Comparative risk assessment modeling of cardiovascular and all-cause burden attributable to sitting time and physical...

Although there is evidence that sitting time (ST) and insufficient physical activity (PA) are associated with premature mortality, the burden of cardiovascular disease (CVD) and all-cause mortality (ACM) attributable to the combined effects of ST and PA in counterfactual scenarios is limited.

Potential impact fractions (PIFs) were used to calculate premature deaths (PDs) and disability-adjusted life years (DALYs). Cause-eliminated life tables were utilized to estimate health-adjusted life expectancy (HALE) gains. Monte Carlo simulations were performed for uncertainty analysis.

The theoretical minimum risk exposure level (ST < 4 $\mathrm{h} \cdot{\mathrm{d}}^{-1}$, PA > 65 $\mathrm{min} \cdot{\mathrm{d}}^{-1}$) could prevent 16.7% of CVD deaths and 12.3% of all-cause deaths annually. This would save 669 to 2,630 DALYs per 100,000 and increase healthy life years by 0.57 to 2.94. Increasing PA to > 65 $\mathrm{min} \cdot{\mathrm{d}}^{-1}$ while maintaining ST could yield gains in HALE from 0.49 (CVD) to 2.60 (ACM) years. Reducing ST to < 4 $\mathrm{h}\cdot{\mathrm{d}}^{-1}$ while keeping PA constant could lead to gains in HALE from 0.07 (CVD) to 0.34 (ACM) years. A 50% reduction in suboptimal ST (≥ 4 $\mathrm{h}\cdot{\mathrm{d}}^{-1}$) doubled HALE gains, ranging from 0.11 to 0.63 years.

Public health decision-makers should prioritize vulnerable populations, including older adults and individuals with inadequate PA levels.