title: Targeting high-risk employees may reduce cardiovascular racial disparities.
abstract: OBJECTIVE
  A possible remedy for health disparities is for employers to promote cardiovascular health among minority employees. We sought to quantify the financial return to employers of interventions to improve minority health, and to determine whether a race- or risk-targeted strategy was better.
  
  
  METHODS
  Retrospective claims-based cohort analysis.
  
  
  METHODS
  Unconditional per-person costs attributable to stroke and myocardial infarction (MI) were estimated for University of Michigan employees from 2006 to 2009 using a 2-part model. The model was then used to predict the costs of cardiovascular disease to the University for 2 subgroups of employees-minorities and high-risk patients-and to calculate cost-savings thresholds: the point at which the costs of hypothetical interventions (eg, workplace fitness programs) would equal the cost savings from stroke/ MI prevention.
  
  
  RESULTS
  Of the 38,314 enrollees, 10% were African American. Estimated unconditional payments for stroke/MI were almost the same in African Americans ($128 per employee per year; 95% CI, $79-$177) and whites ($128 per employee per year; 95% CI, $101- $156), including higher event rates and lower payments per event in African Americans. Targeting the highest risk decile with interventions to reduce stroke/MI would result in a substantially higher cost-savings threshold ($81) compared with targeting African Americans ($13). An unanticipated consequence of risk-based targeting is that African Americans would substantially benefit: an intervention targeted at the top risk decile would prevent 75% of the events in African Americans, just as would an intervention that exclusively targeted African Americans.
  
  
  CONCLUSIONS
  Targeting all high-risk employees for cardiovascular risk reduction may be a win-win-win situation for employers: improving health, decreasing costs, and reducing disparities.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, University of Michigan Medical School, 6312 Medical Science Building 1, Ann Arbor, MI 48109. E-mail: jamesbur@med.umich.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Chekan
authors.forename: Ted M
authors.initials: TM
authors.lastname: Makowiec
authors.forename: Laurita
authors.initials: L
authors.lastname: Thomas
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D017046:Cost Savings / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D018803:Models, Economic; D009203:Myocardial Infarction / Q000453:epidemiology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014495:Universities / Q000191:economics / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D000078329:Workforce