University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany.
University of Bremen, Health Sciences Bremen, Bremen, Germany.
Int J Behav Nutr Phys Act. 2020 Aug 14;17(1):103. doi: 10.1186/s12966-020-00999-4.
Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany.
We created six intervention scenarios targeting the elderly population: Scenarios #1-#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity.
Under scenarios #1-#4, approximately 3589-5829 incident disease cases and 6248-10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381-7163 disease cases and 6914-12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6.
This study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.
行为干预可能会增加健康方面的社会不平等。本研究旨在预测在德国，针对老年人的体育活动干预措施在长期健康不平等方面的公平影响，这些干预措施在不同教育群体中的效果不同。
我们为老年人创建了六个干预场景：场景#1-#4 应用了不同教育程度（低、中、高）的现实干预效果。在场景#5 下，所有老年人都适应了具有高教育程度的人的体育活动模式。在场景#6 下，所有人都将他们的身体活动水平增加到每周 300 分钟的推荐水平。使用 DYNAMO-HIA 工具，在 10 年的预测期内，模拟了每个干预场景下男性和女性的缺血性心脏病、中风和糖尿病的新发病例数以及所有原因导致的死亡数。结果与不变的体育活动的参考场景进行了比较。
在场景#1-#4 下，男性在 10 年的预测期内，大约可以避免 3589-5829 例疾病和 6248-10320 例死亡，女性可以避免 4381-7163 例疾病和 6914-12605 例死亡。在场景#4 下，男性的减少幅度最大，该场景中干预对高教育水平人群最为有效。场景#4 实现了场景#6 中观察到的预防疾病病例和死亡人数的 2.7%和 2.4%，同时增加了教育群体之间的不平等。在女性中，在场景#3 下，减少幅度最大，该场景中干预对低教育水平人群最为有效。该场景实现了场景#6 中预防疾病病例和死亡人数的 2.7%和 2.9%，同时减少了教育群体之间的不平等。在场景#5 下，男性在 10 年的预测期内，大约可以避免 31687 例疾病和 59068 例死亡，女性可以避免 59173 例疾病和 121689 例死亡。这相当于场景#6 中男性和女性预防疾病的 14.4%和 22.2%，以及场景#6 中预防死亡的 13.7%和 27.7%。
本研究表明，干预引起的体力活动变化在不同教育群体中的差异如何影响整体人群的健康影响。对于决策者而言，评估整体健康影响和人群内的健康影响都很重要，因为具有最大人群健康收益的干预措施可能伴随着健康不平等的意外增加。
