Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hamburg Center for Health Economics, Hamburg, Germany.
BMC Public Health. 2024 Oct 8;24(1):2737. doi: 10.1186/s12889-024-20253-x.
Physical activity (PA) plays a vital role in maintaining the functional ability that enables well-being in older age (healthy aging), potentially also saving costs for the healthcare system and society. The aim of this study was to examine the association between PA and healthcare and societal costs in a sample of very mild to moderately frail older adults.
This cross-sectional study is a secondary analysis using baseline data from the PromeTheus randomized-controlled trial, which included 385 very mild to moderately frail community-dwelling older adults (70 + years) from Germany. Participants self-reported their health-related resource use in the previous 6 months (FIMA questionnaire), which was monetarily valued using standardized unit costs. PA was also self-reported using the German Physical Activity Questionnaire for middle-aged and older adults (German-PAQ-50+) and categorized as 'insufficient'/'sufficient' or 'insufficient'/'moderate'/'high' in accordance with the World Health Organization guidelines for PA. Mean and median healthcare costs (including outpatient, inpatient, rehabilitation, formal care, and medication costs) and societal costs (healthcare costs plus informal care costs) for different PA groups were estimated using generalized linear models and quantile regression, with sociodemographic variables and physical capacity (Short Physical Performance Battery) as covariates.
Of the sample, 24% were classified as insufficiently, 23% as moderately, and 54% as highly active. Sufficient PA, especially high PA, was associated with lower costs in the 6 months prior to data collection compared to insufficient PA (-€6,237, 95% CI [-10,656; -1,817] and -€8,333, 95% CI [-12,183; -4,483], respectively). The cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when physical capacity was accounted for in the analyses; e.g., the mean difference in societal costs between sufficient and insufficient PA decreased from -€7,615 (95% CI [-11,404; -3,825]) to -€4,532 (95% CI [-7,930; -1,133]).
Promoting PA throughout the lifespan as a means of promoting healthy aging and reducing dependency in old age could potentially provide economic benefits and help to mitigate the economic consequences of an aging population with increasing health and long-term care needs. Future longitudinal studies should attempt to disentangle the mediating and confounding role of physical capacity and health status in the association between PA and costs.
体力活动（PA）在维持功能能力方面发挥着至关重要的作用，而功能能力使老年人能够保持健康（健康老龄化），这可能还会为医疗保健系统和社会节省成本。本研究的目的是在一个非常轻度到中度虚弱的老年人样本中，研究 PA 与医疗保健和社会成本之间的关系。
这是一项使用德国 PromeTheus 随机对照试验的基线数据进行的横断面研究，该研究纳入了 385 名非常轻度到中度虚弱的社区居住的老年人（70 岁以上）。参与者自我报告了他们在过去 6 个月内的健康相关资源使用情况（FIMA 问卷），并使用标准化单位成本进行货币化估值。PA 也使用德国中老年人体力活动问卷（German-PAQ-50+）进行自我报告，并根据世界卫生组织的 PA 指南将其归类为“不足”/“充足”或“不足”/“中度”/“高”。使用广义线性模型和分位数回归估计不同 PA 组的平均和中位数医疗保健成本（包括门诊、住院、康复、正规护理和药物成本）和社会成本（医疗保健成本加上非正规护理成本），并将社会人口统计学变量和身体能力（简短身体表现电池）作为协变量。
在样本中，24%被归类为活动不足，23%为适度，54%为高度活跃。与活动不足相比，充足的 PA，尤其是高 PA，与数据收集前 6 个月的较低成本相关（-€6,237，95%CI [-10,656；-1,817] 和 -€8,333，95%CI [-12,183；-4,483]）。PA 强度组之间的成本差异主要归因于非正规护理成本的差异，并且当在分析中考虑身体能力时，差异会大大减少；例如，在社会成本方面，充足和不足的 PA 之间的平均差异从 -€7,615（95%CI [-11,404；-3,825]）降至 -€4,532（95%CI [-7,930；-1,133]）。
在整个生命周期中促进 PA，以促进健康老龄化并减少老年人的依赖，可能会带来经济利益，并有助于缓解人口老龄化带来的经济后果，人口老龄化增加了健康和长期护理需求。未来的纵向研究应尝试阐明身体能力和健康状况在 PA 与成本之间的关联中的中介和混淆作用。
