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Duijvestijn M, de Wit GA, van Gils PF, Wendel-Vos GCW. Impact of physical activity on healthcare costs: a systematic review. BMC Health Serv Res 2023; 23:572. [PMID: 37268930 DOI: 10.1186/s12913-023-09556-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND This systematic review aims to describe the relation between physical inactivity and healthcare costs, by taking into account healthcare costs of physical-inactivity-related diseases (common practice), including physical-activity-related injuries (new) and costs in life-years gained due to avoiding diseases (new), whenever available. Moreover, the association between physical inactivity and healthcare costs may both be negatively and positively impacted by increased physical activity. METHODS A systematic review was conducted, including records reporting on physical (in)activity in relation to healthcare costs for a general population. Studies were required to report sufficient information to calculate the percentage of total healthcare costs potentially attributable to physical inactivity. RESULTS Of the 264 records identified, 25 were included in this review. Included studies showed substantial variation in the assessment methods of physical activity and in type of costs included. Overall, studies showed that physical inactivity is related to higher healthcare costs. Only one study included costs of healthcare resources used in prolonged life when physical-inactivity-related diseases were averted, showing net higher healthcare costs. No study included healthcare costs for physical-activity-related injuries. CONCLUSIONS Physical inactivity is associated with higher healthcare costs in the general population in the short-term. However, in the long-term aversion of diseases related with physical inactivity may increase longevity and, as a consequence, healthcare costs in life-years gained. Future studies should use a broad definition of costs, including costs in life-years gained and costs related to physical-activity-related injuries.
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Affiliation(s)
- Marjolein Duijvestijn
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul F van Gils
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - G C Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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KARI JAANAT, NERG IIRO, HUIKARI SANNA, LEINONEN ANNAMAIJU, NURKKALA MARJUKKA, FARRAHI VAHID, KORPELAINEN RAIJA, KORHONEN MARKO. The Individual-Level Productivity Costs of Physical Inactivity. Med Sci Sports Exerc 2023; 55:255-263. [PMID: 36125340 PMCID: PMC9815811 DOI: 10.1249/mss.0000000000003037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE This study estimated the long-term individual-level productivity costs of physical inactivity. METHODS The data were drawn from the Northern Finland Birth Cohort 1966, to which the productivity cost variables (sick leaves and disability pensions) from Finnish registries were linked. Individuals ( N = 6261) were categorized into physical activity groups based on their level of physical activity, which was measured in three ways: 1) self-reported leisure-time moderate- to vigorous-intensity physical activity (MVPA) at 46 yr old, 2) longitudinal self-reported leisure-time MVPA at 31-46 yr old, and 3) accelerometer-measured overall MVPA at 46 yr old. The human capital approach was applied to calculate the observed costs (years 2012-2020) and the expected costs (years 2012-2031). RESULTS The results showed that the average individual-level productivity costs were higher among physically inactive compared with the costs among physically active. The results were consistent regardless of the measurement type of physical activity or the period used. On average, the observed long-term productivity costs among physically inactive individuals were €1900 higher based on self-reported MVPA, €1800 higher based on longitudinal MVPA, and €4300 higher based on accelerometer-measured MVPA compared with the corresponding productivity costs among physically active individuals. The corresponding difference in the expected costs was €2800, €1200, and €8700, respectively. CONCLUSIONS The results provide evidence that productivity costs differ according to an individual's level of physical activity. Therefore, investments in physical activity may decrease not only the direct healthcare costs but also the indirect productivity costs paid by the employee, the employer, and the government.
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Affiliation(s)
- JAANA T. KARI
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, FINLAND
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, FINLAND
| | - IIRO NERG
- Department of Economics, Accounting and Finance, University of Oulu, Oulu, FINLAND
| | - SANNA HUIKARI
- Department of Economics, Accounting and Finance, University of Oulu, Oulu, FINLAND
| | - ANNA-MAIJU LEINONEN
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, FINLAND
- Center for Life Course Health Research, University of Oulu, Oulu, FINLAND
| | - MARJUKKA NURKKALA
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, FINLAND
- Center for Life Course Health Research, University of Oulu, Oulu, FINLAND
| | - VAHID FARRAHI
- Research Unit of Medical Imaging, Physics, and Technology, University of Oulu, Oulu, FINLAND
- Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, FINLAND
| | - RAIJA KORPELAINEN
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, FINLAND
- Center for Life Course Health Research, University of Oulu, Oulu, FINLAND
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, FINLAND
| | - MARKO KORHONEN
- Department of Economics, Accounting and Finance, University of Oulu, Oulu, FINLAND
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Krueger H, Robinson S, Hancock T, Birtwhistle R, Buxton JA, Henry B, Scarr J, Spinelli JJ. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 2022; 22:564. [PMID: 35473549 PMCID: PMC9044882 DOI: 10.1186/s12913-022-07871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing. METHODS We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a 'strong or conditional (weak) recommendation for' by the Canadian Task Force on Preventive Health Care or an 'A' or 'B' rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained. RESULTS Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services. CONCLUSIONS These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
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Affiliation(s)
- Hans Krueger
- H. Krueger & Associates Inc., Delta, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard Birtwhistle
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada
- Canadian Task Force on Preventive Health Care, Ottawa, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Center for Disease Control, Vancouver, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Ministry of Health, Victoria, Canada
| | - Jennifer Scarr
- Child Health BC, Provincial Health Services Authority, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Łyszczarz B, Sowa K. Production losses due to mortality associated with modifiable health risk factors in Poland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:33-45. [PMID: 34236544 PMCID: PMC8882090 DOI: 10.1007/s10198-021-01345-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Epidemiological burden of modifiable mortality risk factors is recognized in literature; however, less is known on the economic losses due to a range of such risks. AIM To estimate production losses (indirect cost) of mortality associated with risk factors as classified in Global Burden of Disease 2019 Study in Poland in years 2000, 2010, and 2017. METHODS We relied on the human capital method and societal perspective and used sex-, age-, region-, and risk-specific data on mortality due to modifiable risk factors and a set of socio-economic measures. RESULTS The production losses due to mortality attributable to all investigated risk factors accounted for 19.6-21.0 billion PLN (Polish zloty; 2017 exchange rate: 1€ = 4.26 PLN) and 1.44-2.45% of gross domestic product, depending on year. Behavioural factors were the most important contributor to overall burden (16.7-18.2 billion PLN), followed by metabolic factors (6.8-7.6 billion PLN) and environmental and occupational factors (3.0-3.5 billion PLN). Of disaggregated risks, alcohol and tobacco, high systolic blood pressure, and dietary risks proved to lead to the highest losses. Cost per death was greatest for child and maternal malnutrition, followed by intimate partner violence and childhood sexual abuse and bullying. Moreover, a notable regional variation of indirect cost was identified with losses ranging from 1.21 to 1.81% of regional gross domestic product in 2017. CONCLUSION Our findings provide economically hierarchised list of modifiable risk factors and they contribute to inform policy-makers in prioritizing programmes to improve health.
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Affiliation(s)
- Błażej Łyszczarz
- Department of Health Economics, Nicolaus Copernicus University in Toruń, Toruń, Poland.
| | - Karolina Sowa
- Department of Analyses and Strategies, Ministry of Health, Warsaw, Poland
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Pelletier CA, Pousette A, Ward K, Fox G. Exploring the perspectives of community members as research partners in rural and remote areas. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:3. [PMID: 32015898 PMCID: PMC6990467 DOI: 10.1186/s40900-020-0179-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Community engagement in research has the potential to support the development of meaningful health promotion interventions to address health inequities. People living in rural and remote areas face increased barriers to participation in health research and may be unjustly excluded from participation. It is necessary to understand the process of patient and public engagement from the perspective of community members to support partnered research in underserved areas. The aim of this project was to increase understanding on how to include community members from rural and remote areas as partners on research teams. METHODS Using purposive sampling, we completed semi-structured interviews with a representative sample of 12 community members in rural and remote areas of northern British Columbia, Canada. Interviews were audio recorded and transcribed verbatim. Following an integrated knowledge translation approach, an inductive thematic analysis was completed to incorporate researcher and knowledge user perspectives. RESULTS The factors important to community members for becoming involved in research include: 1) relevance; 2) communication; and 3) empowering participation. The analysis suggests projects must be relevant to both communities and individuals. Most participants stated that they would not be interested in becoming partners on research projects that did not have a direct benefit or value for their communities. Participants expressed the need for clear expectations and clarification of preferred communication mechanisms. Communication must be regular, appropriate in length and content, and written in a language that is accessible. It is essential to ensure that community members are recognized as subject matter experts, to provide appropriate training on the research process, and to use research outcomes to support decision making. CONCLUSIONS To engage research partners in rural and remote communities, research questions and outcomes should be co-produced with community members. In-person relationships can help establish trust and bidirectional communication mechanisms are prudent throughout the research process, including the appropriate sharing of research findings. Although this project did not include community members as research team members or in the co-production of this research article, we present guidelines for research teams interested in adding a patient or public perspective to their integrated knowledge translation teams.
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Affiliation(s)
- Chelsea A. Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Anne Pousette
- Promotion of Wellness in Northern BC (WINBC), Clinical Faculty, Northern Medical Program, University of British Columbia, Medical Staff, University Hospital of Northern BC, Northern Health, Prince George, Canada
| | - Kirsten Ward
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
- Present address: Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Gloria Fox
- Population and Preventive Public Health, Northern Health, Prince George, Canada
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Pelletier C, Pousette A, Fox G, Keahey R, Ward K, Faulkner G, Rasali D, Allison S. Move the north: evaluation of a regional stakeholder engagement initiative to support the development of a community-partnered physical activity research agenda. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:37. [PMID: 31798963 PMCID: PMC6882157 DOI: 10.1186/s40900-019-0167-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/02/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although it is generally accepted that engaging with members of the public contributes to more actionable and relevant research, there are a limited number of reported evaluations of community engagement initiatives. Certain populations, such as those with lower socioeconomic status and those who live in rural or dispersed communities, tend to face increased barriers to engagement. For researchers and community members alike, it is important to understand and evaluate engagement initiatives to support participatory research methods, particularly when working with underserved or hard to reach populations. METHODS Over 2-days in October 2018, we hosted a Research Agenda Development Workshop and Physical Activity Summit with relevant researchers, health professionals, and community partners. The objectives of this initiative were to develop a physical activity research agenda based on community-identified priorities, create networking opportunities, and understand factors impacting physical activity participation in communities across northern British Columbia (BC). An evaluation plan was created early in the planning process to understand the reach of the event based on representation targets. Stakeholder satisfaction with the event was evaluated with a post-meeting survey. RESULTS The event was successful in engaging community members from a broad geographic region with at least 90 people in attendance from 11 different northern BC communities, representing 46 different organizations. Meeting attendees indicated they were satisfied with the event and felt their perspectives were heard. To advance physical activity in the region, the most commonly desired outcome from the event was the need for ongoing communication channels to support knowledge translation and capacity building in the low-resourced communities of northern BC. There were some gaps in representation targets present at the event. Namely, there were a limited number of people representing Indigenous organizations, and the education and private sectors. CONCLUSIONS This two-day event was successful at achieving its objectives and engaged a diverse group of stakeholders from a broad geographic region. The outcomes from this event are being used to develop a community-partnered physical activity research agenda and contribute to ongoing learning by the research team to understand contextual factors influencing physical activity in the communities of northern BC. This model of engagement could be used by other researchers interested in engaging with a diverse, multi-sector group of academics, health professionals and community members to support community-centered population health research.
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Affiliation(s)
- Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Anne Pousette
- Promotion of Wellness in Northern BC (WINBC), Prince George, Canada
- Northern Medical Program, University of British Columbia, Prince George, Canada
- University Hospital of Northern BC, Northern Health, Prince George, Canada
| | - Gloria Fox
- Population and Public Health, Northern Health, Prince George, Canada
| | - Robin Keahey
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Kirsten Ward
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Drona Rasali
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, Canada Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Sandra Allison
- School of Health Sciences, University of Northern British Columbia, Prince George, Canada
- Population and Public Health, Northern Health, Prince George, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Brenner DR, Poirier AE, Walter SD, King WD, Franco EL, Demers PA, Villeneuve PJ, Ruan Y, Khandwala F, Grevers X, Nuttall R, Smith L, De P, Volesky K, O'Sullivan D, Hystad P, Friedenreich CM. Estimating the current and future cancer burden in Canada: methodological framework of the Canadian population attributable risk of cancer (ComPARe) study. BMJ Open 2018; 8:e022378. [PMID: 30068623 PMCID: PMC6074628 DOI: 10.1136/bmjopen-2018-022378] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Canadian Population Attributable Risk of Cancer project aims to quantify the number and proportion of cancer cases incident in Canada, now and projected to 2042, that could be prevented through changes in the prevalence of modifiable exposures associated with cancer. The broad risk factor categories of interest include tobacco, diet, energy imbalance, infectious diseases, hormonal therapies and environmental factors such as air pollution and residential radon. METHODS AND ANALYSIS Using a national network, we will use population-attributable risks (PAR) and potential impact fractions (PIF) to model both attributable (current) and avoidable (future) cancers. The latency periods and the temporal relationships between exposures and cancer diagnoses will be accounted for in the analyses. For PAR estimates, historical exposure prevalence data and the most recent provincial and national cancer incidence data will be used. For PIF estimates, we will model alternative or 'counterfactual' distributions of cancer risk factor exposures to assess how cancer incidence could be reduced under different scenarios of population exposure, projecting incidence to 2042. DISSEMINATION The framework provided can be readily extended and applied to other populations or jurisdictions outside of Canada. An embedded knowledge translation and exchange component of this study with our Canadian Cancer Society partners will ensure that these findings are translated to cancer programmes and policies aimed at population-based cancer risk reduction strategies.
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Affiliation(s)
- Darren R Brenner
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Abbey E Poirier
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Eduardo L Franco
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Paul A Demers
- Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Farah Khandwala
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Xin Grevers
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Leah Smith
- Canadian Cancer Society, Toronto, Ontario, Canada
| | | | - Karena Volesky
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Dylan O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Christine M Friedenreich
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
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Lieffers JRL, Ekwaru JP, Ohinmaa A, Veugelers PJ. The economic burden of not meeting food recommendations in Canada: The cost of doing nothing. PLoS One 2018; 13:e0196333. [PMID: 29702680 PMCID: PMC5922758 DOI: 10.1371/journal.pone.0196333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/11/2018] [Indexed: 12/31/2022] Open
Abstract
Few studies have estimated the economic burden of chronic diseases (e.g., type 2 diabetes, cardiovascular diseases, cancers) attributable to unhealthy eating. In this study, we estimated the economic burden of chronic disease attributable to not meeting Canadian food recommendations. We first obtained chronic disease risk estimates for intakes of both protective (1. vegetables; 2. fruit; 3. whole grains; 4. milk; 5. nuts and seeds) and harmful (6. processed meat; 7. red meat; 8. sugar-sweetened beverages) foods from the Global Burden of Disease Study, and food intakes from the 2004 Canadian Community Health Survey 24-hour dietary recalls (n = 33,932 respondents). We then calculated population attributable fractions (PAFs) for all relevant food-chronic disease combinations by age and sex groups. These PAFs were then mathematically combined for each disease for each age and sex group. We then estimated attributable costs by multiplying these combined PAFs with estimated 2014 annual direct health care (hospital, drug, physician) and indirect (human capital approach) costs for each disease. We found that not meeting recommendations for the eight foods was responsible for CAD$13.8 billion/year (direct health care: CAD$5.1 billion, indirect: CAD$8.7 billion). Nuts and seeds and whole grains were the top cost contributors rather than vegetables and fruit. Our findings suggest that unhealthy eating constitutes a tremendous economic burden to Canada that is similar in magnitude to the burden of smoking and larger than that of physical inactivity which were estimated using similar approaches. A status quo in promotion of healthy eating will allow this burden to continue. Interventions to reduce the health and economic burden of unhealthy eating in Canada may be more effective if they are broad in focus and include promotion of nuts and seeds and whole grains along with vegetables and fruit rather than have a narrow focus such as primarily on vegetables and fruit.
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Affiliation(s)
- Jessica R. L. Lieffers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - John Paul Ekwaru
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Ding D, Kolbe-Alexander T, Nguyen B, Katzmarzyk PT, Pratt M, Lawson KD. The economic burden of physical inactivity: a systematic review and critical appraisal. Br J Sports Med 2017; 51:1392-1409. [PMID: 28446455 DOI: 10.1136/bjsports-2016-097385] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To summarise the literature on the economic burden of physical inactivity in populations, with emphases on appraising the methodologies and providing recommendations for future studies. DESIGN Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number CRD42016047705). DATA SOURCES Electronic databases for peer-reviewed and grey literature were systematically searched, followed by reference searching and consultation with experts. ELIGIBILITY CRITERIA Studies that examined the economic consequences of physical inactivity in a population/population-based sample, with clearly stated methodologies and at least an abstract/summary written in English. RESULTS Of the 40 eligible studies, 27 focused on direct healthcare costs only, 13 also estimated indirect costs and one study additionally estimated household costs. For direct costs, 23 studies used a population attributable fraction (PAF) approach with estimated healthcare costs attributable to physical inactivity ranging from 0.3% to 4.6% of national healthcare expenditure; 17 studies used an econometric approach, which tended to yield higher estimates than those using a PAF approach. For indirect costs, 10 studies used a human capital approach, two used a friction cost approach and one used a value of a statistical life approach. Overall, estimates varied substantially, even within the same country, depending on analytical approaches, time frame and other methodological considerations. CONCLUSION Estimating the economic burden of physical inactivity is an area of increasing importance that requires further development. There is a marked lack of consistency in methodological approaches and transparency of reporting. Future studies could benefit from cross-disciplinary collaborations involving economists and physical activity experts, taking a societal perspective and following best practices in conducting and reporting analysis, including accounting for potential confounding, reverse causality and comorbidity, applying discounting and sensitivity analysis, and reporting assumptions, limitations and justifications for approaches taken. We have adapted the Consolidated Health Economic Evaluation Reporting Standards checklist as a guide for future estimates of the economic burden of physical inactivity and other risk factors.
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Affiliation(s)
- Ding Ding
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia.,Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Tracy Kolbe-Alexander
- Department of Human Biology, Research Unit for Exercise Science and Sports Medicine (ESSM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,School of Health and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Binh Nguyen
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Michael Pratt
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Kenny D Lawson
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.,Centre for Health Research, School of Medicine, Western Sydney University, Penrith, Australia
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