title: The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.
abstract: OBJECTIVE
  To assess the relationship between modifiable health risks and total health care expenditures for a large employee group.
  
  
  METHODS
  Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period.
  
  
  METHODS
  The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers.
  
  
  METHODS
  Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis.
  
  
  METHODS
  Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures.
  
  
  RESULTS
  Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures.
  
  
  CONCLUSIONS
  Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.
authors.affiliation: StayWell Company, St. Paul, MN, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Anderson
authors.forename: R W
authors.initials: RW
authors.lastname: Whitmer
authors.forename: R Z
authors.initials: RZ
authors.lastname: Goetzel
authors.forename: R J
authors.initials: RJ
authors.lastname: Ozminkowski
authors.forename: R L
authors.initials: RL
authors.lastname: Dunn
authors.forename: J
authors.initials: J
authors.lastname: Wasserman
authors.forename: S
authors.initials: S
authors.lastname: Serxner
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D006264:Health Benefit Plans, Employee / Q000191:economics*; D005102:Health Expenditures; D006293:Health Promotion / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000191:economics*