ABC | Volume 112, Nº6, June 2019

Original Article The Relationship between Lifestyle and Costs Related to Medicine Use in Adults Romulo Araujo Fernandes, 1, 2 Alessandra Madia Mantovani, 1 Jamile Sanches Codogno, 1, 2 B runa Camilo Turi-Lynch, 1 Subhash Pokhrel, 3 Nana Anokye 3 Programa de Pós-Graduação em Ciências da Motricidade - Instituto de Biociências - Universidade Estadual Paulista (UNESP), 1 Rio Claro, SP – Brazil Departmento de Educação Física - Faculdade de Ciências e Tecnologia - Universidade Estadual Paulista (UNESP), 2 Presidente Prudente, SP – Brazil Institute of Environment - Health and Societies - Brunel University - Uxbridge, 3 London – United Kingdom Mailing Address: Rômulo Araújo Fernandes • Roberto Simonsen Avenue, 305. Centro Educacional. Postal Code 19060-900. Presidente Prudente, SP – Brazil Email: romulo_ef@yahoo.com.br Manuscript received May 25, 2018, revised manuscript September 18, 2018, accepted September 19, 2018 DOI: 10.5935/abc.20190049 Abstract Background: The unhealthy lifestyle is growing and this can have repercussions on health status demanding actions on the occurrence of diseases and leads to increased expenses. Objective: To examine the interrelationship between the costs of medicine use and lifestyle behaviors. Methods: A cohort study with 118 participants, age around 51.7 ± 7.1 years old. It was collected personal and anthropometric data and information about medicine of continuous use to calculate the costs. Lifestyle variables included habitual physical activity (PA) assessed by pedometer, sedentary behavior by Baecke questionnaire, sleep quality by mini sleep questionnaire and self-report of smoke and alcohol consumption. Statistical analyses were performed by BioEstat (version 5.2) and the significance level set at p-value < 0.05. Results: In 12 months, 62 subjects bought 172 medicines, representing an overall cost of US$ 3,087.01. Expenditures with drugs were negatively related to PA (r = -0.194, p-value = 0.035 and r = -0.281, p-value = 0.002), but positively related with sleep quality (r = 0.299, p-value=0.001 and r = 0.315, p-value = 0.001) and age (r = 0.274, p-value = 0.003). Four multivariate models were executed considering lifestyle behaviors in different moments of cohort and medicine costs, and all these models identify important relationship between lifestyle behaviors with expenditures with drugs. Conclusion: Worse sleep quality seems to increase the costs related to medicine use in adults, while obesity and ageing play a relevant role in this phenomenon and alcohol consumption seems a variable with relevant economic impact. (Arq Bras Cardiol. 2019; 112(6):749-755) Keywords: Quality of Life; Sedentary Lifestyle; Obesity; Sports Medicine; Longevity; Health Behavior, Exercíse. Introduction Over the last decades, the occurrence of obesity and chronic diseases has increased dramatically among adults worldwide. 1 On the other hand, advances in medical sciences, development of new generation of medicines/therapies, have significantly improved quality of life and longevity. 2,3 In developing countries, the use of any medicine is reported by 60% of the adult population, while the use of three or more medicines in the last two weeks is reported by about 18% of the population. 4 A similar pattern is observed in Central Eastern Europe where more than 20% of adults (18 years plus) report three or more medicine use. 5 Narayan et al. 3 found that in a period of nine years (from 2005 to 2013) the use of drugs for prevention purposes (aspirin, clopidogrel, statins and bisphosphonates) increased significantly among New Zealand adults aged 65 years or more (about 19.5%, 2.9%, 7% and 2.3%, respectively). The dramatic rise in the prevalence of obesity and its associations with the development of metabolic and cardiovascular diseases would explain, at least in part, this increase trend. 1,6 In fact, wide access tomedicines by population signifies an improvement in the prevention/treatment of diseases. 2 However, the potential adverse drug reactions generated by the use of unprescribed medicines constitute a global public health concern related to high healthcare costs. 7,8 The economic burden related to medicine use involves not only health care costs resulting from inappropriate medication but also the purchase of prescribed and unprescribed medicines (public and out of pocket expenses). 7,9 For example, in a period of five years from 2000 to 2004, the Brazilian Ministry of Health expended US$ 916 million in programs to provide high-cost drugs to population. 10 Despite the increasing economic burden related to medicines use, little is known about its underlying determinants. We need to know these determinants in order to identify target areas for policy making on managing health budgets, particularly in health systems in developing settings. Unhealthy lifestyle behaviors (alcohol consumption, smoking, poor sleep habits and sedentary behaviors [SB]) have 749