The Effect Of Physical Activity On Hospital Service Use And Expenditures Of Patients With Coronary Heart Disease

Objectives: Faced with the challenges from the high incidence, long duration and medical costs of chronic diseases, the intervention of behavior is considered to be a strategic priority. The aim of this study is to analyze the correlation between different levels of physical activity(PA) and annual hospital service use and expenditure for inpatient with coronary heart disease(CHD) in China, and to provide evidence and recommendations for reducing the disease burden.Methods: The data was derived from the first follow-up(2013) survey of Dongfeng-Tongji cohort study; hospital service use and expenditure information in2013 came from the DMC affiliated medical insurance system. 1,454 eligible CHD patients were included, excluded the missing data of independent variables. The research contents included demographic characteristics, intensity of PA levels(0,?18.0 MET-h/week, 18.01-36.0 MET-h/week, ?36.01MET-h/week), years of physical activity(0 year, 1-4 years, 5-9 years, ?10 years), and the number of inpatient visits,number of hospital days, inpatient costs and outpatient costs. All analyses were performed using SPSS 17.0. The analysis methods include descriptive analysis,analysis of variance, nonparametric test, Chi squared test, logistic regression analysis and generalized linear regression.Results: Of the CHD patients, the rates of PA intensity(0, ?18.0 MET-h/week,18.01-36.0 MET-h/week, ?36.01MET-h/week) were 13.14%, 29.37%, 30.19%,27.30%, respectively; and those of years of PA(0 year, 1-4 years, 5-9 years, ?10years) were 13.14%, 11.97%, 14.51% and 60.39%, respectively.The rates for more than once inpatient visits were 30.37%, 23.42%, 25.51% and17.88% by PA intensity from no activity, light, moderate and vigorous of CHD patients; the hospital days were 18.91±18.03, 15.61±13.95, 15.62±12.65 and14.50±12.77 days; the median of total medical costs in 4 levels of PA intensity were11.88, 9.61, 9.79, 9.34(thousand RMB), respectively. The rates for more than once inpatient visits were 30.37%, 19.54%, 17.54% and 24.15% by PA years from 0 year,1-4 years, 5-9 years, ?10 years of CHD patients; the hospital days were 18.91±18.03,14.41±12.47, 13.82±11.70, 15.78±13.57 days; the median of total medical costs in 4levels of PA intensity were 11.88, 9.39, 9.00, 9.79(thousand RMB), respectively.After adjustment for potential confounders, multivariable analysis showed that,the number of inpatient visits, hospital days, inpatient costs and total costs were declined with different level of PA intensity, compared to no activity patients;especially for the vigorous PA intensity(OR=0.52, 95%CI=0.34~0.79; ?=-3.07, 95%CI=-5.45~-0.69; ?log =-0.081, 95% CI=-0.147~-0.015; ?log =-0.096, 95% CI=-0.162~-0.031; respectively). Inpatient costs and total medical costs by levels of the intensity of PA are very similar to those of levels of PA years.Conclusions: This study verified the effects of the intensity and years of PA on hospital service use and expenditure of CHD from the perspective of empirical. In particular, to cope with the long course of coronary heart disease and the challenges of the burden of disease caused by long-term care, keep exercising, especially the vigorous PA, should be advocated, which would contribute to the health of patients and the related health decision making.