Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries

Author: Peter T Katzmarzyk1, Christine Friedenreich2,3, Eric J Shiroma4, I-Min Lee5,6
1 Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
2 Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Calgary, Alberta, Canada.
3 Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
4 Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland, USA.
5 Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
6 Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
Conference/Journal: Br J Sports Med
Date published: 2022 Jan 1
Other: Volume ID: 56 , Issue ID: 2 , Pages: 101-106 , Special Notes: doi: 10.1136/bjsports-2020-103640. , Word Count: 255

Physical inactivity is a risk factor for premature mortality and several non-communicable diseases. The purpose of this study was to estimate the global burden associated with physical inactivity, and to examine differences by country income and region.

Population-level, prevalence-based population attributable risks (PAR) were calculated for 168 countries to estimate how much disease could be averted if physical inactivity were eliminated. We calculated PARs (percentage of cases attributable to inactivity) for all-cause mortality, cardiovascular disease mortality and non-communicable diseases including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers of the bladder, breast, colon, endometrium, oesophagus, stomach and kidney.

Globally, 7.2% and 7.6% of all-cause and cardiovascular disease deaths, respectively, are attributable to physical inactivity. The proportions of non-communicable diseases attributable to physical inactivity range from 1.6% for hypertension to 8.1% for dementia. There was an increasing gradient across income groups; PARs were more than double in high-income compared with low-income countries. However, 69% of total deaths and 74% of cardiovascular disease deaths associated with physical inactivity are occurring in middle-income countries, given their population size. Regional differences were also observed, with the PARs occurring in Latin America/Caribbean and high-income Western and Asia-Pacific countries, and the lowest burden occurring in Oceania and East/Southeast Asia.

The global burden associated with physical inactivity is substantial. The relative burden is greatest in high-income countries; however, the greatest number of people (absolute burden) affected by physical inactivity are living in middle-income countries given the size of their populations.

Keywords: physical activity; sedentary.

PMID: 33782046 PMCID: PMC8478970 DOI: 10.1136/bjsports-2020-103640