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. 2020 Jul;8(7):e920-e930.
doi: 10.1016/S2214-109X(20)30211-4.

Use of the prevented fraction for the population to determine deaths averted by existing prevalence of physical activity: a descriptive study

Tessa Strain  1 , Søren Brage  2 , Stephen J Sharp  2 , Justin Richards  3 , Marko Tainio  4 , Ding Ding  5 , Jacques Benichou  6 , Paul Kelly  7
Affiliations

Use of the prevented fraction for the population to determine deaths averted by existing prevalence of physical activity: a descriptive study

Tessa Strain et al. Lancet Glob Health. 2020 Jul.

Abstract

Background: Disease and mortality burdens of unhealthy lifestyle behaviours are often reported. In contrast, the positive narrative around the burdens that an existing behaviour have averted is rarely acknowledged. We aimed to estimate the prevented fraction for the population (PFP) for premature mortality averted by physical activity on a global scale.

Methods: In this descriptive study, we obtained previously published data on physical activity prevalence (2001-16) and relative risks of all-cause mortality for 168 countries. We combined the data in Monte-Carlo simulations to estimate country-specific, mean PFP values, corresponding to percentage of mortality averted, and their 95% CIs. High prevented fractions indicated an increased proportion of deaths averted due to physical activity. Using mortality data for all people in a country aged 40-74 years, we estimated the number of premature deaths averted for all adults and by gender. We present the median and range of the prevented fractions globally, by WHO region, and by World Bank income classification.

Findings: The global median PFP was 15·0% (range 6·6-20·5), conservatively equating to 3·9 million (95% CI 2·5-5·6) premature deaths averted annually. The African region had the highest median prevented fraction (16·6% [range 12·1-20·5]) and the Americas had the lowest (13·1% [10·8-16·6]). Low-income countries tended to have higher prevented fractions (group median 17·9% [12·3-20·5]) than high-income countries (14·1% [6·6-17·8]). Globally, the median prevented fraction was higher for men (16·0% [7·8-20·7] than women (14·1% [5·0-20·4]).

Interpretation: Existing physical activity prevalence has contributed to averting premature mortality across all countries. PFP has utility as an advocacy tool to promote healthy lifestyle behaviours. By making the case of what has been achieved, the prevented fraction can show the value of current investment and services, which might be conducive to political support.

Funding: UK Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, National Institute for Health Research, Wellcome Trust, Heart Foundation Australia.

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Figures

Figure
Figure
Median PFP estimates and corresponding number of deaths averted No range is presented for region and income groups with only one country. Countries in each region and income group are shown in the appendix (pp 29–36). Deaths averted is for the age range 40–74 years. Number of deaths averted for men and women might not add up to the estimate for both genders because the distributions of deaths across men and women are not even, and differences are magnified when multiplied by a derivative of activity prevalence, which also varies considerably by gender. PFP=prevented fraction for the population.
Figure
Figure
Median PFP estimates and corresponding number of deaths averted No range is presented for region and income groups with only one country. Countries in each region and income group are shown in the appendix (pp 29–36). Deaths averted is for the age range 40–74 years. Number of deaths averted for men and women might not add up to the estimate for both genders because the distributions of deaths across men and women are not even, and differences are magnified when multiplied by a derivative of activity prevalence, which also varies considerably by gender. PFP=prevented fraction for the population.
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