Do differences in sport participation contribute to socioeconomic health inequalities? Evidence from the Lifelines cohort study on all-cause mortality, diabetes and obesity

Little is known about the role of sport participation in socioeconomic health inequalities. We studied the association between different aspects of sport participation with all-cause mortality, type 2 diabetes mellitus (T2DM) and obesity, including inequalities between socioeconomic subpopulations. Using the Dutch Lifelines cohort study (n = 84,230), we assessed the associations of sport participation, as well as the amount, intensity, type and number of sports, with all-cause mortality, T2DM and obesity in individuals. We studied the effect of sport participation on health outcomes within and between educational categories. Outcomes were compared with moderate to vigorous physical activity (MVPA). Sport participation was significantly associated with lower mortality (HR = 0.81), T2DM (HR = 0.70), and obesity (HR = 0.77). No significant additional effects of the amount or intensity of sport participation were found, while participating in teams sport was associated with significantly lower mortality (HR = 0.53) compared with other types of sport. These effects were similar among educational categories. Sport participation explained between 11% (T2DM and obesity) and 22% (mortality) of health inequalities between educational categories. This was more than twice the effect size of MVPA. The sensitivity analysis with net income as the socioeconomic indicator showed similar results. Our results suggest that to reduce socioeconomic differences in health, public health policies should focus on increasing sport participation in groups with a low socioeconomic status, rather than increasing the amount or intensity of sport participation, or MVPA in general.