IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v335y2023ics0277953623005592.html

The relationship between physical activity, cognitive function and health care use: A mediation analysis

Author

Listed:
  • Lenzen, Sabrina
  • Gannon, Brenda
  • Rose, Christiern
  • Norton, Edward C.

Abstract

Physical activity is known to provide substantial health benefits and subsequently reduce health care use among older people, but little is known about how much of this effect is due to improved cognitive function as opposed to physical improvements in health. We study the direct and indirect effect of physical activity on health care use using the word recall task as a measure of cognitive function in a mediation framework. We use data from eight waves of the US Health and Retirement Study (HRS) (2004 - 2018) of people aged 65 and older and exploit genetic variations between individuals as an instrumental variable (IV) for cognitive function, a local health care supply measure as IV for health care use, and neighbourhood physical activity as IV for individual physical activity in our simultaneous three-equation model. We find small but negative direct and indirect effects of physical activity through improved cognitive function on the probability to see a GP and being admitted to a hospital, as well as the number of GP visits and the hospital length of stay. Improved cognitive function explains between 5% to 17% of the total effect of physical activity on the reduction in health care use.

Suggested Citation

  • Lenzen, Sabrina & Gannon, Brenda & Rose, Christiern & Norton, Edward C., 2023. "The relationship between physical activity, cognitive function and health care use: A mediation analysis," Social Science & Medicine, Elsevier, vol. 335(C).
    • Handle: RePEc:eee:socmed:v:335:y:2023:i:c:s0277953623005592
    DOI: 10.1016/j.socscimed.2023.116202
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953623005592
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2023.116202?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Guido W. Imbens, 2020. "Potential Outcome and Directed Acyclic Graph Approaches to Causality: Relevance for Empirical Practice in Economics," Journal of Economic Literature, American Economic Association, vol. 58(4), pages 1129-1179, December.
    2. Klepper, Steven & Leamer, Edward E, 1984. "Consistent Sets of Estimates for Regressions with Errors in All Variables," Econometrica, Econometric Society, vol. 52(1), pages 163-183, January.
    3. Contoyannis, Paul & Jones, Andrew M., 2004. "Socio-economic status, health and lifestyle," Journal of Health Economics, Elsevier, vol. 23(5), pages 965-995, September.
    4. Park, Cheolsung & Kang, Changhui, 2008. "Does education induce healthy lifestyle?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1516-1531, December.
    5. von Hinke, Stephanie & Davey Smith, George & Lawlor, Debbie A. & Propper, Carol & Windmeijer, Frank, 2016. "Genetic markers as instrumental variables," Journal of Health Economics, Elsevier, vol. 45(C), pages 131-148.
    6. Lenzen, Sabrina & Gannon, Brenda & Rose, Christiern, 2020. "A dynamic microeconomic analysis of the impact of physical activity on cognition among older people," Economics & Human Biology, Elsevier, vol. 39(C).
    7. Wicker, Pamela & Hallmann, Kirstin & Breuer, Christoph, 2013. "Analyzing the impact of sport infrastructure on sport participation using geo-coded data: Evidence from multi-level models," Sport Management Review, Elsevier, vol. 16(1), pages 54-67.
    8. Nazmi Sari, 2009. "Physical inactivity and its impact on healthcare utilization," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 885-901, August.
    9. Kumagai, Narimasa & 熊谷, 成将, 2013. "Physical Inactivity of Workers and its Relation to Uneven Allocation of Public Sports Facilities," CIS Discussion paper series 598, Center for Intergenerational Studies, Institute of Economic Research, Hitotsubashi University.
    10. Deliana Kostova, 2011. "Can the Built Environment Reduce Obesity? The Impact of Residential Sprawl and Neighborhood Parks on Obesity and Physical Activity," Eastern Economic Journal, Palgrave Macmillan;Eastern Economic Association, vol. 37(3), pages 390-402.
    11. Samuel I. Berchuck & Joshua L. Warren & Amy H. Herring & Kelly R. Evenson & Kari A. B. Moore & Yamini K. Ranchod & Ana V. Diez-Roux, 2016. "Spatially modelling the association between access to recreational facilities and exercise: the ‘Multi-ethnic study of atherosclerosis’," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(1), pages 293-310, January.
    12. Nazmi Sari, 2014. "Sports, Exercise, And Length Of Stay In Hospitals: Is There A Differential Effect For The Chronically Ill People?," Contemporary Economic Policy, Western Economic Association International, vol. 32(2), pages 247-260, April.
    13. Wooldridge, Jeffrey M., 2019. "Correlated random effects models with unbalanced panels," Journal of Econometrics, Elsevier, vol. 211(1), pages 137-150.
    14. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    15. David Roodman, 2011. "Fitting fully observed recursive mixed-process models with cmp," Stata Journal, StataCorp LLC, vol. 11(2), pages 159-206, June.
    16. Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
    17. Haapanen-Niemi, N. & Miilunpalo, S. & Vuori, I. & Pasanen, M. & Oja, P., 1999. "The impact of smoking, alcohol consumption, and physical activity on use of hospital services," American Journal of Public Health, American Public Health Association, vol. 89(5), pages 691-698.
    18. Riju Joshi & Jeffrey M. Wooldridge, 2019. "Correlated Random Effects Models with Endogenous Explanatory Variables and Unbalanced Panels," Annals of Economics and Statistics, GENES, issue 134, pages 243-268.
    19. Federico Belotti & Partha Deb & Willard G. Manning & Edward C. Norton, 2015. "twopm: Two-part models," Stata Journal, StataCorp LLC, vol. 15(1), pages 3-20, March.
    20. Brad R. Humphreys & Logan McLeod & Jane E. Ruseski, 2014. "Physical Activity And Health Outcomes: Evidence From Canada," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 33-54, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ciziceno, M. & Maggio, G., 2025. "Cognitive functioning and depressive symptoms in the aging population: The buffering role of marital status," Social Science & Medicine, Elsevier, vol. 383(C).
    2. Tang, Jia & Ni, Chenxu & Lu, Shuwei & Xiong, Jie & Wang, Mingzhe, 2025. "The cognitive benefits of ecosystem improvement: Evidence from China's National Key Ecological Function Zones," Social Science & Medicine, Elsevier, vol. 381(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Cabane Charlotte & Lechner Michael, 2015. "Physical Activity of Adults: A Survey of Correlates, Determinants, and Effects," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 235(4-5), pages 376-402, August.
    2. Nazmi Sari, 2014. "Sports, Exercise, And Length Of Stay In Hospitals: Is There A Differential Effect For The Chronically Ill People?," Contemporary Economic Policy, Western Economic Association International, vol. 32(2), pages 247-260, April.
    3. Brad Humphreys & Katerina Maresova & Jane Ruseski, 2012. "Institutional Factors, Sport Policy, and Individual Sport Participation: An International Comparison," Working Papers 2012-01, University of Alberta, Department of Economics.
    4. Sefa Awaworyi Churchill & Janet Exornam Ocloo & Diana Siawor-Robertson, 2017. "Ethnic Diversity and Health Outcomes," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 134(3), pages 1077-1112, December.
    5. Nazmi Sari & Michael Lechner, 2015. "Long-Run Health Effects of Sports And Exercise In Canada," Working Papers 150018, Canadian Centre for Health Economics.
    6. Makate, Clifton & Angelsen, Arild & Holden, Stein Terje & Westengen, Ola Tveitereid, 2022. "Crops in crises: Shocks shape smallholders' diversification in rural Ethiopia," World Development, Elsevier, vol. 159(C).
    7. Hans Lööf & Ingrid Viklund‐Ros, 2020. "Board of directors and export spillovers: What is the impact on extensive margins of trade?," The World Economy, Wiley Blackwell, vol. 43(5), pages 1188-1215, May.
    8. Jane E. Ruseski & Katerina Maresova, 2014. "Economic Freedom, Sport Policy, And Individual Participation In Physical Activity: An International Comparison," Contemporary Economic Policy, Western Economic Association International, vol. 32(1), pages 42-55, January.
    9. Lechner, Michael & Sari, Nazmi, 2015. "Labor market effects of sports and exercise: Evidence from Canadian panel data," Labour Economics, Elsevier, vol. 35(C), pages 1-15.
    10. Maria C. Lo Bue, 2024. "Drivers of changes in child nutritional conditions: A panel data‐based study on Indonesian households, 1997–2014," Review of Development Economics, Wiley Blackwell, vol. 28(2), pages 741-776, May.
    11. Arnd Kölling & Claus Schnabel, 2022. "Owners, external managers and industrial relations in German establishments," British Journal of Industrial Relations, London School of Economics, vol. 60(2), pages 424-443, June.
    12. Victor Chernozhukov & Whitney K. Newey & Victor Quintas-Martinez & Vasilis Syrgkanis, 2021. "Automatic Debiased Machine Learning via Riesz Regression," Papers 2104.14737, arXiv.org, revised Mar 2024.
    13. Dilmaghani, Maryam, 2021. "The gender gap in competitive chess across countries: Commanding queens in command economies," Journal of Comparative Economics, Elsevier, vol. 49(2), pages 425-441.
    14. Odolinski, Kristofer & Smith, Andrew & Wheat, Phill & Nilsson, Jan-Eric & Dheilly, Clement, 2023. "Damage or no damage from traffic: Re-examining marginal cost pricing for rail signalling maintenance," Transport Policy, Elsevier, vol. 131(C), pages 13-21.
    15. Fattouh, Bassam & Pisicoli, Beniamino & Scaramozzino, Pasquale, 2024. "Debt and financial fragility: Italian non-financial companies after the pandemic," Economic Modelling, Elsevier, vol. 131(C).
    16. Juergensen, Jill Josefina & Love, James H. & Surdu, Irina & Narula, Rajneesh, 2024. "Learning-by-exporting: The strategic role of organizational innovation," International Business Review, Elsevier, vol. 33(6).
    17. Ron Berman & Ayelet Israeli, 2022. "The Value of Descriptive Analytics: Evidence from Online Retailers," Marketing Science, INFORMS, vol. 41(6), pages 1074-1096, November.
    18. Bo E. Honoré & Luojia Hu & Ekaterini Kyriazidou & Martin Weidner, 2024. "Simultaneity in binary outcome models with an application to employment for couples," Advanced Studies in Theoretical and Applied Econometrics, in: Subal C. Kumbhakar & Robin C. Sickles & Hung-Jen Wang (ed.), Advances in Applied Econometrics, pages 741-777, Springer.
    19. Bruneel, Stijn & Verhelst, Pieterjan & Reubens, Jan & Luca, Stijn & Coeck, Johan & Moens, Tom & Goethals, Peter, 2020. "Combining disciplines: Dealing with observed and cryptic animal residencies in passive telemetry data by applying econometric decision-making models," Ecological Modelling, Elsevier, vol. 438(C).
    20. Becker, Annette & Hottenrott, Hanna & Mukherjee, Anwesha, 2022. "Division of labor in R&D? Firm size and specialization in corporate research," Journal of Economic Behavior & Organization, Elsevier, vol. 194(C), pages 1-23.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:335:y:2023:i:c:s0277953623005592. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.