The association between physical activity and healthcare costs in children – results from the GINIplus and LISAplus cohort studies

Idler, Nadja; Teuner, Christina M; Hunger, Matthias; Holle, Rolf; Ortlieb, Sandra; Schulz, Holger; Bauer, Carl-Peter; Hoffmann, Ute; Koletzko, Sibylle; Lehmann, Irina; von Berg, Andrea; Berdel, Dietrich; Hoffmann, Barbara; Schaaf, Beate; Heinrich, Joachim; Wolfenstetter, Silke B

doi:10.1186/s12889-015-1721-6

Table 3 Association between socioeconomic factors, BMI, MVPA and (in)direct costs (logistic regression model)

From: The association between physical activity and healthcare costs in children – results from the GINIplus and LISAplus cohort studies

Parameter	Direct costs (no/yes)					Indirect costs (no/yes)
	Total	Physician	Therapist	Hospital	Inpatient rehabilitation	Parental work absence
	Odds [95% CI]	Odds [95% CI]	Odds [95% CI]	Odds [95% CI]	Odds [95% CI]	Odds [95% CI]
Age	0.98 [0.63-1.51]	0.98 [0.65-1.48]	0.93 [0.65-1.31]	2.22 [1.28-3.86]**	1.87 [0.65-5.42]	0.86 [0.59-1.25]
Gender, Ref: Girls	1.00	1.00	1.00	1.00	1.00	1.00
Boys	1.17 [0.95-1.43]	1.10 [0.91-1.33]	1.21 [1.04-1.42]*	0.94 [0.69-1.27]	1.10 [0.61-1.98]	1.03 [0.87-1.23]
BMI categories ¹ , Ref: Normal weight (P10 to P90)	1.00	1.00	1.00	1.00	1.00	1.00
Severely underweight (< P3)	1.81 [0.83-3.96]	1.79 [0.86-3.74]	1.14 [0.71-1.85]	1.99 [0.94-4.23]	4.23 [1.43-12.52]**	1.14 [0.66-1.98]
Underweight (P3 to < P10)	1.07 [0.70-1.63]	0.97 [0.66-1.44]	1.34 [0.98-1.82]	1.52 [0.87-2.66]	0.83 [0.20-3.50]	1.13 [0.80-1.60]
Overweight, not obese (> P90 to P97)	1.12 [0.72-1.74]	0.98 [0.66-1.47]	1.55 [1.12-2.14]**	1.49 [0.84-2.66]	0.81 [0.19-3.43]	0.93 [0.63-1.38]
Obese (> P97)	2.24 [0.80-6.26]	2.56 [0.92-7.12]	1.11 [0.61-2.03]	1.62 [0.63-4.19]	5.42 [1.96-15.03]***	1.41 [0.75-2.63]
Missing	0.67 [0.42-1.06]	0.66 [0.42-1.03]	0.64 [0.40-1.04]	1.24 [0.59-2.60]	1.72 [0.51-5.80]	1.10 [0.70-1.75]
Education level of parents ² , Ref: High (>10 years)	1.00	1.00	1.00	1.00	1.00	1.00
Low (<10 years)	1.33 [0.81-2.19]	1.41 [0.87-2.28]	0.78 [0.51-1.19]	1.66 [0.88-3.12]	2.37 [0.84-6.67]	0.69 [0.42-1.15]
Medium (=10 years)	1.04 [0.81-1.33]	1.08 [0.85-1.37]	1.07 [0.87-1.30]	1.08 [0.74-1.57]	1.51 [0.75-3.02]	0.98 [0.79-1.22]
Relative income position ³ , Ref: > 100% of median income	1.00	1.00	1.00	1.00	1.00	1.00
≤60% of median income	0.92 [0.66-1.28]	0.89 [0.66-1.22]	1.01 [0.78-1.32]	1.15 [0.73-1.83]	1.77 [0.75-4.14]	0.77 [0.57-1.04]
>60% and ≤ 100% of median income	0.77 [0.60-0.97]*	0.81 [0.65-1.02]	1.21 [1.00-1.46]*	0.81 [0.56-1.17]	1.03 [0.48-2.23]	0.92 [0.76-1.13]
Single parenthood, Ref: No	1.00	1.00	1.00	1.00	1.00	1.00
Yes	0.93 [0.66-1.30]	1.00 [0.73-1.39]	1.11 [0.86-1.44]	0.75 [0.43-1.29]	1.60 [0.69-3.68]	0.81 [0.60-1.09]
Missing	0.95 [0.44-2.02]	0.84 [0.42-1.68]	1.13 [0.62-2.07]	0.60 [0.14-2.49]	<0.001 [<0.001- > 999.999]	1.57 [0.83-2.94]
Study region, Ref: Munich	1.00	1.00	1.00	1.00	1.00	1.00
Leipzig	1.55 [1.03-2.33]*	1.78 [1.20-2.64]**	0.82 [0.63-1.07]	1.73 [1.10-2.73]*	3.18 [1.36-7.40]**	1.97 [1.52-2.54]***
Bad Honnef	1.15 [0.70-1.88]	1.22 [0.77-1.94]	0.69 [0.48-0.99]*	1.10 [0.56-2.19]	1.09 [0.24-4.96]	0.76 [0.51-1.13]
Wesel	0.68 [0.53-0.86]***	0.75 [0.60-0.94]**	0.50 [0.41-0.61]***	0.89 [0.61-1.31]	1.53 [0.72-3.28]	0.38 [0.30-0.48]***
MVPA activity time ⁴ , Ref: < 7 h/week MVPA ⁵	1.00	1.00	1.00	1.00	1.00	1.00
≥7 h/week MVPA⁶	0.95 [0.76-1.19]	1.06 [0.86-1.30]	1.05 [0.88-1.25]	1.20 [0.85-1.68]	0.97 [0.52-1.84]	1.04 [0.87-1.26]

Abbreviations: BMI: body mass index; CI: confidence interval; h: hours, Odds: odds ratio estimates; %: percentage; Ref: reference category.
¹BMI categories according to Kromeyer-Hauschild et al. 2001 [28].
²Maximum completed school years of either of the parents.
³Categorized relatively to the median equivalence income of the year 2007 (1521 EUR/month) [24].
⁴MVPA: moderate-to-vigorous physical activity (year average, dichotomized according to WHO recommendations ≥ 60 min/day MVPA) [2].
⁵WHO recommendations not met.
⁶WHO recommendations met.
***/**/*, values nominally significant at the 0.1%/1%/5% level (without adjustment for multiple testing); number of observations: 3356.
Model information: dependent variables: odds of direct costs (total, physician use, therapist use, hospital use, inpatient rehabilitation use) and odds of indirect costs (parental work absence);
assumptions: binominal distribution of the error terms, logit-link function.

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