Step counts over time with the burden of 105 non-communicable diseases in older adults from the All of Us Research Program.

Lower daily step counts were associated with both increased risk and burden of cardiovascular disease in older adults.

• Participants with <6000 daily steps had an adjusted hazard ratio of 1.17 (95% CI, 1.04–1.33) for cardiovascular disease compared to those with ≥6000 steps.
• Years lived with disability (YLD) for cardiovascular disease was 85.2 (95% CI, 28.9–141.4) per 100,000 populations in the low-step group.
• The study used a prospective cohort design with 2969 older adults (≥55 years) wearing Fitbit devices linked to electronic health records.

Lower daily step counts were associated with both increased risk and burden of chronic respiratory disease.

• The adjusted hazard ratio for chronic respiratory disease was 1.23 (95% CI, 1.08–1.40) in those with <6000 daily steps.
• YLD for chronic respiratory disease was 138.5 (95% CI, 4.7–272.3) per 100,000 populations.
• This was among the NCD categories where lower step counts were linked to both increased incidence risk and disease burden.

Lower daily step counts were associated with both increased risk and burden of digestive diseases.

• The adjusted hazard ratio for digestive diseases was 1.18 (95% CI, 1.04–1.34) for those with <6000 daily steps.
• YLD for digestive diseases was 116.9 (95% CI, 37.3–196.4) per 100,000 populations.
• Digestive diseases were included in the category of NCDs where both new-onset risk and burden were elevated with low step counts.

Lower daily step counts were associated with both increased risk and burden of diabetes and kidney diseases.

• The adjusted hazard ratio for diabetes and kidney diseases was 1.29 (95% CI, 1.11–1.51) in participants with <6000 daily steps.
• YLD for diabetes and kidney diseases was 186.3 (95% CI, 11.8–360.7) per 100,000 populations, the highest point estimate among reported disease categories.
• This category showed the largest relative increase in hazard ratio among the four disease groups where both risk and burden were elevated.

Lower daily step counts were associated with higher risk but not burden for neurological disorders, mental disorders, and substance use disorders.

• For these three NCD categories, lower step counts increased new-onset risk (elevated aHRs) without a corresponding statistically significant increase in YLD.
• This pattern differentiated neurological and mental health conditions from cardiometabolic and respiratory conditions in terms of the nature of their association with step counts.
• The study assessed 105 NCDs in total across multiple disease categories.

Lower daily step counts were associated with higher disease burden but not new-onset risk for neoplasms and sense organ disorders.

• For neoplasms and sense organ disorders, lower step counts were linked to higher YLD without statistically significant changes in adjusted hazard ratios.
• This pattern suggests that physical activity as measured by step counts may influence disease severity or duration rather than incidence for these conditions.
• These findings were derived from the same prospective cohort of 2969 older adults followed until July 1, 2022.

The study cohort consisted of older adults categorized into a control group (≥6000 steps) and a low-step group (<6000 steps) with differing demographic characteristics.

• The control group (≥6000 steps) had a mean (SD) age of 66.4 (6.9) years and was 62.7% female (n=1243).
• The low-step group (<6000 steps) had a mean (SD) age of 67.9 (7.4) years and was 72.1% female (n=710).
• The total sample included 2969 participants aged ≥55 years from the All of Us Research Program, a large diverse cohort.
• Fitbit wearable device data were linked with electronic health records to assess daily step counts and NCD outcomes.