The association between physical activity and healthcare costs in children--results from the GINIplus and LISAplus cohort studies.
BACKGROUND
Physical inactivity in children is an important risk factor for the development of various morbidities and mortality in adulthood, physical activity already has preventive effects during childhood. The objective of this study is to estimate the association between physical activity, healthcare utilization and costs in children.


METHODS
Cross-sectional data of 3356 children aged 9 to 12 years were taken from the 10-year follow-up of the birth cohort studies GINIplus and LISAplus, including information on healthcare utilization and physical activity given by parents via self-administered questionnaires. Using a bottom-up approach, direct costs due to healthcare utilization and indirect costs resulting from parental work absence were estimated for the base year 2007. A two-step regression model compared effects on healthcare utilization and costs for a higher (≥ 7 h/week) versus a lower (<7 h/week) level of moderate-to-vigorous physical activity (MVPA) adjusted for age, gender, BMI, education and income of parents, single parenthood and study region. Recycled predictions estimated adjusted mean costs per child and activity group.


RESULTS
The analyses for the association between physical activity, healthcare utilization and costs showed no statistically significant results. Different directions of estimates were noticeable throughout cost components in the first step as well as the second step of the regression model. For higher MVPA (≥ 7 h/week) compared with lower MVPA (< 7 h/week) total direct costs accounted for 392 EUR (95% CI: 342-449 EUR) versus 398 EUR (95% CI: 309-480 EUR) and indirect costs accounted for 138 EUR (95% CI: 124-153 EUR) versus 127 EUR (95% CI: 111-146 EUR).


CONCLUSIONS
The results indicate that childhood might be too early in life, to detect significant preventive effects of physical activity on healthcare utilization and costs, as diseases attributable to lacking physical activity might first occur later in life. This underpins the importance of clarifying the long-term effects of physical activity as it may strengthen the promotion of physical activity in children from a health economic perspective.
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. nadja_idler@gmx.de.
Nadja
N
Idler
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. christina.teuner@helmholtz-muenchen.de.|Ludwig-Maximilians-Universität München, Munich School of Management - Institute of Health Economics and Health Care Management and Munich Center of Health Sciences, Munich, Germany. christina.teuner@helmholtz-muenchen.de.
Christina M
CM
Teuner
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. matthias.hunger@helmholtz-muenchen.de.
Matthias
M
Hunger
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. holle@helmholtz-muenchen.de.
Rolf
R
Holle
Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. sandra.ortlieb@helmholtz-muenchen.de.|Technical University of Munich (TUM), Institute for Medicinal Statistics and Epidemiology, Munich, Germany. sandra.ortlieb@helmholtz-muenchen.de.
Sandra
S
Ortlieb
Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. schulz@helmholtz-muenchen.de.
Holger
H
Schulz
Department for Paediatrics, Technical University of Munich (TUM), Munich, Germany. carl-peter.bauer@drv-bayernsued.de.
Carl-Peter
CP
Bauer
Department for Paediatrics, Technical University of Munich (TUM), Munich, Germany. ute.hoffmann@lrz.tum.de.
Ute
U
Hoffmann
Ludwig-Maximilians-Universität München, Dr. von Haunersches Children's Hospital, Munich, Germany. sibylle.koletzko@med.uni-muenchen.de.
Sibylle
S
Koletzko
Department of Environmental Immunology, Helmholtz Centre for Environmental Research Leipzig (UFZ), Leipzig, Germany. irina.lehmann@ufz.de.
Irina
I
Lehmann
Department of Paediatrics, Marien-Hospital Wesel, Wesel, Germany. avb.rodehorst@gmx.de.
Andrea
A
von Berg
Department of Paediatrics, Marien-Hospital Wesel, Wesel, Germany. berdel.vonberg@t-online.de.
Dietrich
D
Berdel
University of Düsseldorf (IUF), Leibniz Research Institute for Environmental Medicine and Medical Faculty, Düsseldorf, Germany. barbara.hoffmann@iuf-duesseldorf.de.
Barbara
B
Hoffmann
Medical Practice for Paediatrics, Bad Honnef, Germany. dr.med.schaaf@t-online.de.
Beate
B
Schaaf
Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. heinrich@helmholtz-muenchen.de.
Joachim
J
Heinrich
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany. silke.wolfenstetter@helmholtz-muenchen.de.|Ludwig-Maximilians-Universität München, Munich School of Management - Institute of Health Economics and Health Care Management and Munich Center of Health Sciences, Munich, Germany. silke.wolfenstetter@helmholtz-muenchen.de.
Silke B
SB
Wolfenstetter
D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009043:Motor Activity; D010290:Parents; D012044:Regression Analysis; D012923:Social Class; D011795:Surveys and Questionnaires