Objective: To analyze sociodemographic and lifestyle factors associated with screen-based sedentary behavior (watching television ≥ 3 hours/day) among adult individuals in Brazil. Methods: Quantitative analysis of ten editions of the cross-sectional health survey VIGITEL, representative at the population level. Individuals from states’ capitals living in households with land-line telephone were randomly selected and interviewed with a structured questionnaire, through the telephone. A multivariate logistic regression model was estimated for identification of factors associated with screen-based sedentary behavior. Results: There was stability in trends referring to prevalence of sedentary behavior from 2008 to 2017. Prevalence of sedentary behavior was higher between individuals with unhealthier lifestyles: consumption of < two in natura food items (vegetables, fruits, and beans) per day (26.73% [95%CI 25.2 – 28.31]) in comparison with ≥ two items per day (23.79% [95%CI 21.92 – 25.77]); consumption of soft drinks ≥ five days per week (31.24% [95%CI 29.58 – 32.95]) than < five days per week (23.82% [95%CI 22.2 – 25.52]); and practice of < 150 minutes of physical activity per week (28.2% [95%CI 26.17 – 30.33]) than ≥ 150 minutes per week (22.54% [95%CI 21.27 – 23.86]). Regular consumption of in natura food items (OR = 0.984), practice of physical activity (OR = 0.798), and living in richer municipality (OR = 0.826) represented protective factors in relation to screen-based sedentary behavior, whilst regular consumption of soft drinks (OR = 1.440), smoking (OR = 1.375) and alcohol abuse (OR = 1.334) represented risk factors. Conclusion: The adoption of screen-based sedentary behavior among adult individuals in Brazil presented significant association with modifiable behavioral factors in the period 2008–2017.

The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

• Hospitalization costs were higher in private sector compared to public sector. • Physical activity and sedentary habits were associated with hospitalization costs. • Adherence to recommended physical activity reduces costs with hospitalizations. • Sedentarism and diagnosis of chronic diseases increase costs with hospitalizations. • There was low adherence to active lifestyles in Sao Paulo city.

The ongoing epidemiological and nutritional transitions impose a significant socioeconomic burden on health systems worldwide. However, evidence integrating population-based biological and lifestyle factors with direct economic valuation in mixed public-private health systems is limited in middle-income countries. Therefore, we analyzed factors associated with outpatient utilization and estimated direct costs (adjusted for International Dollars at Purchasing Power Parity - Int$ PPP) in a representative sample for São Paulo City, Brazil, from 2003 to 2015. Pooled cross-sectional observational study, with quantitative analyses of microdata from the São Paulo Health Survey 2003-2015 (ISA-Capital), combined with administrative data from the Brazilian Unified Health System Department of Informatics (SIA-SUS/DATASUS) and the Brazilian Hierarchical Categorization of Medical Procedures (CBHPM). A two-part regression model (logit and generalized linear model) and average marginal effects (ME) were estimated to identify factors associated with the likelihood of utilization and the direct costs of outpatient services. Utilization and costs were higher in more recent survey years. Socioeconomic factors, notably schooling (ME = 13.28, representing a 43.4% relative increase from the sample mean, p < 0.001), showed a stronger statistical association with direct costs than clinical conditions such as high blood pressure (ME = 10.48, 34.2% relative increase, p < 0.001) and overweight (ME = 5.79, 18.9% relative increase, p < 0.001). Female sex (ME = 3.53, 11.5% relative increase, p = 0.004) and private health insurance ownership (ME = 2.99, 9.8% relative increase, p = 0.021) were also positively associated with the outcomes. Our findings suggest that in the urban context of São Paulo, socioeconomic factors are primarily associated with the outpatient economic burden. Therefore, prioritizing equitable health policies targeting socioeconomically vulnerable groups, aiming to increase outpatient access and utilization, alongside early cardiometabolic risk management, may represent important strategies to strengthen the financial sustainability of Brazil's health system while improving population health.

Background/Objectives: There is a lack of empirical studies of out-of-pocket health expenditures associated with dyslipidemias, which are major cardiovascular risk factors, especially in underrepresented admixed populations. The study investigates associations of health costs with lipid traits, GWAS-derived genetic risk scores (GRSs), and other cardiometabolic risk factors. Methods: Data from the observational cross-sectional 2015 ISA-Nutrition comprised lifestyle, environmental factors, socioeconomic and demographic variables, and biochemical and genetic markers related to the occurrence of cardiometabolic diseases. GWAS-derived genetic risk scores were estimated from SNPs previously associated with lipid traits. There was phenotypic and genetic information available for 490 independent individuals, which was used as inputs for random forests and logistic regression to explain private quantitative and categorical health costs. Results: There were significant correlations between GRSs and their respective lipid phenotypes. The main relevant variables across techniques and outcome variables comprised income per capita, principal components of ancestry, diet quality, global physical activity, inflammatory and lipid markers, and LDL-c GRS and non-HDL-c GRS. The area under the ROC curve (AUC) of quartile-based categorical health expenditure without GRSs was 0.76. GRSs were not significant for this categorical outcome. Conclusions: We present an original contribution to the investigation of determinants of private health expenditures in a highly admixed population, providing insights on associations between genetic and socioeconomic dimensions of health in Brazil. Ancestry information was also among the main factors contributing to health expenses, providing a novel view of the role of genetic ancestry on cardiometabolic risk factors and its potential impact on health costs.

Background/Objectives: Non-Communicable Diseases (NCD) impose a substantial socioeconomic burden on health systems through direct costs and indirect costs from productivity loss due to health-related absenteeism. While lifestyle factors are crucial for NCD prevention, evidence regarding their association with absenteeism in middle-income countries, such as Brazil, remains limited. In this context, the present study aims to analyze factors associated with the odds, duration, and costs of health-related absenteeism in São Paulo City, Brazil. Methods: Quantitative analysis was performed using microdata from the São Paulo Health Survey 2003, 2008, and 2015 (ISA-Capital). Logistic and negative binomial regression models identified factors associated with the odds and duration of health-related absenteeism. The human capital approach was used to estimate indirect costs (Int$ PPP), while two-part regression models (logit and generalized linear model) and average marginal effects (ME) identified cost-associated factors. Results: Tobacco use and NCD diagnoses (hypertension, type 2 diabetes, and cardiovascular diseases) significantly increased the odds and duration of absenteeism. Conversely, meeting recommended leisure-time physical activity levels was associated with lower indirect costs (ME = −33.94, p < 0.05). Higher costs were significantly driven by tobacco use (ME = 48.68, p < 0.01) and NCD, namely cardiovascular diseases (ME = 62.73), diabetes (ME = 55.18), hypertension (ME = 52.13), and obesity (ME = 36.45), all with p < 0.05. Conclusions: Promoting leisure-time physical activity and tobacco cessation may be important strategies for public health policies aiming to enhance productivity by reducing the frequency, duration, and economic burden of health-related absenteeism, complementing the necessary diagnosis and monitoring of NCD.