15 The differences between educational levels are somewhat less pronounced than the different patterns of activity by income class at least between the extreme manifestations in income It is also reasonable to assume that educational attainment and income and thus also the different levels of attainment are correlated In general the results presented here should not be explicitly interpreted as causal causes of the practice of sport but rather as a purely descriptive description of the sportsmen and women who practice sport Causal analyses require the use of multivariate inferential statistical methods see Schüttoff Pawlowski 2017 15 Excursus Estimation of the economic health costs of sports in juries As a counter result to the positive effects on health associated with regular exercise sport is reg ularly associated with injuries and the resulting costs First of all it should be noted that there is no current study for Germany known to the authors which deals comprehensively with the costs associated with sport at the national economic level The following explanations are therefore conceptual estimates based on existing data Sports injuries lead on the one hand to direct costs due to the use of medical services for inpa tient or outpatient treatment and on the other hand to indirect costs for the economy due to days of illness or absence Within the framework of the sports satellite account a survey on the sports behavior of the Ger man population aged 16 and over in 2015 revealed that just under 2 of athletes had to be treated as in patients i e in hospital in order to practice sports In 2015 this corresponded to a total number of approximately 1 million injured A further 5 of the sportsmen and women 3 8 million persons were treated on an outpatient basis An older but much cited study by Henke et al 2000 also reports a sports related injury rate of 5 6 According to the Federal Statistical Office inpatient treatment in general i e independent of sport cost an average of 4 695 in 2017 Destatis 2018 The costs for treatment of typical sports injuries are also roughly at this level In 2016 for example the treatment of a cruciate ligament rupture cost an average of about 3 200 that of a collarbone fracture 2 700 and that of a tibia or fibula fracture almost 5 000 study by the University of Bochum and the Arag sports insur ance company RP Online 2017 According to the authors estimates the costs for sports related inpatient treatment in 2015 amounted to approx 4 3 billion while the costs for outpatient treatment are estimated at 2 2 billion In total the treatment costs thus amount to 6 5 billion 16 In addition to these direct health costs of sports practice indirect costs also arise from the sick ness or absence disability and death associated with sports injuries According to our own cal culations based on a survey of the SSK in 2015 sports induced absences amount to 3 4 days per 15 Schüttoff Pawlowski 2017 and Ainsworth et al 2011 also present alternative approaches to calculating the contri bution of sport to physical activity using metabolic equivalents specific to the sport Metabolic equivalents MET are used to compare the energy consumption of different activities 16 The total costs of inpatient hospital care amounted to 91 3 billion in 2017 Destatis 2018

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