{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T23:14:13Z","timestamp":1771370053611,"version":"3.50.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Amsterdam and Rotterdam in the Netherlands"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Socioeconomic inequalities in healthcare costs are large, but the underlying behavioral mechanisms remain unclear. We examined how neighborhood socioeconomic status (NSES) and lifestyle behaviors\u2014physical activity (PA), sport participation, smoking, and alcohol use\u2014jointly relate to healthcare costs in the Netherlands. Using a population-wide ecological dataset of 6213 neighborhoods, we linked relative (i.e. age- and sex-standardized) healthcare costs with survey-based estimates of lifestyle behaviors. Linear regression models estimated the associations between lifestyle factors and relative healthcare costs, adjusting for demographic and urbanization characteristics. Additional models stratified by NSES decile assessed socioeconomic modification of lifestyle\u2013cost associations. A strong socioeconomic gradient in relative healthcare costs was observed; the most deprived NSES decile having \u20ac1096 higher average costs than the most affluent decile. NSES alone explained over \u20ac300 of this inter-decile cost gap. Across all neighborhoods, each 1-percentage-point higher sport participation, PA adherence, and smoking prevalence were associated with cost changes of \u2212\u20ac14.27 (95% CI \u221216.96 to \u221211.59), \u2212\u20ac6.96 (95% CI \u22129.59 to \u22124.32), and +\u20ac22.06 (95% CI 17.96 to 26.16), respectively; alcohol use showed no association. Within-decile analyses revealed strong protective effects of sport in the most deprived neighborhoods (\u2212\u20ac37.26, 95% CI \u221247.54 to \u221226.97) and consistent cost increases associated with smoking across all deciles. Lifestyle\u2013cost associations differ markedly by socioeconomic context. Structured sport participation shows the greatest cost-saving potential in disadvantaged neighborhoods, while smoking remains the dominant cost driver nationwide. Addressing behavioral inequalities is key to narrowing socioeconomic disparities in healthcare expenditures.<\/jats:p>","DOI":"10.1093\/eurpub\/ckaf252","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:41:21Z","timestamp":1765888881000},"page":"5-11","source":"Crossref","is-referenced-by-count":0,"title":["Neighborhood socioeconomic inequalities in healthcare costs: the role of lifestyle behaviors"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1823-7607","authenticated-orcid":false,"given":"Willem I J","family":"De Boer","sequence":"first","affiliation":[{"name":"University of Groningen, Faculty of Economics and Business, Groningen,","place":["The Netherlands"]},{"name":"HAN University of Applied Sciences, School of Sport and Exercise, Nijmegen,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0699-5777","authenticated-orcid":false,"given":"Laura","family":"Viluma","sequence":"additional","affiliation":[{"name":"University of Groningen, Faculty of Economics and Business, Groningen,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9968-8807","authenticated-orcid":false,"given":"Jochen O","family":"Mierau","sequence":"additional","affiliation":[{"name":"University of Groningen, Faculty of Economics and Business, Groningen,","place":["The Netherlands"]},{"name":"University Medical Center Groningen, Groningen,","place":["The 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