Importance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle-income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle-income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle-income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.

中文翻译：

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高收入、中等收入和低收入国家久坐时间与死亡率和心血管事件的关联。

重要性 在高收入国家，久坐与心血管疾病 (CVD) 和死亡率的风险增加相关，但尚不清楚低收入和中等收入国家的风险是否也会增加。目的 使用前瞻性城乡流行病学研究的数据，调查不同经济水平国家久坐时间与死亡率和主要心血管疾病的关系。设计、地点和参与者 这项基于人群的队列研究包括从 2003 年 1 月 1 日起招募并随访至 2021 年 8 月 31 日的 21 个高收入、中等收入和低收入国家的 35 至 70 岁参与者中位随访时间为 11.1 年。暴露 使用国际身体活动问卷测量的每日坐着时间。主要结果和措施 全因死亡率和主要 CVD（定义为心血管死亡、心肌梗死、中风或心力衰竭）的复合结果。结果 在 105 677 名参与者中，61 925 名 (58.6%) 为女性，平均 (SD) 年龄为 50.4 (9.6) 岁。在 11.1（IQR，8.6-12.2）年的中位随访期间，记录了 6233 例死亡和 5696 例主要心血管事件（2349 例心肌梗塞、2966 例中风、671 例心力衰竭和 1792 例心血管死亡）。与参照组（每天坐着的时间少于 4 小时）相比，久坐的时间更长（每天≥8 小时）与复合结果的风险增加相关（风险比 [HR]，1.19；95% CI，1.11- 1.28；Pfor 趋势 <.001）、全因死亡率（HR，1.20；95% CI，1.10-1.31；Pfor 趋势 <.001）和主要 CVD（HR，1.21；95% CI，1.10-1.34；Pfor趋势 < . 001). 当按国家收入水平分层时，与低收入和中低收入国家（每天≥8 小时：HR，1.29；95% CI，1.16-1.44）相比，坐着时间与综合结果的关联更强高收入和中高收入国家（HR，1.08；95% CI，0.98-1.19；相互作用的 P = .02）。与报告每天坐着时间少于 4 小时且体力活动水平高的参与者相比，每天坐着 8 小时或更长时间的参与者在各种体力活动水平上的综合结果相关风险高 17% 至 50%；随着体力活动水平的增加，风险也随之降低。结论和相关性 在经济多样化的环境中，长时间坐着与全因死亡率和心血管疾病风险增加相关，特别是在低收入和中低收入国家。减少久坐时间并增加身体活动可能是减轻全球过早死亡和 CVD 负担的重要策略。