Abstract
Evidence from studies conducted in high-income countries suggests that lifestyle factors, such as leisure-time physical activity, sedentary habits, and obesity, are associated with a significant socioeconomic burden of disease and the attribution of direct costs to healthcare systems. In Brazil, the occurrence of primary care-sensitive hospitalizations is responsible for a relevant socioeconomic burden. However, there is a scarcity of evidence regarding the association of lifestyle factors on the direct costs of the Brazilian healthcare system. In this context, the present study aims to analyze the association between leisure-time physical activity, sedentary habits, and obesity with hospitalization costs in São Paulo city, Brazil. A quantitative analysis of microdata from the São Paulo Health Survey (ISA-Capital), which is representative for the urban population of São Paulo City, and was conducted in 2003, 2008, and 2015, was employed. Multiple two-part regression models (logit and GLM) and marginal effects (ME) were estimated. The study's findings suggest that meeting the weekly frequency of leisure-time physical activity recommended by the World Health Organization is associated with lower hospitalization costs in the public (logit β = -0.475, p < 0.05; ME = -31.03, p < 0.05) and private sector (logit β = -0.494, p < 0.01; ME = -37.89, p < 0.01). Sedentary habits (logit β = 0.442, p < 0.05; ME = 40.92, p < 0.01), and obesity (GLM β = 0.385, p < 0.05) were associated with higher costs in the private sector. No associations were observed between sedentary habits and obesity for hospitalization costs in the public sector. The evidence from the present study suggests that policies encouraging the adoption of healthy active lifestyles, such as practicing leisure-time physical activity and reducing sedentary habits, as well as policies for obesity prevention, may be important strategies for minimizing hospitalization costs in urban population contexts in the two-tier of the Brazilian healthcare system. Yet, associations identified in the study should be interpreted with caution due to the impossibility of establishment of causal links between lifestyle factors and healthcare expenditures.