Association of sitting time with mortality and cardiovascular events in high-income, middle-income, and low-income countries

• Published in: JAMA Cardiology
• Main Authors: Li, Sidong, Lear, Scott A, Rangarajan, Sumathy, Hu, Bo, Yin, Lu, Bangdiwala, Shrikant I, Alhabib, Khalid F, Rosengren, Annika, Gupta, Rajeev, Mony, Prem K, Wielgosz, Andreas, Rahman, Omar, Mazapuspavina, M Y, Avezum, Alvaro, Oguz, Aytekin, Yeates, Karen, Lanas, Fernando, Dans, Antonio, Abat, Marc Evans, Yusufali, Afzalhussein, Diaz, Rafael, Lopez-Jaramillo, Patricio, Leach, Lloyd, Lakshmi, P V, Basiak-Rasala, Alicja, Iqbal, Romaina, Kelishadi, Roya, Chifamba, Jephat, Khatib, Rasha, Li, Wei, Yusuf, Salim
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2022
• Subjects: Advocate Aurora Research Institute; Population Health and Public Health; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/254; https://doi.org/10.1001/jamacardio.2022.1581; https://libkey.io/libraries/1712/pmid/35704349

Importance: High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective: To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, setting, and participants: This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures: Daily sitting time measured using the International Physical Activity Questionnaire. Main outcomes and measures: The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results: Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and ...