Unhealthy dietary patterns in the American Nations: A crisis with cultural distinctions

INTRODUCTION

Food insecurity and limited healthful food access are critical public health issues in the United States (U.S), with unequal distribution across regions. This report tracked the prevalence of food insecurity, healthful food access, and the food environment, as cultural experiences according to the American Nations Model.

METHODS

Data from the County Health Rankings & Roadmaps program on food insecurity, insufficient healthy food access, and the food environment index were matched at the zip-code level with the American Nations dataset from the Nationhood Lab. Percentages for all three food indicators were estimated based on the population of each American Nation region.

RESULTS

Results show significant disparities across regional cultures. The First Nation, heavily populated by American Indian and Alaska Native communities, reports the highest prevalence of food insecurity (17 %), lowest healthful food access (21 %) and food environment index (4.6 out of 10). New France, Deep South, Great Polynesia, Greater Appalachia, El Norte and Far West, areas with higher minority populations, also show elevated food insecurity rates (range, 11-14 %) and reduced healthful food access (5-9 %). Regions with more favorable metrics across all three indicators include the Spanish Caribbean, Midlands, Yankeedom, Left Coast, Tidewater, and the New Netherlands.

CONCLUSIONS

Disparities in food insecurity, healthful food access, and food environments appear to stem from geographical diversity and cultural history, underscoring the need to recognize and address cultural differences among the American Nations. This insight can inform policy and practices aimed at achieving food security and health equity across the country.

The Potential Influence of Firearm Violence on Physical Inactivity in the United States

BACKGROUND

Despite broad recognition of the physical inactivity pandemic, little to no progress has been made in the past decade in mitigating the problem. The current analysis builds upon previous research into the drivers of physical inactivity to assess the potential interactions with firearm violence in the United States.

METHODS

We merged county-level data on firearm fatality rates, physical inactivity prevalence, the Social Vulnerability Index, and the American nations regional cultures schematic.

RESULTS

Counties with a physical inactivity prevalence currently above the federal government's 2030 goal (ie, ≥21.8%) had a significantly higher firearm fatality rate per 100,000 population. This finding was consistent for both the overall rate and race-based subgroups. The overall White, Hispanic, and Black firearm fatality rates were also significantly higher in the American nations group comprising Greater Appalachia, Deep South, El Norte, New France, and First Nation. Stepwise linear regression analysis revealed that the Social Vulnerability Index, American nations dichotomous grouping, and firearm fatality rate were all retained (P < .001) in predicting physical inactivity prevalence as a continuous variable.

CONCLUSION

In conclusion, the United States faces myriad health and societal challenges. Unhealthy lifestyles and gun violence are two of the leaders. The current analysis in conjunction with previous findings demonstrates that solving these challenges by interacting, create complexity to finding solutions that has not been thoroughly considered.

Evidence to support health system prioritization of health behaviors in the COVID-19 era

BACKGROUND

Since the COVID-19 pandemic health systems have shifted necessarily from chronic to infectious disease treatment, but chronic disease remains critical. One large health system uniquely tracks member health behaviors. This analysis compares data from select months of an ongoing monthly cross-sectional survey before and during the pandemic.

METHODS

Responses in April 2019 (pre-pandemic), April 2020 (early pandemic) or April 2021 (later pandemic) were included in the primary analysis (N = 252). Differences in meeting health behavior guidelines were analyzed via logistic regression.

RESULTS

A significant decline was seen for physical activity (19% not meeting guidelines pre-pandemic vs. 41% later pandemic) but not fruit/vegetable, alcohol, or sleep from early to later pandemic. Prevalence of women not meeting tobacco guidelines increased from early (5%) to later pandemic (10%) while prevalence in men decreased (10% vs 4% respectively). The percent of people not thinking about the good things that happen to them fluctuated closely with reports of new COVID-19 cases.

CONCLUSIONS

Findings show the nuance of changing health behaviors throughout the pandemic. Results should be used by health systems to tailor support based on insights from the pandemic experience.

Qualitative systems mapping in promoting physical activity and cardiorespiratory fitness: Perspectives and recommendations

The purpose of this report is to provide a perspective on the use of qualitative systems mapping, provide examples of physical activity (PA) systems maps, discuss the role of PA systems mapping in the context of iterative learning to derive breakthrough interventions, and provide actionable recommendations for future work. Systems mapping methods and applications for PA are emerging in the scientific literature in the study of complex health issues and can be used as a prelude to mathematical/computational modeling where important factors and relationships can be elucidated, data needs can be prioritized and guided, interventions can be tested and (co)designed, and metrics and evaluations can be developed. Examples are discussed that describe systems mapping based on Group Model Building or literature reviews. Systems maps are highly informative, illustrate multiple components to address PA and physical inactivity issues, and make compelling arguments against single intervention action. No studies were identified in the literature scan that considered cardiorespiratory fitness the focal point of a systems maps. Recommendations for future research and education are presented and it is concluded that systems mapping represents a valuable yet underutilized tool for visualizing the complexity of PA promotion.

Novel Approaches to Addressing the US Physical Inactivity and Obesity Pandemics: An Opportunity for Religious Organizations

BACKGROUND

Physical inactivity and obesity crises persist in the United States despite substantial mitigation efforts. The primary goal of this analysis is to determine whether the geographic concentration of religious institutions overlaps with geographic patterns for physical inactivity and obesity prevalence.

METHODS

We obtained 2021 county-level, age-adjusted physical inactivity ("no leisure time physical activity") and obesity prevalence from the 2023 Centers for Disease Control and Prevention PLACES database. Data on number of congregations per 100,000 individuals and adherents as a percentage of the population were obtained from the 2020 US Religion Census. The American Nations regional cultures model was obtained from the Nationhood Lab.

RESULTS

On a national level, all correlations were statistically significant between health factors and religious infrastructure-higher physical inactivity and obesity were related to more congregations per 100,000 population on a county level. The strength of correlations between congregations per 100,000 county population and both physical inactivity and obesity prevalence was greatest in the American Nations model's Deep South and Tidewater regions.

CONCLUSIONS

Approaches to addressing the pandemics of unhealthy lifestyle-related health factors of physical inactivity and obesity in the United States have, in large part, been unsuccessful. Church-based healthy lifestyle programs, particularly in areas where a high concentration of congregations align with high physical inactivity and obesity, may offer a novel and effective approach to addressing this issue.

Predicting life expectancy in the united states: The importance of healthy living behaviors and residential geography

According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of Collapse

Key Words

• Chronic disease risk
• Culture
• Healthy living
• Sedentary lifestyle
• Social justice

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MESH Headings Collapse

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The Influence of Social Vulnerability and Culture on Physical Inactivity in the United States - Identifying Hot Spots in Need of Attention

BACKGROUND

In the United States, ongoing efforts to increase individual- and population-level physical activity have made little to no progress over the past decade in reducing the percentage of individuals who report no leisure-time physical activity. The purpose of the current study is to further assess the relationship between social vulnerability and the prevalence of physical inactivity at the county level.

METHODS

We merged county-level data on physical inactivity prevalence, the Social Vulnerability Index (SVI), and the American Nations regional cultures schematic.

RESULTS

Physical inactivity significantly correlated (P < .001) with the overall SVI score and all subtheme scores to varying levels of strength. Clear and statistically significant heterogeneity in the SVI scores was apparent across distinct regions using the American Nations model, consistent with previously demonstrated patterns of physical inactivity prevalence.

CONCLUSIONS

On a national level, physical inactivity prevalence is unacceptably high and has not appreciably improved over the past decade. Within the United States, high levels of social vulnerability and physical inactivity are concentrated within specific geographic regions that need tailored solutions to resolve health disparities.

Physical Inactivity and Obesity in the United States Through the Lens of the 2012 and 2016 Presidential Elections

The physical inactivity (PI) and obesity pandemics in the United States (U.S.) have undauntingly persisted in recent history. We have previously demonstrated differences in PI, obesity, socioeconomics, race, and regional culture according to county-level results for the 2020 presidential election. This commentary extends this analysis by considering if the 2020 trend is consistent with the 2 previous presidential election cycles. On a national level, during both the 2012 and 2016 presidential elections, counties where the Democratic candidate received more votes than the Republican one had a significantly lower PI and obesity prevalence. Counties where the Democratic candidate received more votes also had higher median national incomes, a higher proportion of the population who identify as Black, and a higher percentage of people who had completed at least some college. However, at a U.S. regional level, unique, region-specific cultural identities and partisan coalition demographics were apparent and showed some variation between election cycles. In most of the distinct U.S. cultural regions defined by the American Nations model, PI and obesity prevalence were lower in democratic-majority counties, although there were exceptions. These results support our previous findings demonstrating PI and obesity trends in the U.S. are influenced by cultural and political factors that are likely interrelated and which warrant further attention.

Physical Inactivity and Obesity in the United States: At the Intersection of Politics, Socioeconomics, Race, and Culture

Efforts to reverse the physical inactivity (PI) and obesity pandemics in the United States (U.S.) have been unsuccessful. This commentary provides a view of PI and obesity in the U.S. from the intersection of politics, socioeconomics, race, and culture. On a national level, counties where the Democratic presidential candidate received more votes in 2020 than the Republican candidate had a lower PI and obesity prevalence. The percentage completing some college and Black individuals as well as median household income were higher in counties where the Democratic candidate received more votes. Regionally, unique, region-specific cultural identities and partisan coalition demographics were apparent and serve as potential explanations for inconsistencies in PI and obesity prevalence across the U.S. Identifying the driving forces of PI and obesity within specific U.S. regions and crafting messaging that has optimal efficacy on a local level is essential to reducing the burden of cardiovascular disease and other chronic conditions.

Equitable well-being, social trust, and the economy: An integrated health system's perspectives on the long-term implications of COVID-19

To address organizational concerns related to the longer-term implications of coronavirus disease 2019 (COVID-19) and generate priorities for organizational focus, we facilitated an in-depth dialogue and discussion among health system leaders who collectively represented medical, public health, and business expertise. Key insights and observations were identified, prioritized, collected, discussed, and organized into overarching themes. A set of five overarching themes that are considered important themes to be addressed by the larger health system emerged. The five observed themes include: 1) Health disparities persist; 2) physical activity, healthful diet, and healthy weight reduce severe COVID-19 health outcomes; 3) an urgent need exists to rebuild social trust; 4) partnerships and collaborations among public health, business and industry, and health care are central to rebuilding social trust and implementation of equitable and sustainable solutions; and 5) health, well-being, and healing are business imperatives.

Systems science approaches to cardiovascular disease prevention and management in the era of COVID-19: A Humpty-Dumpty dilemma?

The coronavirus disease 2019 (COVID-19) pandemic necessitated the implementation and prioritizing of strict public health strategies to mitigate COVID-19 transmission and infection over all else. As we enter a 'recovery' phase in which the impact of the virus recedes (but does not relent), we ask, "How do we develop a game plan that considers prevention over management of public health threats of a more chronic nature, including cardiovascular disease?" We frame this choice point as a "Humpty-Dumpty" moment for public health with enduring and potentially irreversible consequences. Citing clear examples of other public health successes and failures, we outline in detail how sustaining cardiovascular population health under complex post-pandemic conditions will necessitate decision-making to be informed with a systems science approach, in which interventions, goals, outcomes and features of complex systems are carefully aligned.

Research gaps and opportunities in precision nutrition: an NIH workshop report

Precision nutrition is an emerging concept that aims to develop nutrition recommendations tailored to different people's circumstances and biological characteristics. Responses to dietary change and the resulting health outcomes from consuming different diets may vary significantly between people based on interactions between their genetic backgrounds, physiology, microbiome, underlying health status, behaviors, social influences, and environmental exposures. On 11-12 January 2021, the National Institutes of Health convened a workshop entitled "Precision Nutrition: Research Gaps and Opportunities" to bring together experts to discuss the issues involved in better understanding and addressing precision nutrition. The workshop proceeded in 3 parts: part I covered many aspects of genetics and physiology that mediate the links between nutrient intake and health conditions such as cardiovascular disease, Alzheimer disease, and cancer; part II reviewed potential contributors to interindividual variability in dietary exposures and responses such as baseline nutritional status, circadian rhythm/sleep, environmental exposures, sensory properties of food, stress, inflammation, and the social determinants of health; part III presented the need for systems approaches, with new methods and technologies that can facilitate the study and implementation of precision nutrition, and workforce development needed to create a new generation of researchers. The workshop concluded that much research will be needed before more precise nutrition recommendations can be achieved. This includes better understanding and accounting for variables such as age, sex, ethnicity, medical history, genetics, and social and environmental factors. The advent of new methods and technologies and the availability of considerably more data bring tremendous opportunity. However, the field must proceed with appropriate levels of caution and make sure the factors listed above are all considered, and systems approaches and methods are incorporated. It will be important to develop and train an expanded workforce with the goal of reducing health disparities and improving precision nutritional advice for all Americans.

Mapping One Million COVID-19 Deaths and Unhealthy Lifestyle Behaviors in the United States: Recognizing the Syndemic Pattern and Taking Action

Tragically, the United States (US) surpassed one million documented deaths due to the coronavirus disease 2019 (COVID-19) pandemic. A convincing association between unhealthy lifestyle behaviors and poorer outcomes associated with COVID-19 infection has already been demonstrated and communicated by the Centers for Disease Control and Prevention in public health messaging. The US is experiencing not a pandemic, but a syndemic, specifically an unhealthy lifestyle behaviors-chronic diseases-COVID-19 syndemic. This syndemic has almost certainly significantly contributed to the more than one million deaths the United States has experienced during the pandemic. Decades of a high prevalence of unhealthy lifestyle behaviors laid the foundation for our current unfortunate situation by increasing vulnerability to a novel virus, especially among subgroups who have been historically marginalized. As such, a major pathway to defeating this syndemic is through the promotion of healthy living behaviors for all. Now is the time for action appropriate to meet the demands of a syndemic and a new path forward to a healthier and more equitable future.

Cancer systems epidemiology: Overcoming misconceptions and integrating systems approaches into cancer research

Patricia Mabry and coauthors discuss application of systems approaches in cancer research.

Causal systems mapping to promote healthy living for pandemic preparedness: a call to action for global public health

COVID-19 has severely impacted population health and well-being globally. Acknowledging that COVID-19 will not be the world’s last pandemic, improving healthy living factors (i.e., physical activity, healthful nutrition, healthy weight), which are important in mitigating negative outcomes of future infectious disease pandemics, should be prioritized. Although well-documented, promoting healthy living factors remains challenged by a lack of scalability and sustainability due, in part, to a mismatch between intervention focus on individual behavior change as opposed to recognizing complex and multifactorial causes that prevent people from living healthy lifestyles and maintaining them long-term (such as political will, economic benefits, urban planning, etc.). To recognize this complexity in promoting healthy living, we propose the application of systems science methods for the creation of a comprehensive causal systems map of healthy living factors in the context of COVID-19 to inform future pandemic preparedness. Generating such a map would benefit researchers, practitioners, and policy makers in multi-sector collaborative efforts to improve public health preparedness in the context of future pandemics in a scalable, sustainable, and equitable manner. This effort should be facilitated by a trusted and widely respected governing body with global reach.

Physical Activity Surveillance in the United States for Work and Commuting: Understanding the Impact on Population Health and Well-being

OBJECTIVE

To summarize and describe the current US surveillance systems that assess physical activity (PA) for work and commuting.

METHODS

An expert group conducted an environmental scan, generating a list (n = 18) which was ultimately reduced to 12, based on the inclusion of PA and/or sedentary behavior data.

RESULTS

The 12 surveys or surveillance systems summarized provide nationally representative data on occupational-level PA or individual-level PA at work, data on active commuting, some are scorecards that summarize workplace health best practices and allow benchmarking, and one is a comprehensive nationally representative survey of employers assessing programs and practices in different worksites.

CONCLUSIONS

The various surveillance systems and surveys/scorecards are disparate and need to be better analyzed and summarized to understand the impact of occupational-level PA and commuting on population health and well-being, life expectancy, and workforce productivity.

Cardiovascular Health Research in the Workplace: A Workshop Report

Heart disease and stroke are the first and fifth leading causes of death in the United States, respectively. Employers have a unique opportunity to promote cardiovascular health, because >60% of US adults are employed, and most spend half of their waking hours at work. Despite the scope of the opportunity, <1 in 5 businesses implement evidence-based, comprehensive workplace health programs, policies, and practices. Integrated, systems-based workplace health approaches that harness data science and technology may have the potential to reach more employees and be cost-effective for employers. To evaluate the role of the workplace in promoting cardiovascular health across the lifespan, the National Heart, Lung, and Blood Institute, the National Institute for Occupational Safety and Health, and the American Heart Association convened a workshop on March 7, 2019, to share best practices, and to discuss current evidence and knowledge gaps, practical application, and dissemination of the evidence, and the need for innovation in workplace health research and practice. This report presents the broad themes discussed at the workshop and considerations for promoting worker cardiovascular health, including opportunities for future research.

Pragmatic Evaluation of a Health System-Based Employee Weight Management Program

Objective: We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal replacements optionally enrolled in the 12-month study. Longitudinal, single-arm analyses were conducted evaluating change over time via survey, claims and programmatic data. Token participation incentives were offered for survey completion. Results: In total, 140 participants enrolled (51.2 ± 9.8 years; BMI = 33.2 ± 6.5 kg/m²; 89.3% female). During 1 year, participants attended 18.0 ± 12.2 coaching appointments and self-reported significant improvements in weight (−8.2 ± 10.5% body weight), BMI (−3.9 ± 6.5 kg/m²), fruit/vegetable intake, home food preparation, added sugar, sugar sweetened beverages and life satisfaction (all p < 0.05). No significant changes were reported in physical activity, weight-related social support, self-efficacy or healthcare utilization (all p > 0.05). Conclusions: The findings from this evaluation establish implementation fidelity. Clinically significant self-reported weight loss, coupled with improvements in many weight-related behaviors, suggest the program is an effective weight management tool when offered as an employee well-being program.

Building Capacity for Integrated Occupational Safety, Health, and Well-Being Initiatives Using Guidelines for Total Worker Health® Approaches

OBJECTIVES

To describe the process used to build capacity for wider dissemination of a Total Worker Health® (TWH) model using the infrastructure of a health and well-being vendor organization.

METHODS

A multiple-case study mixed-methods design was used to learn from a year-long investigation of the experiences by participating organizations.

RESULTS

Increased capacity for TWH solutions was observed as evidenced by the participation, plans of action, and experience ratings of the participating organizations. The planning process was feasible and acceptable, although the challenges of dealing with the COVID-19 pandemic only afforded two of the three worksites to deliver a comprehensive written action plan.

CONCLUSIONS

A suite of services including guidelines, trainings, and technical assistance is feasible to support planning, acceptable to the companies that participated, and supports employers in applying the TWH knowledge base into practice.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Implementing movement at the workplace: Approaches to increase physical activity and reduce sedentary behavior in the context of work

The purpose of this article is to highlight approaches to increase movement, physical activity (PA), and cardiorespiratory fitness, and reduce sedentary behavior (SB) in the context of the workplace. A deliberate strategy that will enable the successful promotion of movement at the workplace includes a business plan and rationale, an organizing framework, prioritization of interventions that are known to generate outcomes, and alignment of programmatic solutions with strong program design principles. Recommended principles of design include leadership, relevance, partnership, comprehensiveness, implementation, engagement, communications, being data-driven, and compliance. Specific evidence-based intervention examples are presented in the context of a socio-ecological framework including the individual, group, communications environment, physical environment, and policy domains. Increased movement at the workplace, as a result of promoting PA and reducing SB, generates important health outcomes across physical, mental, social, and economic domains and these benefits extend across the individual and organizational levels.

A strategy to promote population-wide life satisfaction while advancing equity

OBJECTIVES

To develop a strategy to promote life satisfaction with equity for a diverse insured population.

STUDY DESIGN

Cross-sectional survey and claims analysis.

METHODS

We conduct an ongoing survey of a stratified random sample of adult plan members. Among other questions, the survey asks about adequacy of physical activity, healthy eating, abstinence from tobacco, limited alcohol consumption, adequate sleep, and whether the respondent takes time to think about the good things that happen to them (hereafter referred to as "healthy thinking"). We assessed the association of demographic characteristics and the 6 behaviors with life satisfaction.

RESULTS

We found that although all 6 behaviors were positively associated with life satisfaction, healthy thinking was the behavior associated with the greatest difference in life satisfaction between individuals who did and those who did not practice the behavior. We also found that although members insured through Medicaid or who had a psychosocial diagnosis tended to report significantly lower levels of life satisfaction, two-thirds of the opportunity to improve life satisfaction across the member population was among individuals with neither of these attributes.

CONCLUSIONS

The most effective strategy to promote both overall life satisfaction and equity will address social determinants for members with unmet social needs, provide the behavioral and mental health services that benefit members with these needs, and promote healthy lifestyles with an emphasis on healthy thinking for the entire population.

The health and well-being of an ACO population

OBJECTIVES

To identify opportunities to improve the health and well-being of members of HealthPartners, a health plan based in Minnesota.

STUDY DESIGN

Cross-sectional analysis of insurance claims, death records, and survey data.

METHODS

We calculated a current health score from insurance claims and death records for all 754,584 members 18 years and older who met inclusion and exclusion criteria for the period January 1, 2015, to December 31, 2015, and/or January 1, 2016, to December 31, 2016. Adjusting responses to represent the member population, we calculated a future health score based on 7 items and a 1-item well-being score from survey data that we collected between July 1, 2015, and December 31, 2016.

RESULTS

Forty-four percent of the loss to the current health score among HealthPartners members is attributable to musculoskeletal, psychosocial, and neurologic conditions. Among the 7 components of the future health score, the greatest opportunity for improvement (31% of the total potential) is increasing dietary fruits and vegetables. Although 42% of the members reported high levels of well-being, 14% reported low levels. On average, members with the lowest levels of well-being were insured by a Medicaid product and had low educational achievement.

CONCLUSIONS

By applying the summary measures of health and well-being to the HealthPartners member population, we identified opportunities to address conditions that created a high burden on current health, opportunities to improve prospects for future health, and subpopulations who would benefit from interventions that would increase their sense of well-being.

Economics of Community Health Workers for Chronic Disease: Findings From Community Guide Systematic Reviews

CONTEXT

Cardiovascular disease in the U.S. accounted for healthcare cost and productivity losses of $330 billion in 2013-2014 and diabetes accounted for $327 billion in 2017. The impact is disproportionate on minority and low-SES populations. This paper examines the available evidence on cost, economic benefit, and cost effectiveness of interventions that engage community health workers to prevent cardiovascular disease, prevent type 2 diabetes, and manage type 2 diabetes.

EVIDENCE ACQUISITION

Literature from the inception of databases through July 2016 was searched for studies with economic information, yielding nine studies in cardiovascular disease prevention, seven studies in type 2 diabetes prevention, and 13 studies in type 2 diabetes management. Analyses were done in 2017. Monetary values are reported in 2016 U.S. dollars.

EVIDENCE SYNTHESIS

The median intervention cost per patient per year was $329 for cardiovascular disease prevention, $600 for type 2 diabetes prevention, and $571 for type 2 diabetes management. The median change in healthcare cost per patient per year was -$82 for cardiovascular disease prevention and -$72 for type 2 diabetes management. For type 2 diabetes prevention, one study saw no change and another reported -$1,242 for healthcare cost. One study reported a favorable 1.8 return on investment from engaging community health workers for cardiovascular disease prevention. Median cost per quality-adjusted life year gained was $17,670 for cardiovascular disease prevention, $17,138 (mean) for type 2 diabetes prevention, and $35,837 for type 2 diabetes management.

CONCLUSIONS

Interventions engaging community health workers are cost effective for cardiovascular disease prevention and type 2 diabetes management, based on a conservative $50,000 benchmark for cost per quality-adjusted life year gained. Two cost per quality-adjusted life year estimates for type 2 diabetes prevention were far below the $50,000 benchmark.

Validating a method to assess disease burden from insurance claims

OBJECTIVES

To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population.

STUDY DESIGN

Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners' commercial products and completed a health assessment in 2011, 2012, or 2013.

METHODS

We calculated values of Spearman's ρ, the rank-order coefficient of correlation, for the correlation of DALYs with self-reported function and self-reported health. We did the same for the number of medical conditions per member and the cost of claims per member.

RESULTS

The Spearman's ρ values for the correlation of DALYs with function were -0.241, -0.238, and -0.229 in 2011, 2012, and 2013, respectively (all P <.0001). The respective Spearman's ρ values for the correlation of DALYs with health were -0.197, -0.189, and -0.192 (all P <.0001). These Spearman's ρ values were similar in magnitude to those for the correlation of the number of medical conditions per member with function (-0.212, -0.213, and -0.205) and health (-0.199, -0.196, and -0.198) over the 3 years. The Spearman's ρ values for the correlation of DALYs with function and health were greater than or equal to those for the correlation of cost of claims per member with function (-0.144, -0.193, and -0.186) and greater than those for the cost of claims per member with health (-0.126, -0.150, and -0.151).

CONCLUSIONS

Health plans can use DALYs calculated from their own health insurance claims and death records as a valid and inexpensive method to identify the conditions that place the greatest burden of poor function and ill health on their insured populations.

Research Methodologies for Total Worker Health®: Proceedings From a Workshop

OBJECTIVE

There is growing interest in the NIOSH Total Worker Health program, specifically in the process of designing and implementing safer, health-promoting work and workplaces. A Total Worker Health (TWH) Research Methodology Workshop was convened to discuss research methods and future needs.

METHODS

Twenty-six experts in occupational safety and health and related fields reviewed and discussed current methodological and measurement issues and those showing promise.

RESULTS

TWH intervention studies face the same challenges as other workplace intervention studies and some unique ones. Examples are provided of different approaches and their applications to TWH intervention studies, and desired developments in the TWH literature.

CONCLUSIONS

This report discusses and outlines principles important to building the TWH intervention research base. Rigorous, valid methodologic, and measurement approaches are needed for TWH intervention as well as for basic/etiologic, translational, and surveillance research.