Association Between Cardiorespiratory Fitness and Healthcare Costs in Adults Using the Criterion Referenced Fitness Thresholds: The Korea Institute of Sport Science Fitness Standards Study

Abstract

PURPOSE: This study aimed to determine the association between cardiorespiratory fitness (CRF) and healthcare utilization and healthcare costs in Korean adults using criterion-referenced health fitness thresholds.METHODS: The sample was drawn from the Korea Institute of Sport Science Fitness Standards Study (2014–2015) participants (n=1,780) aged 19–64 years. Participants completed a treadmill exercise test in which the peak oxygen uptake was estimated from the treadmill time. CRF thresholds were identified using receiver operating characteristic curve analysis using CRF z-scores as the test and metabolic syndrome as the criterion. The participants were categorized into low-, middle-, and high-risk groups. Healthcare utilization and healthcare costs, derived from the Korea National Health Insurance Data Sharing Service, were compared using multiple linear regression with control for body mass index (BMI), income, healthcare utilization, and healthcare costs in the previous year.RESULTS: In this study, two CRF thresholds were established: one for high sensitivity, the other for high specificity. CRF thresholds at the low-risk group were 35.2–42.6 mL/kg/min for men and 26.8–34.3 mL/kg/min for women. The total healthcare costs per participant per year for the middle- and high-risk groups were 173,016 Won and 324,840 Won, respectively, higher than those in the low-risk group after the adjustment for BMI, income, healthcare utilization, and costs in the previous year (p=.006, p<.001). The high-risk group had 2.890 visits, 3.177 visit days, and 27.215 prescription days, all of which were significantly higher than those of the low-risk group (p=.003, p=.003, p=.002).CONCLUSIONS: A low CRF is associated with higher healthcare utilization and costs. Improving CRF may result in lower healthcare utilization and costs.