title: Association of physical inactivity with circulatory disease events and hospital treatment costs.
abstract: OBJECTIVE
  Epidemiological studies of chronic disorders need to consider more responsive outcomes, particularly those that manifest themselves across a defined population over a shorter time period, to improve our ability to detect the causes of and intervene in the global epidemics of today. We explore the use of hospital episode statistics as a candidate for this role and estimate the strength of the association of circulatory disease-related events with physical inactivity, considered here as an undesirable health behavior. SETTINGS PATIENTS AND METHODS: The primary research was set in a mid-sized city in central England. Aggregation was at output area level (comprising ~300 residents); 51 of which were included. A random sample of 761 adults was selected to obtain estimates of the mean level of physical activity within each area. Circulatory disease hospital events were recorded and aggregated by output area over a 2-year period. Hierarchical linear modeling was used to establish the strength of the association between area-level physical activity and circulatory disease events. Sex, age, and reporting quarter were included as additional individual-level explanatory variables.
  
  
  RESULTS
  Areas reporting greater activity were less likely (event rate ratio = 0.855; 95% confidence interval [CI]: 0.78-0.94) to have a circulatory disease event, as were females (0.593; 95% CI: 0.47-0.75). Areas with older residents (1.578; 95% CI: 1.5-1.66) and later reporting quarters (1.095; 95% CI: 1.04-1.15) were more likely to report circulatory disease events.
  
  
  CONCLUSIONS
  This study supports the use of hospital episode statistics as an outcome measure in the epidemiology of circulatory disease and reaffirms the potential importance of physical inactivity in the disease process.
authors: Centre for Research and Action in Public Health, University of Canberra, ACT, Australia.
authors: Rachel C
authors: RC
authors: Davey
authors: Thomas
authors: T
authors: Cochrane
keywords: cardiovascular disease; chronic disease epidemiology; exercise; lifestyle; physical environment
references: CMAJ. 2006 Mar 14;174(6):801-9
references: 16534088
references: Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):239-46
references: 18525377
references: Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):247-57
references: 18525378
references: Int J Environ Res Public Health. 2009 Feb;6(2):654-77
references: 19440408
references: Circulation. 2010 Aug 17;122(7):743-52
references: 20713909
references: Lancet. 1953 Nov 28;262(6796):1111-20; concl
references: 13110075
references: N Engl J Med. 1975 Mar 13;292(11):545-50
references: 1128551