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Is the association between physical activity and healthcare utilization affected by self-rated health and socio-economic factors?

Rocca P, Beckman A, Ekvall Hansson E, Ohlsson H - BMC Public Health (2015)

Bottom Line: While the mediation analysis illustrated that the indirect effects were strong (and in the expected order so that higher levels of LTPA were more negatively associated with poor health) and highly significant, the direct effects suggested that higher levels of physical activity were more positively associated with healthcare utilization than lower levels.There was a significant negative association between decreased healthcare utilization and increased LPTA, and the association remained after adjustment for socio-economic variables.These results suggest that even though higher physical activity in total decreases the healthcare utilization, parts of the association that is not mediated through SRH actually increase healthcare utilization.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences in Malmö/General Practice, Lund University,, CRC, Jan Waldenströms gata 35:28:11, SE 205 02, Malmö, Sweden. patriciarocca75@gmail.com.

ABSTRACT

Background: Physical activity and healthcare utilization has negative association. However, there appears to be limited knowledge of how this association is affected by self-rated health (SRH) and socio-economic status (SES). Therefore, the aim of this study was to examine the association between leisure-time physical activity (LTPA) and healthcare utilization, and investigate how SRH, gender, age and SES affected this association.

Methods: A cross-sectional public health survey was conducted in Skåne, Sweden 2012, based on a random sample with 55,000 participants (response rate 51 %; 28,028 individuals included in the study) aged 18-80 years. The data was linked to individual healthcare utilization data and socio-economic data. Logistic regression analyses were conducted to study the association between LTPA and healthcare utilization. Path analysis was used to investigate the possible mediation effect of SRH to the association between LTPA and healthcare utilization.

Results: Compared to sedentary leisure time the odds ratio for health care utilization decreased with increasing level of LPTA; physically active 0.89 (95 % CI: 0.81-0.96), for average exercise 0.74 (0.67-0.81) and for vigorous exercise 0.65 (0.60-0.72). The socio-economic variables attenuated this association to a small degree, but SRH had a strong impact. While the mediation analysis illustrated that the indirect effects were strong (and in the expected order so that higher levels of LTPA were more negatively associated with poor health) and highly significant, the direct effects suggested that higher levels of physical activity were more positively associated with healthcare utilization than lower levels. The indirect effects were substantially stronger than the direct effects.

Conclusions: There was a significant negative association between decreased healthcare utilization and increased LPTA, and the association remained after adjustment for socio-economic variables. The mediation analysis (with SRH as the mediator between LTPA and healthcare utilization) showed that the indirect effects were strong and in the expected order, but the direct effects of LTPA on healthcare utilization was positive so that higher levels of LTPA had higher healthcare utilization. These results suggest that even though higher physical activity in total decreases the healthcare utilization, parts of the association that is not mediated through SRH actually increase healthcare utilization.

No MeSH data available.


Related in: MedlinePlus

Path model with the probit link on 20,488 individuals from the Skåne public health survey. Path model with the probit link on 20,488 individuals from the Skåne public health survey. Physically = physically active; Average = Average active; Vigorous = Vigorous exercise; SRH = Self-rated health (coded as 0 = good health and 1 = Poor health); healthcare = Healthcare utilization (0: No and 1 = Yes)
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Fig1: Path model with the probit link on 20,488 individuals from the Skåne public health survey. Path model with the probit link on 20,488 individuals from the Skåne public health survey. Physically = physically active; Average = Average active; Vigorous = Vigorous exercise; SRH = Self-rated health (coded as 0 = good health and 1 = Poor health); healthcare = Healthcare utilization (0: No and 1 = Yes)

Mentions: The results from the path model are illustrated in Fig. 1. In order to simplify the models we excluded individuals that answered ‘average’ to the SRH question, so that the mediator became a binary variable (with poor health coded as 1 and good health coded as 0). As shown the association between different levels of physical activity was highly correlated with SRH and the effect sizes were in the expected order so that higher levels of LTPA were more negatively associated with poor health. We can also see that there is an expected positive association between poor health and healthcare utilization. The indirect effects (i.e. the effect from different levels of LTPA via SRH to healthcare utilization) are shown in Table 3 and they are all highly significant. The indirect effect (probit coefficients) from vigorous exercise (via SRH) to healthcare utilization is -0.51 (95 % CI: -0.57; -0.45; calculated by multiplying the path from vigorous exercise to SRH with the path from SRH to healthcare utilization), from average exercise -0.45 (-0.51; -0.40) and from physically active -0.32 (-0.35; -0.28). For the direct effects from different levels of LTPA to healthcare utilization we see some unexpected results. The direct effects from different levels of LTPA to healthcare utilization suggest that higher levels of physical activity are more positively associated than lower levels. Note however, that the indirect effects are substantially stronger than the direct effects. These results were only attenuated to a small degree when age, gender, income, education and immigrant status were included in the model (results not shown).Fig. 1


Is the association between physical activity and healthcare utilization affected by self-rated health and socio-economic factors?

Rocca P, Beckman A, Ekvall Hansson E, Ohlsson H - BMC Public Health (2015)

Path model with the probit link on 20,488 individuals from the Skåne public health survey. Path model with the probit link on 20,488 individuals from the Skåne public health survey. Physically = physically active; Average = Average active; Vigorous = Vigorous exercise; SRH = Self-rated health (coded as 0 = good health and 1 = Poor health); healthcare = Healthcare utilization (0: No and 1 = Yes)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522137&req=5

Fig1: Path model with the probit link on 20,488 individuals from the Skåne public health survey. Path model with the probit link on 20,488 individuals from the Skåne public health survey. Physically = physically active; Average = Average active; Vigorous = Vigorous exercise; SRH = Self-rated health (coded as 0 = good health and 1 = Poor health); healthcare = Healthcare utilization (0: No and 1 = Yes)
Mentions: The results from the path model are illustrated in Fig. 1. In order to simplify the models we excluded individuals that answered ‘average’ to the SRH question, so that the mediator became a binary variable (with poor health coded as 1 and good health coded as 0). As shown the association between different levels of physical activity was highly correlated with SRH and the effect sizes were in the expected order so that higher levels of LTPA were more negatively associated with poor health. We can also see that there is an expected positive association between poor health and healthcare utilization. The indirect effects (i.e. the effect from different levels of LTPA via SRH to healthcare utilization) are shown in Table 3 and they are all highly significant. The indirect effect (probit coefficients) from vigorous exercise (via SRH) to healthcare utilization is -0.51 (95 % CI: -0.57; -0.45; calculated by multiplying the path from vigorous exercise to SRH with the path from SRH to healthcare utilization), from average exercise -0.45 (-0.51; -0.40) and from physically active -0.32 (-0.35; -0.28). For the direct effects from different levels of LTPA to healthcare utilization we see some unexpected results. The direct effects from different levels of LTPA to healthcare utilization suggest that higher levels of physical activity are more positively associated than lower levels. Note however, that the indirect effects are substantially stronger than the direct effects. These results were only attenuated to a small degree when age, gender, income, education and immigrant status were included in the model (results not shown).Fig. 1

Bottom Line: While the mediation analysis illustrated that the indirect effects were strong (and in the expected order so that higher levels of LTPA were more negatively associated with poor health) and highly significant, the direct effects suggested that higher levels of physical activity were more positively associated with healthcare utilization than lower levels.There was a significant negative association between decreased healthcare utilization and increased LPTA, and the association remained after adjustment for socio-economic variables.These results suggest that even though higher physical activity in total decreases the healthcare utilization, parts of the association that is not mediated through SRH actually increase healthcare utilization.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Sciences in Malmö/General Practice, Lund University,, CRC, Jan Waldenströms gata 35:28:11, SE 205 02, Malmö, Sweden. patriciarocca75@gmail.com.

ABSTRACT

Background: Physical activity and healthcare utilization has negative association. However, there appears to be limited knowledge of how this association is affected by self-rated health (SRH) and socio-economic status (SES). Therefore, the aim of this study was to examine the association between leisure-time physical activity (LTPA) and healthcare utilization, and investigate how SRH, gender, age and SES affected this association.

Methods: A cross-sectional public health survey was conducted in Skåne, Sweden 2012, based on a random sample with 55,000 participants (response rate 51 %; 28,028 individuals included in the study) aged 18-80 years. The data was linked to individual healthcare utilization data and socio-economic data. Logistic regression analyses were conducted to study the association between LTPA and healthcare utilization. Path analysis was used to investigate the possible mediation effect of SRH to the association between LTPA and healthcare utilization.

Results: Compared to sedentary leisure time the odds ratio for health care utilization decreased with increasing level of LPTA; physically active 0.89 (95 % CI: 0.81-0.96), for average exercise 0.74 (0.67-0.81) and for vigorous exercise 0.65 (0.60-0.72). The socio-economic variables attenuated this association to a small degree, but SRH had a strong impact. While the mediation analysis illustrated that the indirect effects were strong (and in the expected order so that higher levels of LTPA were more negatively associated with poor health) and highly significant, the direct effects suggested that higher levels of physical activity were more positively associated with healthcare utilization than lower levels. The indirect effects were substantially stronger than the direct effects.

Conclusions: There was a significant negative association between decreased healthcare utilization and increased LPTA, and the association remained after adjustment for socio-economic variables. The mediation analysis (with SRH as the mediator between LTPA and healthcare utilization) showed that the indirect effects were strong and in the expected order, but the direct effects of LTPA on healthcare utilization was positive so that higher levels of LTPA had higher healthcare utilization. These results suggest that even though higher physical activity in total decreases the healthcare utilization, parts of the association that is not mediated through SRH actually increase healthcare utilization.

No MeSH data available.


Related in: MedlinePlus