Impact of physical inactivity on cardiovascular mortality in united states: county-level analysis from 2011 to 2019
Authors: Abohashem S , Sayed A , Aldosoky W , Dar T , Abbasi T 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Physical inactivity and sedentary behavior are among the leading modifiable risk factors worldwide for cardiovascular (CV) disease and mortality. However, data about disparities of CV mortality related to physical inactivity, has been limited and/or inconsistent.

Purpose
We sought to evaluate county-level associations between physical inactivity and cardiovascular mortality (CVM) in overall population and among different age, gender, and racial/ethnic subgroups.

Methods
Age-adjusted CV mortality rates (ACVM) between 2011 to 2019, were obtained using Wide-ranging Online Data for Epidemiologic Research tool of Center for Disease Control (CDC). Behavioral Risk Factors Surveillance System, CDC Diabetes Interactive Atlas, Census population estimates, environmental public health network and drinking water information system, were utilized to acquire county physical inactivity levels (percentage of adults reporting no physical activity in past month), demographics, rates of obesity, diabetes, smoking and environmental factors. Poisson generalized linear mixed models were employed to assess incidence rate ratios (IRR) of ACVM associated with physical inactivity while adjusting for other potential confounders. The burden of additional yearly deaths (AYD) per 100,000 individuals was calculated by multiplying the baseline CV death rates by the percentage increase attributable to physical inactivity in each subgroup.

Results
Among 303,857,140 residents (49.5% men, 11.9% non-Hispanic blacks, 23.8% [45-64 age group]) lived at 2900 US counties in 2011, total 7,226,447 (2.4%) CV deaths occurred between 2011-2019. In fully adjusted model*, physical inactivity significantly associated with high ACVM (IRR: 1.02; 95% CI: 1.01 to 1.02), that translated to 4.4 AYD per 100,000 individuals. Notably, physical inactivity associated with a relatively higher ACVM among middle aged adults [45 to 64] (IRR: 1.04; 95% CI: 1.03 to 1.04) versus elderly [≥65] (IRR: 1.02; 95% CI: 1.01 to 1.02), and in males (IRR: 1.03; 95% CI: 1.02 to 1.03) versus females (IRR: 1.01; 95% CI: 1.01 to 1.02). Interestingly, middle aged adults were relatively most impacted by physical inactivity as compared to elderly, among each of gender and racial/ethnic subgroups, (Figure). Additionally, physical inactivity seemed to have similar impact on both non-Hispanic whites (IRR: 1.02), and non-Hispanic blacks (IRR: 1.02), with a slightly larger impact among Hispanics (IRR: 1.03), (Figure).

Conclusion
Physical inactivity is robustly associated with age-adjusted CVM independent of other well-established determinants of CV death, including CV risk factors, socioeconomic, environmental and health care access factors. Physical inactivity appears to confer greater negative impact among middle-aged adults, males, and Hispanic individuals. Therefore, public health policies directed towards greater efforts at preventing sedentary behavior and promoting adequate physical activity, are desperately needed.