Socioeconomic inequalities in leisure-time physical activity worldwide: analyses from 68 countries using the WHO STEPwise

Background: Despite being referred to as a “healthy choice”, access to leisure-time physical activity (LPA) remains a privilege in most societies worldwide, especially in low- and middle-income countries (LMICs). An equity lens is critical for understanding and reverting this current scenario.
Purpose: To describe between and within-country socioeconomic inequalities in LPA worldwide and by World Bank country-income groups.
Methods: Data were sourced from the World Health Organization (WHO) STEPwise approach to surveillance (STEPS) database. Proportion of participants meeting WHO physical activity guidelines with LPA was derived from Global Questionnaire of Physical Activity (GPAQ) data. Socioeconomic status was estimated by levels of formal education, standardized across countries as none, primary (incomplete and complete primary), secondary (incomplete and complete secondary, technical, and professional education), and higher (incomplete and complete undergraduate at the university, graduate courses). Slope Index of Inequality (SII) was used to assess absolute inequality. World Bank income groups classification was used for between-country group comparisons.
Results: In total, data from 68 countries were analyzed (9 High-income, 16 Upper middle-income, 28 lower middle-income and 15 low-income). LPA inequalities were consistently identified in all countries. Within countries, average LPA prevalence was approximately 20 percentage points (p.p.) among those with no formal education compared to those with higher levels of education. Afghanistan, Ecuador, Malawi, and Vanuatu had the largest absolute gaps between the extreme levels of education (above 40 p.p). LPA prevalence among those in the lowest level of education in low-income countries was approximately 35 p.p. lower than among those with the highest level of education in high-income countries.
Conclusions: Between and within-country socioeconomic inequalities in LPA are marked in all income classification of countries.
Practical implications: Domain-specific and equity oriented public policies to promote LPA are urgent at national and global levels.