Evolution of sedentarism prevalence in Spanish population between 1987 and 2020

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"etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de la prevalencia de sedentarismo en la población española entre los años 1987 y 2020" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1372 "Ancho" => 2421 "Tamanyo" => 177045 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Annual percentage change (APC) in the prevalence of sedentary lifestyles in the main activity and in leisure time according to sex and age group with 95% confidence intervals (95% CI)." ] ] ] "textoCompleto" => "IntroductionA sedentary lifestyle is defined as any waking behaviour characterised by energy expenditure equal to or less than 1.5 metabolic equivalents (METs) while sitting, reclining or lying down.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> This behaviour is associated with an increased risk of all-cause mortality and an increased risk of developing chronic diseases such as type 2 diabetes, obesity, cardiovascular disease and cancer.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Moreover, it poses a separate health risk from physical inactivity. Thus, a person may be physically active, but will still be sedentary if he/she spends most of the day in a sedentary position.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>In order to counteract the impact of sedentary lifestyles on health, the World Health Organisation (WHO) recommends engaging in any physical activity, even light activity. However, the recommendation for additional health benefits focuses on more than 300 min of moderate physical activity, more than 150 min of vigorous physical activity or an equivalent combination over a week.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Thus, physical inactivity is defined as an insufficient level of physical activity that does not meet current WHO recommendations. Some authors have reported that performing 60−75 min of moderate physical activity daily eliminates the increased risk of mortality associated with sitting for more than 8 h.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The last 50 years have seen profound social changes affecting the industrial and service sectors, transport, urban planning and information technologies. This has resulted in an increase in the prevalence of sedentary lifestyles in Europe.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> Thus, a study that analysed the evolution of the prevalence of sedentary lifestyles in Europe between 2002–2017, using sitting for more than 4.30 h per day as the cut-off point for sedentary lifestyles, observed an increase of almost 7 percentage points in the prevalence of sedentary lifestyles between 2005 and 2017.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>In Spain, several studies have been carried out in which a sedentary lifestyle was analysed using data from National Health Surveys and European Health Surveys.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> However, none of these studies analysed changes in prevalence of sedentary lifestyles in Spain by sex and age group. Therefore, the aim of this study was to assess changes in the prevalence of sedentary lifestyles in the adult Spanish population during the period 1987–2020, as well as to assess how the prevalence varied in the Autonomous Communities (ACs) during the period 2011–2020.MethodsData sourceThe data sources for calculating the prevalence of sedentary lifestyles were the different editions of the Spanish National Health Survey (ENSE)<a class="elsevierStyleCrossRef" href="#bib0055">11</a> and the European Health Survey in Spain (EESE)<a class="elsevierStyleCrossRef" href="#bib0060">12</a> carried out during the period 1987–2020. Both surveys include the population resident in Spain aged 15 and over (before the ENSE-2011, 16 and over). Data for the years 1987 (n = 29,647), 1993 (n = 21,061), 1995 (n = 6395), 1997 (n = 6.396), 2001 (n = 21,067), 2003 (n = 21,650), 2006 (n = 29.478), 2011–2012 (n = 21,007) and 2017 (n = 23,089) were collected from the ENSE. Data for the years 2014 (n = 22,842) and 2020 (n = 22,072) were collected from the EESE. Data from the 2009 EESE were not used because it does not include any questions on sedentary lifestyles.Definition of a sedentary lifestyleA sedentary lifestyle was assessed through 3 indicators. The first indicator was a sedentary lifestyle in the main activity, understood as activity performed at work, school or at home. The second indicator was a sedentary lifestyle in leisure-time and the third indicator was a sedentary lifestyle in all settings, understood as the activity performed during a typical weekday without differentiating between main activity and leisure time.A sedentary lifestyle was assessed in all editions of ENSE and EESE using the adapted short version of the International Physical Activity Questionnaire (IPAQ).<a class="elsevierStyleCrossRef" href="#bib0065">13</a> This questionnaire uses the physical activity performed in the last 7 days as the time reference.A sedentary lifestyle in the main activityThe question "Which of these possibilities best describes your main activity (at work, at school, at home, at home…)?" was included in all the editions of the ENSE and EESE under consideration. The response options were "Sitting most of the day", "Standing most of the day without much movement or effort", "Walking, carrying some weight, frequent travelling" and "Heavy work, tasks requiring great physical effort". A sedentary person in the main activity was defined as a person who answered, "Sitting most of the day".A sedentary lifestyle in leisure timeThe 1993, 1995, 1997, 2001, 2011, 2014 and 2017 editions of the ENSE and EESE included the question "Which of these possibilities best describes the frequency with which you do some physical activity in your leisure time?" was included. The response options were "I don't do exercise. I spend my free time almost entirely sedentary (reading, watching TV, going to the cinema…)", "Some occasional physical activity or sport", "Regular physical activity, several times a month" and "Physical training several times a week". A sedentary person in leisure time was defined as a person who answered "I don't do exercise. I spend my free time almost entirely sedentary (reading, watching TV, going to the cinema…)".A sedentary lifestyle in all settingsThe 2011, 2017 and 2020 editions of the ENSE and EESE included the question "In the last 7 days, how long did you sit for on a typical weekday?". The total time referred to in this question was collected in hours and minutes. Since there is no agreed cut-off point for classifying a person as sedentary, the 2 cut-off points most commonly used in the scientific literature have been used: 270 min (4.30 h) and 420 min (7 h). Thus, a sedentary person in all settings was considered to be a person who exceeded 270 or 420 min per day of sedentary behaviour. A sedentary behaviour is defined as sitting at work, at home, in class, studying, reading, on public transport, during leisure time or watching TV.Statistical analysisPrevalence of a sedentary lifestyle for each setting were estimated overall, according to sex and age group and accompanied by 95% confidence intervals (95% CI). We also estimated the prevalence of a sedentary lifestyle in all settings by each Autonomous Community (A.C.) overall and according to sex, using more than 270 min sitting as the cut-off point. The prevalence of sedentary lifestyles by A.C. is shown in maps, categorising the prevalence of sedentary lifestyles into quartiles. Changes in the prevalence of sedentary lifestyles in main activity and leisure time was analysed through Joinpoint regression models. The Joinpoint regression models considered a maximum of 3 change points and selected the simplest model, i.e. with the fewest change points, with an acceptable degree of fit. For each period identified, the annual percentage change (APC) was extracted along with its 95% CI.Statistical analysis was performed with IBM SPSS® Statistics v.25 and Stata® v.17. The Joinpoint regression analysis was performed with the Joinpoint regression software v.4.9.1 and the spatial representation with QGIS v.3.14.16.ResultsA sedentary lifestyle in the main activity (period 1987–2020)In Spain, the prevalence of a sedentary lifestyle in the main activity increased from 31.2% (95% CI 30.7–31.7) in 1987 to 38.4% (95% CI 37.6–39.2) in 2020 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 1 in the Supplementary material). The Joinpoint model shows an upward trend in sedentary prevalences, with no change point and an APC of 0.7 (95% CI 0.5–1.0) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 in the Supplementary material).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>In males, a sedentary lifestyle increased by 4 percentage points between 1987 and 2020, reaching 37.8% in 2020 (95% CI 36.6–39.0). However, this increase was more significant among women. Thus, in 1987 the prevalence of a sedentary lifestyle in the main activity among women was 28.8% (95% CI 28.1–29.5) and in 2020 it was 39.0% (95% CI 37.8–40.1). The prevalence of sedentary lifestyles was always higher in males until 2017 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 1 in the Supplementary material). These upward trends were observed in the Joinpoint models. Thus, for the period 1987–2020, the APC for males was 0.4 (95% CI 0.1−0.7) and for females 1.1 (95% CI 0.7–1.4) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 in the Supplementary material).The highest prevalences of sedentary lifestyles were observed in the population aged 16−24 over the period, followed by the population aged 65 and over (<a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 1 of the Supplementary material). Through the Joinpoint models, it can be seen that the prevalence of sedentary lifestyles increased in all age groups, except in the 65+ age group (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 2 in the Supplementary material).A sedentary lifestyle in leisure time (period 1993–2020)The prevalence of a leisure-time sedentary lifestyle decreased by 18.7 percentage points overall between 1993 and 2020, 15 percentage points for males and 22.2 percentage points for females. Thus, the prevalence of a leisure-time sedentary lifestyle was 36.4% (95% CI 35.6–37.2) overall, 32.3% (95% CI 31.2–33.4) in males and 40.3% (95% CI 39.2–41.5) in females in 2020. Although the most significant decrease is observed in women, they had the highest prevalence of leisure-time sedentary lifestyle over the period (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 3 in the Supplementary material). In the Joinpoint models, a single period with a downward trend was found both overall and in males and females. Thus, overall, for the period 1993–2020 the APC was −1.4 (95% CI: −1.9 to −0.9), for males it was −1.3 (95% CI: −1.9 to −0.7), and for females it was –1.5 (95% CI: −2.0 to −0.9) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 of the Supplementary material).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The 16−24 age group showed the lowest prevalence of leisure-time sedentary lifestyle over the whole period, while the 65+ age group showed the highest (<a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 3 of the Supplementary material). In most age groups the Joinpoint model located periods with a decreasing trend, except for 16–24-year-olds. The highest APC (APC = −2.1; 95% CI: −2.7 to −1.4) was found in the 45–64 age group (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 of the Supplementary material).A sedentary lifestyle in all settings (2011–2020 period)Using 270 min as the cut-off point, the prevalence of a sedentary lifestyle in all settings in 2020 was 52.8% (95% CI 52.0–53.7), while using 420 min it was 25.0% (95% CI 24.2–25.7). Both cut-off points show an increase in the prevalence of sedentary lifestyles since 2011, both overall and in males and females. Regardless of the cut-off point used, the prevalence of sedentary lifestyles in the years 2011 and 2017 were higher in males. However, in 2020, prevalences were very similar in both sexes. The highest prevalence of a sedentary lifestyle in all settings was observed in the age group 16−24 years for both cut-off points (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The prevalence of a sedentary lifestyle in all settings (cut-off point 270 min) in 2011 ranged from 29.4% (95% CI 25.0–34.2) in Cantabria to 56.8% (95% CI 54.0–59.5) in the Community of Madrid. In 2017, Cantabria (14.5%, 95% CI 11.4–18.3) continued to have the lowest prevalence, but the highest value was observed in Catalonia (57.0%, 95% CI 54.5–59.4). In 2020, the Canary Islands had the lowest prevalence of sedentary lifestyles (29.2%, 95% CI 25.6–33.0) and the Community of Madrid the highest prevalence (67.9%, 95% CI 65.7–70.0) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 4 in the Supplementary material). The prevalence distribution by A.C. is similar in males, but different in females (<a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 4 of the Supplementary material). Data on prevalence of sedentary lifestyles in all settings by A.C. using 420 min as cut-off point are shown in <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 5 of the Supplementary material.<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionThe results of this study indicate that the prevalence of sedentary lifestyles in the main activity in the Spanish adult population has increased irrespective of gender and age group. However, the prevalence of leisure-time sedentary lifestyle shows a decreasing trend. The prevalence of a sedentary lifestyle in all settings, irrespective of the cut-off point, also increased, although in 2020 it was very similar for males and females. Cantabria and the Canary Islands were the most affected regions. The prevalence of sedentary lifestyles in all settings, irrespective of the cut-off point, also increased, although in 2020 it was very similar for males and females. Cantabria and the Canary Islands were the regions with the lowest prevalence of sedentary lifestyles in all settings during the period 2011–2020, while Catalonia and the Autonomous Community of Madrid were the regions with the highest prevalence.The increase in the prevalence of sedentary lifestyles in the main activity observed in this study has gone hand in hand with social changes and the increase in technological and administrative jobs, as well as the automation of the production process, which has eliminated many physical jobs.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Industrialisation and technological advances have led to an increase in sedentary jobs in recent decades,<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> which may explain the increase in the prevalence of sedentary lifestyles in this setting. The 2017 report on physical inactivity and sedentary lifestyles in the Spanish adult population also found an increase in the prevalence of sedentary lifestyles in the main activity between 1993 and 2014.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>The prevalence of sedentary lifestyles in the main activity was higher in males throughout much of the study period. However, the gap between men and women is narrowing. In fact, in 2020, the prevalence of a sedentary lifestyle in the main activity was for the first time higher in women. This may be due to the fact that the percentage of women with higher levels of education is increasingly higher,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> allowing them to reach positions of greater responsibility and importance that are often linked to more sedentary lifestyles.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> In addition, previous studies have found that having a high level of education is associated with an increased likelihood of a sedentary behavior.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>The population aged 16−24 years had the highest prevalence of a sedentary lifestyle in the main activity. This may be explained by the fact that a high percentage of the population in this age group are students, spending long periods of the day in a seated position due to their academic activity. On the other hand, the older population also showed a high prevalence of sedentary lifestyles during the main activity, which could be related to the reduced mobility associated with the physical problems of ageing.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a>A decrease in prevalence was observed in the leisure-time sedentary lifestyle setting. This decrease could be explained by the growing interest in the practice of physical activity in leisure time, to compensate for its absence during the working day, as well as strategies for the promotion of physical activity and healthy lifestyles in our country.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> In this setting, the highest prevalences were observed in females. These data coincide with studies carried out in Spain,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Madrid<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and Galicia,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> where a higher prevalence of sedentary lifestyles and physical inactivity in leisure time was observed in women. Several studies indicate that males are more physically active than females during leisure time and therefore show less sedentary behaviours.<a class="elsevierStyleCrossRefs" href="#bib0040">8,20</a> On the other hand, it should be noted that, although the prevalence of leisure-time sedentary lifestyle is decreasing, there are people who spend a large part of their free time in front of a screen. This behaviour is associated with increased mortality and increased incidence of cardiovascular disease or depression.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a>The population aged 16−24 had the lowest prevalence of sedentary lifestyles in the leisure-time sedentary lifestyle setting, while the population aged 65 and over had the highest prevalence. This can be explained by the fact that age is inversely related to physical activity.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Although a decrease in sedentary behaviours was observed in all age groups, it is important to note that 2 out of 10 people aged 16−24 remain sedentary. This sedentary behaviour could be related to the fact that many young people today spend their free time linked to the use of technologies that make them increasingly physically inactive.<a class="elsevierStyleCrossRefs" href="#bib0050">10,25</a>When assessing the presence of a sedentary behaviour, there is no clear criterion on the minimum time a person has to be in a sedentary position to be considered sedentary. From a public health point of view, individuals who spend more than 270 min (4.30 h) per day sitting are considered to have an increased risk of cardiovascular disease and associated mortality.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> However, in other studies, a minimum cut-off point of 420 min (7 h) is associated with increased all-cause mortality. In this study we have used 2 cut-off points (270 and 420 min) and no differences in prevalence behaviour were found, as expected, beyond higher prevalences for the 270 min cut-off point.In Spain, the prevalence of a sedentary lifestyle in all settings using 270 min as a cut-off point is 52.8% (2020). A study that assessed the changes in prevalence of sedentary lifestyles in all settings between 2002 and 2017 using the same cut-off point found that the prevalence in Spain was very similar to that observed in this study.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> According to data from the study by López-Valenciano et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Spain is one of the countries with the lowest prevalence of sedentary lifestyles, along with other European countries such as Romania, Portugal and Hungary. This is also in line with another study that looked at sedentary behaviour in 32 European countries and found Spain to be one of the least sedentary European countries, with an average of 284 min/day of sedentary behaviours.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> On the other hand, countries such as the Netherlands, Sweden and Denmark had the highest prevalence of sedentary lifestyles.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> This higher prevalence in Northern European countries was also observed in other studies.<a class="elsevierStyleCrossRefs" href="#bib0040">8,17</a>The prevalence of a sedentary lifestyle in all settings was higher in males than in females regardless of the cut-off point. This is in line with results obtained in previous studies using different cut-off points.<a class="elsevierStyleCrossRefs" href="#bib0035">7,17,27,28</a> However, prevalence data for the latest year (2020) show that differences in the prevalence of sedentary lifestyles between males and females have narrowed. As prevalence in all settings is analysed on the basis of self-reported number of hours a person sits per day, this increase may be influenced by the increase in sedentary occupations in recent years.<a class="elsevierStyleCrossRef" href="#bib0145">29</a>The prevalence of sedentary lifestyles in all settings varies according to the A.C. The regions with a higher Gross Domestic Product (GDP) had a higher prevalence of sedentary lifestyles (Comunidad de Madrid in 2011 and in 2020 and Catalonia in 2017), while those with a lower GDP showed the lowest prevalence (Cantabria in 2011 and 2017 and Canary Islands in 2020).<a class="elsevierStyleCrossRef" href="#bib0150">30</a> In the study by Bennie et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> high levels of sedentary lifestyles in European countries were associated with higher GDP. It is precisely these countries that have the highest proportion of white-collar jobs, the highest exposure to technology in the workplace, and the greatest access to automatic devices and technology in the home.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> This would explain their higher prevalence of sedentary lifestyles.This study has some limitations. Firstly, the information collected on the different sedentary lifestyle settings was self-reported, so the prevalence of a sedentary lifestyle might be underestimated. When all settings were assessed, it was not possible to perform an analysis of the changes in prevalence using Joinpoint models, because only three years of prevalence data were available. Data from the autonomous cities could not be included due to their limited sample size and, in the case of Melilla, data were only available for the year 2017.The main strength of this study is that the same questions regarding sedentary lifestyles were asked in all editions of the survey, making it possible to make comparisons between years. In addition, all surveys are representative of the Spanish population and the CIs have been calculated under the assumption of random sample selection and taking into account the weighting of respondents according to the sample design.ConclusionsIn conclusion, the prevalence of a sedentary lifestyle in the main activity in the Spanish population is increasing, while there is a decreasing trend in the leisure time setting. In terms of gender, in the last years of the period analysed, a higher prevalence of sedentary lifestyles is observed among women in both the main activity and leisure time settings. The prevalence of sedentary lifestyles in all the settings varies according to the Autonomous Community, with a higher prevalence of sedentary lifestyles found in the Autonomous Communities with a higher GDP. The increase in sedentary lifestyles in the main activity highlights the need to implement measures to prevent a sedentary lifestyle in occupations requiring long periods of sitting. On the other hand, it is essential to continue to promote physical activity during leisure time so that sedentary behaviours continue to decrease.Ethical considerationsEthical approval was not required, as this study is not conducted with human participants, including identifiable human material or identifiable data, and no human intervention is performed.FundingNo funding has been received for this work.Conflict of interestAll authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2149731" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1824889" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2149732" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1824890" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data source" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definition of a sedentary lifestyle" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "A sedentary lifestyle in the main activity" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "A sedentary lifestyle in leisure time" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "A sedentary lifestyle in all settings" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "A sedentary lifestyle in the main activity (period 1987–2020)" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "A sedentary lifestyle in leisure time (period 1993–2020)" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "A sedentary lifestyle in all settings (2011–2020 period)" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Ethical considerations" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-08-04" "fechaAceptado" => "2023-10-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1824889" "palabras" => array:5 [ 0 => "Sedentary behaviour" 1 => "Prevalence" 2 => "Surveys" 3 => "Physical activity" 4 => "Spain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1824890" "palabras" => array:5 [ 0 => "Sedentarismo" 1 => "Prevalencia" 2 => "Encuestas" 3 => "Actividad física" 4 => "España" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectiveSedentary behaviour is a predictive factor for numerous diseases. The objective of this study was to assess the evolution of the prevalence of sedentary behaviour in the Spanish adult population between 1987and 2020. MethodsThe data sources were the National and European Health Surveys. The prevalence of sedentary behaviour was assessed in three scenarios (main activity, leisure time and all scenarios). Prevalence of sedentary behaviour was estimated overall, by sex and age group. In all scenarios, prevalence was also estimated by Autonomous Community. The prevalence trend was analysed with the annual percent change (APC) obtained through joinpoint models. ResultsThe prevalence of sedentary in the main activity ranged from 31.2% in 1987 to 38.4% in 2020 (PCA: 0.7 (0.5–1.0)), being higher in men than in women and higher in younger and older people. The prevalence of sedentary in the leisure time varied between 55.1% in 1993 and 36.4% in 2020 (PCA: −1.4 (−1.9 to −0.9)), being always higher in women, higher in those over 64 years of age and lower in those aged 16−24 years. Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behaviour in all scenarios. ConclusionsThe prevalence of sedentary behaviour in the main activity is increasing in Spain, whereas during leisure time it is decreasing. It is important to implement prevention and health promotion measures aimed at reducing sedentary behaviour in the population." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivoEl sedentarismo es un factor predictivo para numerosas enfermedades. El objetivo de este estudio fue valorar la evolución de la prevalencia de sedentarismo en población española adulta entre 1987–2020. MétodosLas fuentes de datos fueron las Encuestas Nacionales y Europeas de Salud. La prevalencia de sedentarismo se valoró en tres escenarios (actividad principal, tiempo libre y todos los escenarios). Se estimaron prevalencias de sedentarismo global, por sexo y grupo de edad. En todos los escenarios la prevalencia también se estimó por Comunidad Autónoma. La tendencia de las prevalencias se analizó con los porcentajes de cambio anual (PCA) obtenidos a través de modelos joinpoint. ResultadosLa prevalencia de sedentarismo en la actividad principal varió entre el 31,2% en 1987 y el 38,4% en 2020 (PCA: 0,7 (0,5 a 1,0)), siendo mayor en hombres que en mujeres y más elevada en los más jóvenes y en los más mayores. La prevalencia de sedentarismo en el tiempo libre varió entre el 55,1% en 1993 y el 36,4% en 2020 (PCA: -1,4 (-1,9 a -0,9)), siendo siempre superior en mujeres, más alta en mayores de 64 años y menor en los de 16−24 años. Cantabria y Canarias fueron las Comunidades Autónomas con la prevalencia de sedentarismo más baja en todos los escenarios. ConclusionesLa prevalencia de sedentarismo en la actividad principal está aumentando en España, mientras que durante el tiempo libre está descendiendo. Es importante aplicar medidas de prevención y promoción de la salud dirigidas a disminuir el sedentarismo en la población." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0095" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1181 "Ancho" => 1625 "Tamanyo" => 82374 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Changes in the overall prevalence of a sedentary lifestyle in the main activity, in males and females with 95% confidence intervals. Period 1987–2020." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1372 "Ancho" => 2421 "Tamanyo" => 177045 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Annual percentage change (APC) in the prevalence of sedentary lifestyles in the main activity and in leisure time according to sex and age group with 95% confidence intervals (95% CI)." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1180 "Ancho" => 1625 "Tamanyo" => 78195 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Changes in the overall prevalence of leisure-time sedentary lifestyle, for males and females, with 95% confidence intervals. Period 1993–2020." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 925 "Ancho" => 3458 "Tamanyo" => 231667 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Prevalence of overall sedentary lifestyle in all settings in the years 2011, 2017 and 2020 according to autonomous community (cut-off point 270 min)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "95% CI: 95% confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Overall</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Males</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Females</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="12" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age groups</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">16−24 years</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">25−44 years old</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">45−64 years</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65 years old</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95% CI</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="22" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cut-off point 270 min</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="22" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cut-off point 420 min</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3542890.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prevalence of a sedentary lifestyle in all settings, in males, in females and by age group, with 95% confidence intervals. Period 2011–2020." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 57305 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.S. Tremblay" 1 => "S. Aubert" 2 => "J.D. Barnes" 3 => "T.J. Saunders" 4 => "V. Carson" 5 => "A.E. 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Original article

Evolution of sedentarism prevalence in Spanish population between 1987 and 2020

Evolución de la prevalencia de sedentarismo en la población española entre los años 1987 y 2020

María Fe Montero-Torreiroa,b, Julia Rey-Brandariza,c,

Corresponding author

juliarey.brandariz@usc.es

Corresponding author.

, Carla Guerra-Torta, Cristina Candal-Pedreiraa,c,d, María Isolina Santiago-Pérezb, Leonor Varela-Lemaa,c,d, Silvia Suárez Luqueb, Mónica Pérez-Ríosa,c,d

a Área de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain

b Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain

c CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

d Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A sedentary lifestyle is defined as any waking behaviour characterised by energy expenditure equal to or less than 1&#46;5 metabolic equivalents &#40;METs&#41; while sitting&#44; reclining or lying down&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This behaviour is associated with an increased risk of all-cause mortality and an increased risk of developing chronic diseases such as type 2 diabetes&#44; obesity&#44; cardiovascular disease and cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Moreover&#44; it poses a separate health risk from physical inactivity&#46; Thus&#44; a person may be physically active&#44; but will still be sedentary if he&#47;she spends most of the day in a sedentary position&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to counteract the impact of sedentary lifestyles on health&#44; the World Health Organisation &#40;WHO&#41; recommends engaging in any physical activity&#44; even light activity&#46; However&#44; the recommendation for additional health benefits focuses on more than 300&#8239;min of moderate physical activity&#44; more than 150&#8239;min of vigorous physical activity or an equivalent combination over a week&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Thus&#44; physical inactivity is defined as an insufficient level of physical activity that does not meet current WHO recommendations&#46; Some authors have reported that performing 60&#8722;75&#8239;min of moderate physical activity daily eliminates the increased risk of mortality associated with sitting for more than 8&#8239;h&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The last 50 years have seen profound social changes affecting the industrial and service sectors&#44; transport&#44; urban planning and information technologies&#46; This has resulted in an increase in the prevalence of sedentary lifestyles in Europe&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> Thus&#44; a study that analysed the evolution of the prevalence of sedentary lifestyles in Europe between 2002&#8211;2017&#44; using sitting for more than 4&#46;30&#8239;h per day as the cut-off point for sedentary lifestyles&#44; observed an increase of almost 7 percentage points in the prevalence of sedentary lifestyles between 2005 and 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain&#44; several studies have been carried out in which a sedentary lifestyle was analysed using data from National Health Surveys and European Health Surveys&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> However&#44; none of these studies analysed changes in prevalence of sedentary lifestyles in Spain by sex and age group&#46; Therefore&#44; the aim of this study was to assess changes in the prevalence of sedentary lifestyles in the adult Spanish population during the period 1987&#8211;2020&#44; as well as to assess how the prevalence varied in the Autonomous Communities &#40;ACs&#41; during the period 2011&#8211;2020&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data source</span><p id="par0025" class="elsevierStylePara elsevierViewall">The data sources for calculating the prevalence of sedentary lifestyles were the different editions of the Spanish National Health Survey &#40;ENSE&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and the European Health Survey in Spain &#40;EESE&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> carried out during the period 1987&#8211;2020&#46; Both surveys include the population resident in Spain aged 15 and over &#40;before the ENSE-2011&#44; 16 and over&#41;&#46; Data for the years 1987 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;29&#44;647&#41;&#44; 1993 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;21&#44;061&#41;&#44; 1995 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;6395&#41;&#44; 1997 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;6&#46;396&#41;&#44; 2001 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;21&#44;067&#41;&#44; 2003 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;21&#44;650&#41;&#44; 2006 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;29&#46;478&#41;&#44; 2011&#8211;2012 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;21&#44;007&#41; and 2017 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;23&#44;089&#41; were collected from the ENSE&#46; Data for the years 2014 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;22&#44;842&#41; and 2020 &#40;<span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;22&#44;072&#41; were collected from the EESE&#46; Data from the 2009 EESE were not used because it does not include any questions on sedentary lifestyles&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definition of a sedentary lifestyle</span><p id="par0030" class="elsevierStylePara elsevierViewall">A sedentary lifestyle was assessed through 3 indicators&#46; The first indicator was a sedentary lifestyle in the main activity&#44; understood as activity performed at work&#44; school or at home&#46; The second indicator was a sedentary lifestyle in leisure-time and the third indicator was a sedentary lifestyle in all settings&#44; understood as the activity performed during a typical weekday without differentiating between main activity and leisure time&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A sedentary lifestyle was assessed in all editions of ENSE and EESE using the adapted short version of the International Physical Activity Questionnaire &#40;IPAQ&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This questionnaire uses the physical activity performed in the last 7 days as the time reference&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">A sedentary lifestyle in the main activity</span><p id="par0040" class="elsevierStylePara elsevierViewall">The question &#34;<span class="elsevierStyleItalic">Which of these possibilities best describes your main activity &#40;at work&#44; at school&#44; at home&#44; at home&#8230;&#41;&#63;</span>&#34; was included in all the editions of the ENSE and EESE under consideration&#46; The response options were &#34;<span class="elsevierStyleItalic">Sitting most of the day&#34;&#44; &#34;Standing most of the day without much movement or effort&#34;&#44; &#34;Walking&#44; carrying some weight&#44; frequent travelling&#34; and &#34;Heavy work&#44; tasks requiring great physical effort</span>&#34;&#46; A sedentary person in the main activity was defined as a person who answered&#44; &#34;<span class="elsevierStyleItalic">Sitting most of the day</span>&#34;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">A sedentary lifestyle in leisure time</span><p id="par0045" class="elsevierStylePara elsevierViewall">The 1993&#44; 1995&#44; 1997&#44; 2001&#44; 2011&#44; 2014 and 2017 editions of the ENSE and EESE included the question <span class="elsevierStyleItalic">&#34;Which of these possibilities best describes the frequency with which you do some physical activity in your leisure time&#63;&#34;</span> was included&#46; The response options were <span class="elsevierStyleItalic">&#34;I don&#39;t do exercise&#46; I spend my free time almost entirely sedentary &#40;reading&#44; watching TV&#44; going to the cinema&#8230;&#41;&#34;&#44; &#34;Some occasional physical activity or sport&#34;&#44; &#34;Regular physical activity&#44; several times a month&#34;</span> and <span class="elsevierStyleItalic">&#34;Physical training several times a week&#34;&#46;</span> A sedentary person in leisure time was defined as a person who answered <span class="elsevierStyleItalic">&#34;I don&#39;t do exercise&#46; I spend my free time almost entirely sedentary &#40;reading&#44; watching TV&#44; going to the cinema&#8230;&#41;&#34;&#46;</span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">A sedentary lifestyle in all settings</span><p id="par0050" class="elsevierStylePara elsevierViewall">The 2011&#44; 2017 and 2020 editions of the ENSE and EESE included the question &#34;<span class="elsevierStyleItalic">In the last 7 days&#44; how long did you sit for on a typical weekday&#63;</span>&#34;&#46; The total time referred to in this question was collected in hours and minutes&#46; Since there is no agreed cut-off point for classifying a person as sedentary&#44; the 2 cut-off points most commonly used in the scientific literature have been used&#58; 270&#8239;min &#40;4&#46;30&#8239;h&#41; and 420&#8239;min &#40;7&#8239;h&#41;&#46; Thus&#44; a sedentary person in all settings was considered to be a person who exceeded 270 or 420&#8239;min per day of sedentary behaviour&#46; A sedentary behaviour is defined as sitting at work&#44; at home&#44; in class&#44; studying&#44; reading&#44; on public transport&#44; during leisure time or watching TV&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Prevalence of a sedentary lifestyle for each setting were estimated overall&#44; according to sex and age group and accompanied by 95&#37; confidence intervals &#40;95&#37; CI&#41;&#46; We also estimated the prevalence of a sedentary lifestyle in all settings by each Autonomous Community &#40;A&#46;C&#46;&#41; overall and according to sex&#44; using more than 270&#8239;min sitting as the cut-off point&#46; The prevalence of sedentary lifestyles by A&#46;C&#46; is shown in maps&#44; categorising the prevalence of sedentary lifestyles into quartiles&#46; Changes in the prevalence of sedentary lifestyles in main activity and leisure time was analysed through Joinpoint regression models&#46; The Joinpoint regression models considered a maximum of 3 change points and selected the simplest model&#44; i&#46;e&#46; with the fewest change points&#44; with an acceptable degree of fit&#46; For each period identified&#44; the annual percentage change &#40;APC&#41; was extracted along with its 95&#37; CI&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with IBM SPSS&#174; Statistics v&#46;25 and Stata&#174; v&#46;17&#46; The Joinpoint regression analysis was performed with the Joinpoint regression software v&#46;4&#46;9&#46;1 and the spatial representation with QGIS v&#46;3&#46;14&#46;16&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">A sedentary lifestyle in the main activity &#40;period 1987&#8211;2020&#41;</span><p id="par0065" class="elsevierStylePara elsevierViewall">In Spain&#44; the prevalence of a sedentary lifestyle in the main activity increased from 31&#46;2&#37; &#40;95&#37; CI 30&#46;7&#8211;31&#46;7&#41; in 1987 to 38&#46;4&#37; &#40;95&#37; CI 37&#46;6&#8211;39&#46;2&#41; in 2020 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 1 in the Supplementary material&#41;&#46; The Joinpoint model shows an upward trend in sedentary prevalences&#44; with no change point and an APC of 0&#46;7 &#40;95&#37; CI 0&#46;5&#8211;1&#46;0&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 in the Supplementary material&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In males&#44; a sedentary lifestyle increased by 4 percentage points between 1987 and 2020&#44; reaching 37&#46;8&#37; in 2020 &#40;95&#37; CI 36&#46;6&#8211;39&#46;0&#41;&#46; However&#44; this increase was more significant among women&#46; Thus&#44; in 1987 the prevalence of a sedentary lifestyle in the main activity among women was 28&#46;8&#37; &#40;95&#37; CI 28&#46;1&#8211;29&#46;5&#41; and in 2020 it was 39&#46;0&#37; &#40;95&#37; CI 37&#46;8&#8211;40&#46;1&#41;&#46; The prevalence of sedentary lifestyles was always higher in males until 2017 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 1 in the Supplementary material&#41;&#46; These upward trends were observed in the Joinpoint models&#46; Thus&#44; for the period 1987&#8211;2020&#44; the APC for males was 0&#46;4 &#40;95&#37; CI 0&#46;1&#8722;0&#46;7&#41; and for females 1&#46;1 &#40;95&#37; CI 0&#46;7&#8211;1&#46;4&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 in the Supplementary material&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The highest prevalences of sedentary lifestyles were observed in the population aged 16&#8722;24 over the period&#44; followed by the population aged 65 and over &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 1 of the Supplementary material&#41;&#46; Through the Joinpoint models&#44; it can be seen that the prevalence of sedentary lifestyles increased in all age groups&#44; except in the 65&#43; age group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 2 in the Supplementary material&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">A sedentary lifestyle in leisure time &#40;period 1993&#8211;2020&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">The prevalence of a leisure-time sedentary lifestyle decreased by 18&#46;7 percentage points overall between 1993 and 2020&#44; 15 percentage points for males and 22&#46;2 percentage points for females&#46; Thus&#44; the prevalence of a leisure-time sedentary lifestyle was 36&#46;4&#37; &#40;95&#37; CI 35&#46;6&#8211;37&#46;2&#41; overall&#44; 32&#46;3&#37; &#40;95&#37; CI 31&#46;2&#8211;33&#46;4&#41; in males and 40&#46;3&#37; &#40;95&#37; CI 39&#46;2&#8211;41&#46;5&#41; in females in 2020&#46; Although the most significant decrease is observed in women&#44; they had the highest prevalence of leisure-time sedentary lifestyle over the period &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 3 in the Supplementary material&#41;&#46; In the Joinpoint models&#44; a single period with a downward trend was found both overall and in males and females&#46; Thus&#44; overall&#44; for the period 1993&#8211;2020 the APC was &#8722;1&#46;4 &#40;95&#37; CI&#58; &#8722;1&#46;9 to &#8722;0&#46;9&#41;&#44; for males it was &#8722;1&#46;3 &#40;95&#37; CI&#58; &#8722;1&#46;9 to &#8722;0&#46;7&#41;&#44; and for females it was &#8211;1&#46;5 &#40;95&#37; CI&#58; &#8722;2&#46;0 to &#8722;0&#46;9&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 of the Supplementary material&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The 16&#8722;24 age group showed the lowest prevalence of leisure-time sedentary lifestyle over the whole period&#44; while the 65&#43; age group showed the highest &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 3 of the Supplementary material&#41;&#46; In most age groups the Joinpoint model located periods with a decreasing trend&#44; except for 16&#8211;24-year-olds&#46; The highest APC &#40;APC&#8239;&#61;&#8239;&#8722;2&#46;1&#59; 95&#37; CI&#58; &#8722;2&#46;7 to &#8722;1&#46;4&#41; was found in the 45&#8211;64 age group &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 2 of the Supplementary material&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">A sedentary lifestyle in all settings &#40;2011&#8211;2020 period&#41;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Using 270&#8239;min as the cut-off point&#44; the prevalence of a sedentary lifestyle in all settings in 2020 was 52&#46;8&#37; &#40;95&#37; CI 52&#46;0&#8211;53&#46;7&#41;&#44; while using 420&#8239;min it was 25&#46;0&#37; &#40;95&#37; CI 24&#46;2&#8211;25&#46;7&#41;&#46; Both cut-off points show an increase in the prevalence of sedentary lifestyles since 2011&#44; both overall and in males and females&#46; Regardless of the cut-off point used&#44; the prevalence of sedentary lifestyles in the years 2011 and 2017 were higher in males&#46; However&#44; in 2020&#44; prevalences were very similar in both sexes&#46; The highest prevalence of a sedentary lifestyle in all settings was observed in the age group 16&#8722;24 years for both cut-off points &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The prevalence of a sedentary lifestyle in all settings &#40;cut-off point 270&#8239;min&#41; in 2011 ranged from 29&#46;4&#37; &#40;95&#37; CI 25&#46;0&#8211;34&#46;2&#41; in Cantabria to 56&#46;8&#37; &#40;95&#37; CI 54&#46;0&#8211;59&#46;5&#41; in the Community of Madrid&#46; In 2017&#44; Cantabria &#40;14&#46;5&#37;&#44; 95&#37; CI 11&#46;4&#8211;18&#46;3&#41; continued to have the lowest prevalence&#44; but the highest value was observed in Catalonia &#40;57&#46;0&#37;&#44; 95&#37; CI 54&#46;5&#8211;59&#46;4&#41;&#46; In 2020&#44; the Canary Islands had the lowest prevalence of sedentary lifestyles &#40;29&#46;2&#37;&#44; 95&#37; CI 25&#46;6&#8211;33&#46;0&#41; and the Community of Madrid the highest prevalence &#40;67&#46;9&#37;&#44; 95&#37; CI 65&#46;7&#8211;70&#46;0&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> and <a class="elsevierStyleCrossRef" href="#sec0090">Appendix</a> Table 4 in the Supplementary material&#41;&#46; The prevalence distribution by A&#46;C&#46; is similar in males&#44; but different in females &#40;<a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 4 of the Supplementary material&#41;&#46; Data on prevalence of sedentary lifestyles in all settings by A&#46;C&#46; using 420&#8239;min as cut-off point are shown in <a class="elsevierStyleCrossRef" href="#sec0090">Appendix A</a> Table 5 of the Supplementary material&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The results of this study indicate that the prevalence of sedentary lifestyles in the main activity in the Spanish adult population has increased irrespective of gender and age group&#46; However&#44; the prevalence of leisure-time sedentary lifestyle shows a decreasing trend&#46; The prevalence of a sedentary lifestyle in all settings&#44; irrespective of the cut-off point&#44; also increased&#44; although in 2020 it was very similar for males and females&#46; Cantabria and the Canary Islands were the most affected regions&#46; The prevalence of sedentary lifestyles in all settings&#44; irrespective of the cut-off point&#44; also increased&#44; although in 2020 it was very similar for males and females&#46; Cantabria and the Canary Islands were the regions with the lowest prevalence of sedentary lifestyles in all settings during the period 2011&#8211;2020&#44; while Catalonia and the Autonomous Community of Madrid were the regions with the highest prevalence&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The increase in the prevalence of sedentary lifestyles in the main activity observed in this study has gone hand in hand with social changes and the increase in technological and administrative jobs&#44; as well as the automation of the production process&#44; which has eliminated many physical jobs&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Industrialisation and technological advances have led to an increase in sedentary jobs in recent decades&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> which may explain the increase in the prevalence of sedentary lifestyles in this setting&#46; The 2017 report on physical inactivity and sedentary lifestyles in the Spanish adult population also found an increase in the prevalence of sedentary lifestyles in the main activity between 1993 and 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The prevalence of sedentary lifestyles in the main activity was higher in males throughout much of the study period&#46; However&#44; the gap between men and women is narrowing&#46; In fact&#44; in 2020&#44; the prevalence of a sedentary lifestyle in the main activity was for the first time higher in women&#46; This may be due to the fact that the percentage of women with higher levels of education is increasingly higher&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> allowing them to reach positions of greater responsibility and importance that are often linked to more sedentary lifestyles&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In addition&#44; previous studies have found that having a high level of education is associated with an increased likelihood of a sedentary behavior&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The population aged 16&#8722;24 years had the highest prevalence of a sedentary lifestyle in the main activity&#46; This may be explained by the fact that a high percentage of the population in this age group are students&#44; spending long periods of the day in a seated position due to their academic activity&#46; On the other hand&#44; the older population also showed a high prevalence of sedentary lifestyles during the main activity&#44; which could be related to the reduced mobility associated with the physical problems of ageing&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">A decrease in prevalence was observed in the leisure-time sedentary lifestyle setting&#46; This decrease could be explained by the growing interest in the practice of physical activity in leisure time&#44; to compensate for its absence during the working day&#44; as well as strategies for the promotion of physical activity and healthy lifestyles in our country&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In this setting&#44; the highest prevalences were observed in females&#46; These data coincide with studies carried out in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Madrid<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and Galicia&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> where a higher prevalence of sedentary lifestyles and physical inactivity in leisure time was observed in women&#46; Several studies indicate that males are more physically active than females during leisure time and therefore show less sedentary behaviours&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;20</span></a> On the other hand&#44; it should be noted that&#44; although the prevalence of leisure-time sedentary lifestyle is decreasing&#44; there are people who spend a large part of their free time in front of a screen&#46; This behaviour is associated with increased mortality and increased incidence of cardiovascular disease or depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The population aged 16&#8722;24 had the lowest prevalence of sedentary lifestyles in the leisure-time sedentary lifestyle setting&#44; while the population aged 65 and over had the highest prevalence&#46; This can be explained by the fact that age is inversely related to physical activity&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Although a decrease in sedentary behaviours was observed in all age groups&#44; it is important to note that 2 out of 10 people aged 16&#8722;24 remain sedentary&#46; This sedentary behaviour could be related to the fact that many young people today spend their free time linked to the use of technologies that make them increasingly physically inactive&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">When assessing the presence of a sedentary behaviour&#44; there is no clear criterion on the minimum time a person has to be in a sedentary position to be considered sedentary&#46; From a public health point of view&#44; individuals who spend more than 270&#8239;min &#40;4&#46;30&#8239;h&#41; per day sitting are considered to have an increased risk of cardiovascular disease and associated mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> However&#44; in other studies&#44; a minimum cut-off point of 420&#8239;min &#40;7&#8239;h&#41; is associated with increased all-cause mortality&#46; In this study we have used 2 cut-off points &#40;270 and 420&#8239;min&#41; and no differences in prevalence behaviour were found&#44; as expected&#44; beyond higher prevalences for the 270&#8239;min&#8239;cut-off point&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In Spain&#44; the prevalence of a sedentary lifestyle in all settings using 270&#8239;min as a cut-off point is 52&#46;8&#37; &#40;2020&#41;&#46; A study that assessed the changes in prevalence of sedentary lifestyles in all settings between 2002 and 2017 using the same cut-off point found that the prevalence in Spain was very similar to that observed in this study&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> According to data from the study by L&#243;pez-Valenciano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Spain is one of the countries with the lowest prevalence of sedentary lifestyles&#44; along with other European countries such as Romania&#44; Portugal and Hungary&#46; This is also in line with another study that looked at sedentary behaviour in 32 European countries and found Spain to be one of the least sedentary European countries&#44; with an average of 284&#8239;min&#47;day of sedentary behaviours&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> On the other hand&#44; countries such as the Netherlands&#44; Sweden and Denmark had the highest prevalence of sedentary lifestyles&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This higher prevalence in Northern European countries was also observed in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;17</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The prevalence of a sedentary lifestyle in all settings was higher in males than in females regardless of the cut-off point&#46; This is in line with results obtained in previous studies using different cut-off points&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;17&#44;27&#44;28</span></a> However&#44; prevalence data for the latest year &#40;2020&#41; show that differences in the prevalence of sedentary lifestyles between males and females have narrowed&#46; As prevalence in all settings is analysed on the basis of self-reported number of hours a person sits per day&#44; this increase may be influenced by the increase in sedentary occupations in recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The prevalence of sedentary lifestyles in all settings varies according to the A&#46;C&#46; The regions with a higher Gross Domestic Product &#40;GDP&#41; had a higher prevalence of sedentary lifestyles &#40;Comunidad de Madrid in 2011 and in 2020 and Catalonia in 2017&#41;&#44; while those with a lower GDP showed the lowest prevalence &#40;Cantabria in 2011 and 2017 and Canary Islands in 2020&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> In the study by Bennie et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> high levels of sedentary lifestyles in European countries were associated with higher GDP&#46; It is precisely these countries that have the highest proportion of white-collar jobs&#44; the highest exposure to technology in the workplace&#44; and the greatest access to automatic devices and technology in the home&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This would explain their higher prevalence of sedentary lifestyles&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">This study has some limitations&#46; Firstly&#44; the information collected on the different sedentary lifestyle settings was self-reported&#44; so the prevalence of a sedentary lifestyle might be underestimated&#46; When all settings were assessed&#44; it was not possible to perform an analysis of the changes in prevalence using Joinpoint models&#44; because only three years of prevalence data were available&#46; Data from the autonomous cities could not be included due to their limited sample size and&#44; in the case of Melilla&#44; data were only available for the year 2017&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The main strength of this study is that the same questions regarding sedentary lifestyles were asked in all editions of the survey&#44; making it possible to make comparisons between years&#46; In addition&#44; all surveys are representative of the Spanish population and the CIs have been calculated under the assumption of random sample selection and taking into account the weighting of respondents according to the sample design&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; the prevalence of a sedentary lifestyle in the main activity in the Spanish population is increasing&#44; while there is a decreasing trend in the leisure time setting&#46; In terms of gender&#44; in the last years of the period analysed&#44; a higher prevalence of sedentary lifestyles is observed among women in both the main activity and leisure time settings&#46; The prevalence of sedentary lifestyles in all the settings varies according to the Autonomous Community&#44; with a higher prevalence of sedentary lifestyles found in the Autonomous Communities with a higher GDP&#46; The increase in sedentary lifestyles in the main activity highlights the need to implement measures to prevent a sedentary lifestyle in occupations requiring long periods of sitting&#46; On the other hand&#44; it is essential to continue to promote physical activity during leisure time so that sedentary behaviours continue to decrease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Ethical considerations</span><p id="par0165" class="elsevierStylePara elsevierViewall">Ethical approval was not required&#44; as this study is not conducted with human participants&#44; including identifiable human material or identifiable data&#44; and no human intervention is performed&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">No funding has been received for this work&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">All authors declare that they have no conflict of interest&#46;</p></span></span>"
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              "titulo" => "A sedentary lifestyle in the main activity"
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              "titulo" => "A sedentary lifestyle in the main activity &#40;period 1987&#8211;2020&#41;"
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              "identificador" => "sec0055"
              "titulo" => "A sedentary lifestyle in leisure time &#40;period 1993&#8211;2020&#41;"
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              "titulo" => "A sedentary lifestyle in all settings &#40;2011&#8211;2020 period&#41;"
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            0 => "Sedentary behaviour"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Sedentary behaviour is a predictive factor for numerous diseases&#46; The objective of this study was to assess the evolution of the prevalence of sedentary behaviour in the Spanish adult population between 1987and 2020&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The data sources were the National and European Health Surveys&#46; The prevalence of sedentary behaviour was assessed in three scenarios &#40;main activity&#44; leisure time and all scenarios&#41;&#46; Prevalence of sedentary behaviour was estimated overall&#44; by sex and age group&#46; In all scenarios&#44; prevalence was also estimated by Autonomous Community&#46; The prevalence trend was analysed with the annual percent change &#40;APC&#41; obtained through joinpoint models&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The prevalence of sedentary in the main activity ranged from 31&#46;2&#37; in 1987 to 38&#46;4&#37; in 2020 &#40;PCA&#58; 0&#46;7 &#40;0&#46;5&#8211;1&#46;0&#41;&#41;&#44; being higher in men than in women and higher in younger and older people&#46; The prevalence of sedentary in the leisure time varied between 55&#46;1&#37; in 1993 and 36&#46;4&#37; in 2020 &#40;PCA&#58; &#8722;1&#46;4 &#40;&#8722;1&#46;9 to &#8722;0&#46;9&#41;&#41;&#44; being always higher in women&#44; higher in those over 64 years of age and lower in those aged 16&#8722;24 years&#46; Cantabria and the Canary Islands were the Autonomous Communities with the lowest prevalence of sedentary behaviour in all scenarios&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The prevalence of sedentary behaviour in the main activity is increasing in Spain&#44; whereas during leisure time it is decreasing&#46; It is important to implement prevention and health promotion measures aimed at reducing sedentary behaviour in the population&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El sedentarismo es un factor predictivo para numerosas enfermedades&#46; El objetivo de este estudio fue valorar la evoluci&#243;n de la prevalencia de sedentarismo en poblaci&#243;n espa&#241;ola adulta entre 1987&#8211;2020&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Las fuentes de datos fueron las Encuestas Nacionales y Europeas de Salud&#46; La prevalencia de sedentarismo se valor&#243; en tres escenarios &#40;actividad principal&#44; tiempo libre y todos los escenarios&#41;&#46; Se estimaron prevalencias de sedentarismo global&#44; por sexo y grupo de edad&#46; En todos los escenarios la prevalencia tambi&#233;n se estim&#243; por Comunidad Aut&#243;noma&#46; La tendencia de las prevalencias se analiz&#243; con los porcentajes de cambio anual &#40;PCA&#41; obtenidos a trav&#233;s de modelos joinpoint&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de sedentarismo en la actividad principal vari&#243; entre el 31&#44;2&#37; en 1987 y el 38&#44;4&#37; en 2020 &#40;PCA&#58; 0&#44;7 &#40;0&#44;5 a 1&#44;0&#41;&#41;&#44; siendo mayor en hombres que en mujeres y m&#225;s elevada en los m&#225;s j&#243;venes y en los m&#225;s mayores&#46; La prevalencia de sedentarismo en el tiempo libre vari&#243; entre el 55&#44;1&#37; en 1993 y el 36&#44;4&#37; en 2020 &#40;PCA&#58; -1&#44;4 &#40;-1&#44;9 a -0&#44;9&#41;&#41;&#44; siendo siempre superior en mujeres&#44; m&#225;s alta en mayores de 64 a&#241;os y menor en los de 16&#8722;24 a&#241;os&#46; Cantabria y Canarias fueron las Comunidades Aut&#243;nomas con la prevalencia de sedentarismo m&#225;s baja en todos los escenarios&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de sedentarismo en la actividad principal est&#225; aumentando en Espa&#241;a&#44; mientras que durante el tiempo libre est&#225; descendiendo&#46; Es importante aplicar medidas de prevenci&#243;n y promoci&#243;n de la salud dirigidas a disminuir el sedentarismo en la poblaci&#243;n&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">16&#8722;24 years</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">25&#8722;44 years old</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">45&#8722;64 years</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">65 years old</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="22" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cut-off point 270&#8239;min</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">50&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2023.10.015

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