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@ARTICLE{Gottschalk:290165,
      author       = {S. Gottschalk and H.-H. König and A. Weber and M. F.
                      Leitzmann and M. J. Stein and A. Peters and C. Flexeder and
                      L. Krist and S. N. Willich and K. Nimptsch and T. Pischon
                      and S. Gastell and K. Steindorf$^*$ and F. Herbolsheimer$^*$
                      and N. Ebert and K. B. Michels and A. Dorrn and V. Harth and
                      N. Obi and A. Karch and H. Teismann and H. Völzke and C.
                      Meinke-Franze and L. Klimeck$^*$ and T. Seum$^*$ and J.
                      Dams},
      title        = {{C}osts associated with insufficient physical activity in
                      {G}ermany: cross-sectional results from the baseline
                      examination of the {G}erman national cohort ({NAKO}).},
      journal      = {The European journal of health economics},
      volume       = {26},
      number       = {1},
      issn         = {1618-7598},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DKFZ-2024-01001},
      pages        = {117-128},
      year         = {2025},
      note         = {2025 Feb;26(1):117-128},
      abstract     = {Insufficient physical activity (PA) is a leading risk
                      factor for non-communicable diseases posing a significant
                      economic burden to healthcare systems and societies. The
                      study aimed to examine the differences in healthcare and
                      indirect costs between sufficient and insufficient PA and
                      the cost differences between PA intensity groups.The
                      cross-sectional analysis was based on data from 157,648
                      participants in the baseline examination of the German
                      National Cohort (NAKO) study. Healthcare and indirect costs
                      were calculated based on self-reported information on
                      health-related resource use and productivity losses. PA in
                      the domains leisure, transport, and work was assessed by the
                      Global Physical Activity Questionnaire and categorized into
                      sufficient/insufficient and intensity levels (very
                      low/low/medium/high) based on PA recommendations of the
                      World Health Organization. Two-part models adjusted for
                      relevant covariates were used to estimate mean costs for PA
                      groups.Insufficiently active people had higher average
                      annual healthcare costs (Δ €188, $95\%$ CI [64, 311]) and
                      healthcare plus indirect costs (Δ €482, $95\%$ CI [262,
                      702]) compared to sufficiently active people. The difference
                      was especially evident in the population aged 60 + years and
                      when considering only leisure PA. An inverse association was
                      observed between leisure PA and costs, whereas a direct
                      association was found between PA at work and costs.
                      Adjusting for the number of comorbidities reduced the
                      differences between activity groups, but the trend
                      persisted. The association between PA and costs differed in
                      direction between PA domains. Future research may provide
                      further insight into the temporal relationship between PA
                      and costs.},
      keywords     = {Cohort study (Other) / Exercise (Other) / Health
                      expenditure (Other) / Healthcare costs (Other) / Physical
                      activity (Other)},
      cin          = {C110 / C070},
      ddc          = {610},
      cid          = {I:(DE-He78)C110-20160331 / I:(DE-He78)C070-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38727776},
      doi          = {10.1007/s10198-024-01697-9},
      url          = {https://inrepo02.dkfz.de/record/290165},
}