title: The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity: A Mediation Analysis.
abstract: To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs.
  
  
  
  Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1).
  
  
  
  A random sample of a Dutch online interview panel was obtained.
  
  
  
  Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s).
  
  
  
  Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire.
  
  
  
  Linear regression analysis.
  
  
  
  The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs.
  
  
  
  Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle.
authors.affiliation: Netherlands Organisation for Applied Scientific Research TNO, Expertise Center Life Style, Leiden, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Hartman
authors.affiliation: Department of Health Sciences & EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: van Dongen
authors.affiliation: Netherlands Organisation for Applied Scientific Research TNO, Expertise Center Life Style, Leiden, the Netherlands.
authors.forename: V H
authors.initials: VH
authors.lastname: Hildebrandt
authors.affiliation: Netherlands Organisation for Applied Scientific Research TNO, Expertise Center Life Style, Leiden, the Netherlands jorien.strijk@tno.nl.
authors.forename: J E
authors.initials: JE
authors.lastname: Strijk
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics*; D004032:Diet; D004526:Efficiency; D015444:Exercise; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
keywords: health-care costs; lifestyle; productivity-related costs; vitality