Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, University of Greenwich, London, UK.
Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2022 Sep 30;112(8b):639-648. doi: 10.7196/SAMJ.2022.v112i8b.1648.
Physical activity is associated with a lower risk of cardiovascular outcomes, certain cancers and diabetes. The previous South African Comparative Risk Assessment (SACRA1) study assessed the attributable burden of low physical activity for 2000, but updated estimates are required, as well as an assessment of trends over time.
To estimate the national prevalence of physical activity by age, year and sex and to quantify the burden of disease attributable to low physical activity in South Africa (SA) for 2000, 2006 and 2012.
Comparative risk assessment methodology was used. Physical activity was treated as a categorical variable with four categories, i.e. inactive, active, very active and highly active. Prevalence estimates of physical activity levels, representing the three different years, were derived from two national surveys. Physical activity estimates together with the relative risks from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2016 study were used to calculate population attributable fractions due to inactive, active and very active levels of physical activity relative to highly active levels considered to be the theoretical minimum risk exposure (>8 000 metabolic equivalent of time (MET)-min/wk), in accordance with the GBD 2016 study. These were applied to relevant disease outcomes sourced from the Second National Burden of Disease Study to calculate attributable deaths, years of life lost, years lived with disability and disability adjusted life years (DALYs). Uncertainty analysis was performed using Monte Carlo simulation.
The prevalence of physical inactivity (<600 METS) decreased by 16% and 8% between 2000 and 2012 for females and males, respectively. Attributable DALYs due to low physical activity increased between 2000 (n=194 284) and 2006 (n=238 475), but decreased thereafter in 2012 (n=219 851). The attributable death age-standardised rates (ASRs) declined between 2000 and 2012 from 60/100 000 population in 2000 to 54/100 000 population in 2012. Diabetes mellitus type 2 displaced ischaemic heart disease as the largest contributor to attributable deaths, increasing from 31% in 2000 to 42% in 2012.
Low physical activity is responsible for a large portion of disease burden in SA. While the decreased attributable death ASR due to low physical activity is encouraging, this burden may be lowered further with an additional reduction in the overall prevalence of physical inactivity, in particular. It is concerning that the attributable burden for diabetes mellitus is growing, which suggests that existing non-communicable disease policies need better implementation, with ongoing surveillance of physical activity, and population- and community-based interventions are required in order to reach set targets.
身体活动与心血管疾病结局、某些癌症和糖尿病风险降低有关。之前的南非比较风险评估（SACRA1）研究评估了 2000 年低身体活动的归因负担，但需要更新估计值，并评估随时间推移的趋势。
估计按年龄、年份和性别划分的身体活动全国流行率，并量化南非（SA）2000 年、2006 年和 2012 年低身体活动造成的疾病负担。
使用比较风险评估方法。身体活动被视为一个有四个类别的分类变量，即不活跃、活跃、非常活跃和高度活跃。2000 年和 2006 年两次全国性调查得出了身体活动水平的流行率估计值。身体活动估计值与 2016 年全球疾病、伤害和风险因素负担研究（GBD）中的相对风险一起用于计算归因于不活跃、活跃和非常活跃水平的人群归因分数与高度活跃水平相比，后者被认为是理论上的最低风险暴露（>8000 代谢当量时间（MET）-min/wk），这符合 GBD 2016 年的研究。这些应用于第二国家疾病负担研究中与疾病相关的结局，以计算归因于死亡、生命损失年、残疾生活年和残疾调整生命年（DALY）。使用蒙特卡罗模拟进行不确定性分析。
女性和男性的身体不活动（<600 梅茨）的流行率分别在 2000 年至 2012 年间下降了 16%和 8%。2000 年（n=194284）和 2006 年（n=238475）之间归因于低身体活动的 DALY 增加，但 2012 年有所下降（n=219851）。2000 年至 2012 年间，归因于低身体活动的年龄标准化死亡率（ASR）从 2000 年的 60/100000 人下降到 2012 年的 54/100000 人。2 型糖尿病取代缺血性心脏病成为归因于死亡的最大原因，从 2000 年的 31%上升到 2012 年的 42%。
低身体活动是南非疾病负担的主要原因。尽管由于低身体活动导致的归因死亡 ASR 下降令人鼓舞，但通过进一步降低整体身体不活动的流行率，可能会进一步降低这一负担，尤其是如此。令人担忧的是，糖尿病的归因负担正在增加，这表明现有的非传染性疾病政策需要更好地实施，需要对身体活动进行持续监测，并需要开展以人群和社区为基础的干预措施，以实现既定目标。
