Gesa Czwikla1,2, Filip Boen3, Derek G Cook4, Johan de Jong5, Tess Harris4, Lisa K Hilz6,7, Steve Iliffe8, Lilian Lechner9, Richard W Morris10, Saskia Muellmann11, Denise A Peels9, Claudia R Pischke12, Benjamin Schüz7,13, Martin Stevens14, Klaus Telkmann6,7, Frank J van Lenthe15, Julie Vanderlinden3, Gabriele Bolte6,7. 1. Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany. gesa.czwikla@uni-bremen.de. 2. Health Sciences Bremen, University of Bremen, Bremen, Germany. gesa.czwikla@uni-bremen.de. 3. Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium. 4. Population Health Research Institute, St George's University of London, London, UK. 5. School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands. 6. Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany. 7. Health Sciences Bremen, University of Bremen, Bremen, Germany. 8. Research Department of Primary Care & Population Health, University College London, London, UK. 9. Faculty of Psychology, Open University, Heerlen, The Netherlands. 10. Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 11. Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. 12. Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine UniversityDuesseldorf, Duesseldorf, Germany. 13. Department of Prevention and Health Promotion, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany. 14. Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 15. Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. METHODS: The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. RESULTS: The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. CONCLUSIONS: To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
BACKGROUND: Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. METHODS: The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. RESULTS: The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. CONCLUSIONS: To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
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