Research Article
Health Care Costs Associated with Prolonged Sitting and Inactivity

https://doi.org/10.1016/j.amepre.2013.11.014Get rights and content

Background

Physical inactivity and prolonged sitting are associated with negative health outcomes.

Purpose

To examine the health-related costs of prolonged sitting and inactivity in middle-aged women.

Methods

Australian Longitudinal Study on Women’s Health participants (born 1946−1951) answered questions about time spent sitting, walking, and in moderate and vigorous leisure activities in 2001 (n=6108); 2004 (n=5902); 2007 (n=5754); and 2010 (n=5535) surveys. Sitting time was categorized as low (0−4); moderate (5−7); and high (≥8 hours/day). Physical activity was categorized as inactive (<40); low (40−600); moderate (600−1200); and high (≥1200 MET-minutes/week). National health insurance claims data averaged over the survey year ±1 year were used to calculate annual costs (Australian dollars [AU$]). Differences between categories in median costs were estimated using quantile regression over four surveys with bootstrapped 95% CIs. Analyses were performed in 2013.

Results

In 2010, annual median costs were AU$689 (interquartile range [IQR]=274, 1541) in highly active participants; AU$741 (IQR=279, 1690) in inactive participants; AU$671 (IQR=273, 1551) in participants with low sitting time; and AU$709 (IQR=283, 1575) in participants with high sitting time. The difference in median costs for inactive and highly active participants was AU$94 (CI=57, 131) after adjustment for confounders. No statistically significant associations were found between sitting time and costs. When sitting and physical activity were combined, high sitting time did not add to the inactivity-associated increased costs. Associations were consistent across normal-weight, overweight, and obese subgroups.

Conclusions

Physical inactivity, but not prolonged sitting, was associated with higher health-related costs in middle-aged women.

Introduction

Physical inactivity is associated with numerous physical and mental health conditions and accounts for approximately 1.5%−3.0% of the total direct health care costs in developed countries.1 It is estimated that a 10% reduction in the prevalence of inactivity could potentially reduce health care expenditures by 96 million Australian dollars (AU$) and 150 million Canadian dollars per year in Australia and Canada (equating to 99 and 129 million U.S. dollars, respectively).2, 3 Despite the potential health and economic benefits, only about half the population in developed countries meet the recommended levels of physical activity.4, 5, 6

In addition to inactivity, prolonged sitting is thought to be associated with negative health outcomes such as weight gain and increased risk of mortality.7 However, the economic consequences of prolonged sitting remain unknown. Moreover, as some studies have reported interaction effects of physical activity and sedentary time in association with mortality,8, 9 the combined effects of prolonged sitting and inactivity on direct health care costs may be more important than their individual effects.

A previous study by our group found an interaction with BMI in the relationship between physical activity and health care costs in middle-aged women: costs were lower for overweight active women than for healthy-weight inactive women.10 However, that study did not include measures of sitting time and was cross-sectional in design.

Medicare is the Australian government’s system for subsidising the costs of approximately 3800 medical services, including general practitioner and out-of-hospital specialist services, medical diagnostic services such as pathology and radiology, selected dental surgery, optometry, and allied health services, and limited additional primary health care services, for all Australian citizens and permanent residents.11 The aim of this study was to examine the total Medicare costs associated with prolonged sitting and physical inactivity in middle-aged women. Associations with costs were examined for sitting and physical activity separately, as well as for combinations of these, referred to as “activity patterns.” Potential interaction effects of BMI were taken into account.

Section snippets

Participants

The Australian Longitudinal Study on Women’s Health (ALSWH) is an ongoing study of the health and well-being of three generations of women.12 Samples were randomly drawn from the national Medicare health insurance database, which includes all Australian citizens and permanent residents, with oversampling of women from rural and remote areas. Appropriate ethics approval was obtained from the Ethics Committees of the Universities of Newcastle and Queensland, and informed consent was received from

Results

In 2001, the women were an average of 52.5 (SD=1.5, range=49−56) years old. The women in the four activity pattern categories differed in demographic and health characteristics (Table 1). In general, inactive women with high sitting time were more often current smokers, had higher BMI, had a higher prevalence of chronic conditions, and scored higher on the depressive symptoms scale than those in the more active categories (p<0.001).

Compared with participants who did not consent to data linkage,

Discussion

This is the first study to examine health costs associated with both inactivity and prolonged sitting in a longitudinal context. The results showed that in middle-aged women, physical inactivity, but not prolonged sitting, was associated with higher health-related costs. When the combination of physical activity and sitting time were examined, physical inactivity was associated with increased costs, regardless of sitting time. These findings were consistent across the normal weight, overweight,

Acknowledgments

The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health, the University of Newcastle, and the University of Queensland. We are grateful to the Australian Government Department of Health and Ageing for funding and to the women who provided the survey data. G.P. was supported by grants from the Australian National Health and Medical Research Council (program grant [Owen, Bauman, and Brown], grant number: 569940; Centre of Research

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