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      Forecasting Diabetes Cases Prevented and Cost Savings Associated with Population Increases of Walking in the Greater Toronto and Hamilton Area, Canada

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          Abstract

          Promoting adequate levels of physical activity in the population is important for diabetes prevention. However, the scale needed to achieve tangible population benefits is unclear. We aimed to estimate the public health impact of increases in walking as a means of diabetes prevention and health care cost savings attributable to diabetes. We applied the validated Diabetes Population Risk Tool (DPoRT) to the 2015/16 Canadian Community Health Survey for adults aged 18–64, living in the Greater Toronto and Hamilton area, Ontario, Canada. DPoRT was used to generate three population-level scenarios involving increases in walking among individuals with low physical activity levels, low daily step counts and high dependency on non-active forms of travel, compared to a baseline scenario (no change in walking rates). We estimated number of diabetes cases prevented and health care costs saved in each scenario compared with the baseline. Each of the three scenarios predicted a considerable reduction in diabetes and related health care cost savings. In order of impact, the largest population benefits were predicted from targeting populations with low physical activity levels, low daily step counts, and non active transport use. Population increases of walking by 25 min each week was predicted to prevent up to 10.4 thousand diabetes cases and generate CAD 74.4 million in health care cost savings in 10 years. Diabetes reductions and cost savings were projected to be higher if increases of 150 min of walking per week could be achieved at the population-level (up to 54.3 thousand diabetes cases prevented and CAD 386.9 million in health care cost savings). Policy, programming, and community designs that achieve modest increases in population walking could translate to meaningful reductions in the diabetes burden and cost savings to the health care system.

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          Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants

          Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends.
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            The global economic burden of diabetes in adults aged 20-79 years: a cost-of-illness study.

            Differences in methods and data used in past studies have limited comparisons of the cost of illness of diabetes across countries. We estimate the full global economic burden of diabetes in adults aged 20-79 years in 2015, using a unified framework across all countries. Our objective was to highlight patterns of diabetes-associated costs as well as to identify the need for further research in low-income regions.
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              Large-scale physical activity data reveal worldwide activity inequality

              Understanding the basic principles that govern physical activity is needed to curb the global pandemic of physical inactivity 1–7 and the 5.3 million deaths per year associated with in-activity 2 . Our knowledge, however, remains limited owing to the lack of large-scale measurements of physical activity patterns across free-living populations worldwide 1, 6 . Here, we leverage the wide usage of smartphones with built-in accelerometry to measure physical activity at planetary scale. We study a dataset consisting of 68 million days of physical activity for 717,527 people, giving us a window into activity in 111 countries across the globe. We find inequality in how activity is distributed within countries and that this inequality is a better predictor of obesity prevalence in the population than average activity volume. Reduced activity in females contributes to a large portion of the observed activity inequality. Aspects of the built environment, such as the walkability of a city, were associated with less gender gap in activity and activity inequality. In more walkable cities, activity is greater throughout the day and throughout the week, across age, gender, and body mass index (BMI) groups, with the greatest increases in activity for females. Our findings have implications for global public health policy and urban planning and highlight the role of activity inequality and the built environment for improving physical activity and health.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                31 July 2021
                August 2021
                : 18
                : 15
                : 8127
                Affiliations
                [1 ]Dalla Lana School of Public Health, University of Toronto, Toronto, ON L5L 1C6, Canada; kathy.kornas@ 123456utoronto.ca
                [2 ]ICES, Toronto, ON M4N 3M5, Canada
                [3 ]Institute for Better Health, Trillium Health Partners, Mississauga, ON L5B 1B8, Canada
                [4 ]MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; ghazal.fazli@ 123456unityhealth.to (G.S.F.); gillian.booth@ 123456unityhealth.to (G.L.B.)
                [5 ]Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON L5L 1C6, Canada
                [6 ]Department of Medicine, St. Michael’s Hospital and the University of Toronto, Toronto, ON M5B 1W8, Canada
                Author notes
                [* ]Correspondence: laura.rosella@ 123456utoronto.ca ; Tel.: +1-416-978-6064
                Author information
                https://orcid.org/0000-0003-4867-869X
                Article
                ijerph-18-08127
                10.3390/ijerph18158127
                8345977
                34360428
                393a920d-181f-4b42-9ac1-35e01c4a8938
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 18 June 2021
                : 29 July 2021
                Categories
                Article

                Public health
                population-level,prevention,attributable costs,prediction model,type 2 diabetes
                Public health
                population-level, prevention, attributable costs, prediction model, type 2 diabetes

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