RESUMEN
BACKGROUND: There is a robust understanding of how specific behavioural, metabolic, and environmental risk factors increase the risk of health burden. However, there is less understanding of how these risks individually and jointly affect health-care spending. The objective of this study was to quantify health-care spending attributable to modifiable risk factors in the USA for 2016. METHODS: We extracted estimates of US health-care spending by condition, age, and sex from the Institute for Health Metrics and Evaluation's Disease Expenditure Study 2016 and merged these estimates with population attributable fraction estimates for 84 modifiable risk factors from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to produce estimates of spending by condition attributable to these risk factors. Because not all spending can be linked to health burden, we adjusted attributable spending estimates downwards, proportional to the association between health burden and health-care spending across time and age for each aggregate health condition. We propagated underlying uncertainty from the original data sources by randomly pairing the draws from the two studies and completing our analysis 1000 times independently. FINDINGS: In 2016, US health-care spending attributable to modifiable risk factors was US$730·4 billion (95% uncertainty interval [UI] 694·6-768·5), corresponding to 27·0% (95% UI 25·7-28·4) of total health-care spending. Attributable spending was largely due to five risk factors: high body-mass index ($238·5 billion, 178·2-291·6), high systolic blood pressure ($179·9 billion, 164·5-196·0), high fasting plasma glucose ($171·9 billion, 154·8-191·9), dietary risks ($143·6 billion, 130·3-156·1), and tobacco smoke ($130·0 billion, 116·8-143·5). Spending attributable to risk factor varied by age and sex, with the fraction of attributable spending largest for those aged 65 years and older (45·5%, 44·2-46·8). INTERPRETATION: This study shows high spending on health care attributable to modifiable risk factors and highlights the need for preventing and controlling risk exposure. These attributable spending estimates can contribute to informed development and implementation of programmes to reduce risk exposure, their health burden, and health-care cost. FUNDING: Vitality Institute.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Encuestas Epidemiológicas/economía , Encuestas Epidemiológicas/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: Efforts to realize the potential of disease prevention in the United States have fallen behind those of peer countries, and workplace disease prevention is a major gap. This article investigates the reasons for this gap. METHODS: Literature review and expert discussions. RESULTS: Obstacles to effective use of workplace disease prevention include limited leadership and advocacy, poor alignment of financial incentives, limitations in research quality and investment, regulation that does not support evidence-based practice, and a dearth of community-employer partnerships. CONCLUSIONS: We make recommendations to address these obstacles, such as the inclusion of health metrics in corporate reporting, making the workplace a central component of the strategy to combat the effect of noncommunicable diseases, and linking prevention directly benefit businesses' bottom lines.
Asunto(s)
Enfermedad Crónica/prevención & control , Promoción de la Salud , Lugar de Trabajo , Conductas Relacionadas con la Salud , Promoción de la Salud/economía , Promoción de la Salud/legislación & jurisprudencia , Humanos , Liderazgo , Asociación entre el Sector Público-Privado , Estados UnidosRESUMEN
BACKGROUND: : Workplace wellness programs have become increasingly popular despite large inconsistencies in the analyses of their ability to produce long-term medical care savings. OBJECTIVE: : To clarify the aforesaid situation by estimating potential long-term medical care savings linked to chronic disease. METHODS: : We combined data from the Global Burden of Disease Study and Medical Expenditure Panel Surveys to estimate the annual savings that would result from lowering risk factors typically managed by workplace wellness programs to their theoretical minimums. RESULTS: : Lowering risk factors to their theoretical minimums, if this were possible, would reduce average annual costs per working-age adult by 18.4%. CONCLUSION: : These findings have important implications for workplace wellness programs because they provide a robust estimate of potential savings.