The survey was online and comprised 1,482 adults aged 60 years and older. The outcome was the hours per week of walking time (for utilitarian purposes, as exercise, and total), estimated by the frequency and duration and analyzed by average and rate of decrease, comparing pre- and during the pandemic. Total walking time was used to estimate transition patterns between levels of walking intensity. A moderate reduction of 1.76 hr per week in the total walking time was observed, and 28.1% of the participants' walking transition patterns were from more to less physically active. Our findings demonstrate the need for gender-specific interventions and policies to increase the walking levels among older adults after the COVID-19 pandemic period.

Magnitude and Composition of Sedentary Behavior in Older Adults Living in a Retirement Community

High amount of sedentary behavior (SB) has been associated with a multitude of adverse health events in older adults. There are limited data regarding SB in older adults living in retirement communities (RC). This study described the magnitude and composition of SB [non-screen sedentary time (NSST) and screen sedentary time (SST)] in older adults living in a RC and documented variation in this behavior as a function of demographic, health, health behavior and clinical variables. This cross sectional descriptive study enrolled and assessed 100 older males and females living a RC located in the Midwest region of United States. Participants completed a questionnaire for sample characterization and a SB questionnaire. Metric of SB (i.e., TST, NSST and SST) were analyzed overall and separated by the variables of interest. Participants reported on average 10 h/day of sedentary activity (65% on NSST and 35% on SST). Older adults reported to spend most of their awaking hours in activities such as reading, watching TV and computer use. Significant variations on NSST and SST were observed for gender, BMI, perceived health, mobility aid use and number of chronic diseases. These findings may help in the development of tailored strategies and interventions focusing on reducing SB in this particular under-researched subgroup.

Sedentary Behavior Research in the Chinese Population: A Systematic Scoping Review

Background: The negative effects of sedentary behavior (SB) on public health have been extensively documented. A large number of studies have demonstrated that high prevalence of SB is a critical factor of all-cause mortality. Globally, the frequency of SB research has continued to rise, but little is known about SB in the Chinese population. Therefore, this review was conducted to scope the research situation and to fill the gaps related to the effects of SB in the Chinese population. Methods: Using a scoping review based on York methodology, a comprehensive search of published journal articles and grey literature was carried out through 12 databases. The literature research was conducted by two authors in July 2019, and included journal articles that targeted on the Chinese population were published between 1999 and 2019. The two authors screened the records independently and included those research topics related to SB in the Chinese population. Results: The number of included studies increased from 1 to 29 per year during the analyzed period, during which, a remarkable climb happened from 8 in 2013 to 19 in July 2019. Out of the 1303 screened studies, a total of 162 studies (81 English and 81 Chinese journal articles) met the inclusion criteria in this review. Most of the included studies (66.0%) reported the overall estimated prevalence of SB, in which, 43.2% of studies reported the average time of SB, and 40.0% of studies reported the cutoff point of SB. Besides this, 54.9% and 23.5% of studies focused on the outcomes and correlates/determinants of SB, and the proportions of studies based on testing the validation of measurement tools and on interventions were 3.7% and 4.9%, respectively. Nearly all of the reviewed articles used data from cross-sectional studies (75.9%) and longitudinal studies (13.6%), while intervention trials are less developed. The majority of the studies (64.8%) used self-reported surveys, and only 3.7% studies used device-based measurement tools. Furthermore, 35.8% of the included studies were focused on children and adolescents, while only a few studies investigated infants/toddlers and older adults. Both female and male were examined in most studies, and non-clinical populations were investigated in the context of SB in a relatively large number of studies. Conclusions: The number of research articles on SB in the Chinese population published per year has increased year by year, indicating a growing interest in this research area. More studies using population subgroup samples are needed, particularly among infants/toddlers, older adults, and clinical populations. To provide stronger evidence of the determinants and outcomes of SB, longitudinal studies using device-based measures of SB are required.