Heart disease is the leading cause of death in the United States, and most people are already on their way towards that fate: 99 percent of the population has at least one of seven cardiovascular health risks. In addition to being incredibly common, it’s costly – racking up $207 billion per year in medical expenditures and lost productivity. But a new study suggests workplace programs that address heart disease risk factors in daily, working life could be effective in lowering the prevalence of the condition.
“The workplace is an ideal setting for improving heart health because approximately 151 million US adults are in the civilian non-institutionalized workforce, and the labor force participation rate exceeds 60 percent,” the researchers wrote in the study published in Health Affairs today.
Using a scoring index called the Worksite Health Achievement Index (WHAI), which was developed a year ago by the American Heart Association, researchers at IBM company Truven Health Analytics and the Center for Workplace Health Research and at the AHA assessed the comprehensiveness of 20 different employers’ heart health programs, policies and environmental support structures to their employees’ cardiovascular health. They then linked the employers’ WHAI scores with their employees’ MarketScan health risk and medical claims data.
The WHAI score is calculated from 55 questions, collectively worth 151 points, which look at the program across seven domains: leadership, organizational policies and environment, strategic communications, health-promoting programs, employee engagement practices, community partnerships, and measuring and reporting of outcomes. Employers scored an average of 106.2 points, bringing the total standardized score to 100.
From the 20 organizations, researchers got anonymized data from 373,478 workers from a population that included active, full-time employees aged 18 to 64 who were not pregnant and who had health benefits for the full year. Researchers examined three sets of health measures: prevalence of heart disease, prevalence of risk factors for it, and medical and drug expenditures on the disease. One-fifth of employees had cardiovascular disease, and it was very common for them to have one or more risk factors: for example, nearly 72 percent were at an unhealthy weight and over 66 percent had high blood pressure. Employees spent an average of $329 per year on cardiovascular disease.
Among large employers, the researchers found higher scores were associated with lower rates of four modifiable risk factors: high blood pressure, high cholesterol, tobacco use and physical inactivity. With those high scores, however, comes higher costs.
“In terms of heart disease prevalence, we found that a higher WHAI score was associated with lower levels of heart disease but higher per capita spending for the condition,” the researchers write. “This may be because heart patients have many comorbid conditions that explain a large portion of their medical spending, above and beyond spending for heart disease alone.”
Citing a lack of longitudinal evidence, researchers weren’t fully able to understand the relationship between the organizational practices and employees’ health risks, disease prevalence and expenditures, and called the study a “snapshot” view. If employers continue to complete the WHAI annually, however, the researchers expect to have a dataset that will “provide greater insights into how changes in what WHAI scores influence changes” in the risks, prevalence and expenditures of their employees, thus enabling investigation of a cause-effect relationship between employer policies and health and spending outcomes.
“This study represents the start of a major effort to address the types of organizational interventions that employers can introduce to improve heart health and financial outcomes that benefit both workers and businesses,” the researchers write. “Future analyses of WHAI scores and associated MarketScan worker-level data may lead to greater insights regarding what specific policies, programs and environmental supports employers can implement to positively influence population health and concomitantly reduce medical spending for cardiovascular disease in a working population.”