title: The economic burden of physical inactivity: a global analysis of major non-communicable diseases.
abstract: The pandemic of physical inactivity is associated with a range of chronic diseases and early deaths. Despite the well documented disease burden, the economic burden of physical inactivity remains unquantified at the global level. A better understanding of the economic burden could help to inform resource prioritisation and motivate efforts to increase levels of physical activity worldwide.
  
  
  
  Direct health-care costs, productivity losses, and disability-adjusted life-years (DALYs) attributable to physical inactivity were estimated with standardised methods and the best data available for 142 countries, representing 93·2% of the world's population. Direct health-care costs and DALYs were estimated for coronary heart disease, stroke, type 2 diabetes, breast cancer, and colon cancer attributable to physical inactivity. Productivity losses were estimated with a friction cost approach for physical inactivity related mortality. Analyses were based on national physical inactivity prevalence from available countries, and adjusted population attributable fractions (PAFs) associated with physical inactivity for each disease outcome and all-cause mortality.
  
  
  
  Conservatively estimated, physical inactivity cost health-care systems international $ (INT$) 53·8 billion worldwide in 2013, of which $31·2 billion was paid by the public sector, $12·9 billion by the private sector, and $9·7 billion by households. In addition, physical inactivity related deaths contribute to $13·7 billion in productivity losses, and physical inactivity was responsible for 13·4 million DALYs worldwide. High-income countries bear a larger proportion of economic burden (80·8% of health-care costs and 60·4% of indirect costs), whereas low-income and middle-income countries have a larger proportion of the disease burden (75·0% of DALYs). Sensitivity analyses based on less conservative assumptions led to much higher estimates.
  
  
  
  In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases.
  
  
  
  None.
authors.affiliation: Prevention Research Collaboration/the Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia; Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia. Electronic address: melody.ding@sydney.edu.au.
authors.forename: Ding
authors.initials: D
authors.lastname: Ding
authors.affiliation: Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, Australia.
authors.forename: Kenny D
authors.initials: KD
authors.lastname: Lawson
authors.affiliation: Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia; Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Kolbe-Alexander
authors.affiliation: Duke University-National University of Singapore, Singapore.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Katzmarzyk
authors.affiliation: Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia; Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center, Amsterdam, Netherlands; School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pratt
mesh_terms: D002908:Chronic Disease; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2; D014943:Global Health; D017048:Health Care Costs; D006801:Humans; D061213:Mortality, Premature; D019057:Quality-Adjusted Life Years