North Carolina Supplemental Cardiovascular Disease Prevention Project: Design and Objectives

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Actual National Health Care Costs (in billions)
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U.S. Health Care as a Percentage of the GDP
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Doctor day, January 1, 2360
D-day
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Current Financing of U.S. Health Care
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Portion of Health Care That is Related to Health
Risk
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What is the Impact of Lifestyle on Employee Costs

• health care costs
• disability
• workers compensation
• productivity
• absenteeism

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Absenteeism averages about 2.7

• Based upon 2004 salaries
• median employee costs 514/yr
• companies with lt100 employees pay 23,100 per
  year
• companies gt5,000 employees pay 2.75 million per
  year

CCH, 1999
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Reasons for Absenteeism
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What are Health Promotion Programs?

• any health enhancing efforts
• efforts that enhance awareness, change behavior,
  and create environments that support good health
  practices
• programs vary by intensity, quality, and design

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Review of the Published Literature

• Do individuals with high health risks have worse
  financial outcomes than individuals with low
  health risks?
• Do health promotion programs improve financial
  outcomes?

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Health Risks and Health Care Costs

• Obesity
• Hypertension
• Stress
• Multiple Risk Factors
• Depression

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Health Risks and Absenteeism

• Stress
• Multiple Risk Factors
• Depression
• Obesity and overweight

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Health Promotion Programs and Absenteeism

• 14 studies
• all 14 studies reported reduced absenteeism
• Average cost benefit ratio was 4.3

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What caused the reductions?
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Health Promotion Programs and Health Care Costs

• Only 4 of the 32 studies failed to report lower
  health care costs
• Cost benefit ratios from this literature ranged
  from a low of 2.3 to a high of 5.9 (average was
  3.48)

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Conclusion

• health promotion programs are associated with
  lower health care costs

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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4 woman)
22
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4 woman)
23
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4 woman)
24
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4 woman)
25
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4 woman)
26
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4 woman)
27
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4 woman)
28
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4 woman)
29
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4 woman)
32
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
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Diabetes Among Adults in the U.S.,BRFSS 1990
Source Mokdad et al., Diabetes Care
2000231278-83.
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Diabetes Among Adults in the U.S.,BRFSS 1991-92
Source Mokdad et al., Diabetes Care
2000231278-83.
38
Diabetes Among Adults in the U.S.,BRFSS 1993-94
Source Mokdad et al., Diabetes Care
2000231278-83.
39
Diabetes Among Adults in the U.S.,BRFSS 1995-96
Source Mokdad et al., Diabetes Care
2000231278-83.
40
Diabetes Among Adults in the U.S.,BRFSS 1995
Source Mokdad et al., Diabetes Care
2000231278-83.
41
Diabetes Among Adults in the U.S.,BRFSS 1997-98
Source Mokdad et al., Diabetes Care
2000231278-83.
42
Diabetes Among Adults in the U.S.,BRFSS 1999
Source Mokdad et al., Diabetes Care 200124412.
43
Diabetes Among Adults in the U.S.,BRFSS 2000
Source Mokdad et al., J Am Med Assoc 200128610.
44
Diabetes Among Adults in the U.S.,BRFSS 2001
Source Mokdad et al., J Am Med Assoc 200128610.
45
Lifetime Risk of Diabetes for Children Born in
2003
Venkat Narayan, JAMA 20032901884
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Lifetime Risk for Chronic Diseases
NCI Canada, 2.0 Lancet 199935389
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National prevalence of lifestyle related health
risks
CDC, BRFSS, 2002
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Leading Causes of Death in the U.S. 2001
Cancer 24
Other 40
Cardiovascular Disease 36
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Lifestyle Related Causes of Death in the U.S. 2001
CVD
Cancer
Other
Up to 70 of all causes of death are lifestyle
related and preventable
Louis Sullivan HHS Sec Surgeon Generals
Report, 1990
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Percent of Selected Chronic Diseases That Are
Likely Avoidable
91
82
71
70
Sources Stampfer, 2000 Platz, 2000 Hu, 2001
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Lung cancer and vegetable intake
Relative risk
Vegetable intake grams/day
Am Inst for Cancer Research, 1997
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Stomach cancer and vegetable intake
Relative risk
Vegetable intake grams/day
Am Inst for Cancer Research, 1997
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Stomach cancer and fruit intake
Relative risk
Fruit intake grams/day
Am Inst for Cancer Research, 1997
54

• DNA in each cell gets a hit from a free radical
  every 10 seconds
• Each cell gets 10,000 hits/day

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Cancer deaths by age, in 2001
80 of all cancers occur after age 55
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Cancer deaths by age, in 2001
80 of all cancers occur after age 65
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Where do free radicals come from?

• Most are produced by our own bodies by the
  electron transport system (ETC)
• UV light
• burned food
• toxic chemicals
• Industrial
• automobile pollution
• unknown sources

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Cigarette Smoke

• One of the largest sources of free radicals
• One puff of smoke contains
• 100,000,000,000,000,000 free radical species
• Tobacco is responsible for 31 of all cancers

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Cancer death and smoking
Relative risk
Number of cigarettes/day
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How do we protect our selves?

• Anti oxidants
• Phytochemicals
• Anti free radicals

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Phytochemicals

• Carotenoids
• Beta-carotene
• Lycopene
• Lutein
• Zeaxanthin
• Organosulfurs
• Flavinoids

• Phytosterols
• Alkaloids
• Tannins
• Saponins
• 10,000 more we have yet to identify an name

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Spontaneous or inherited mutation
Abnormal cell
Normal cell
Repair
Carcinogen
Tumor
Metastasis
Cell proliferation
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Spontaneous or inherited mutation
Abnormal cell
Normal cell
Repair
Activated carcinogen
Tumor
Metastasis
Cell proliferation
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What We Do
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Percent of Americans by state who consume 5
servings of fruits and/or vegetables per day
CA 27.4
National 22.6
Percent
UT 20.6
NV 22.3
AZ 22.6
NM 21.9
2002 BRFSS, CDC
66
Percent of Americans by State Who Are Sedentary
National 78.0
AZ 78.7
NV 75.5
NM 76.2
Percent
CA 76.0
UT 74.0
2000 BRFSS, CDC
67
Percent of Americans by State Who are Overweight
or Obese
National 59.2
Percent
UT 53.6
2002 BRFSS, CDC
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Type of Fat and Risk of Coronary Heart Disease
CVD risk
Hu, New Eng J Med1997
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A Western Lifestyle

• Little Physical Activity
• Red meat
• Processed meat
• Butter
• Potatoes
• Refined grains
• High fat dairy foods

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A Prudent Lifestyle
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Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 200313824-32
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Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 20032901884-1890
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Diabetes and Reduction in Quality Adjusted Life
Years
-18.6 yrs
-22.0 yrs
JAMA 20032901884-1890
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If you are a smoker
-14.5 yrs
-13.2 yrs
MMWR 199746444-51
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If you are a meat eater.
An average loss of 3.6 yrs
Pramil Singh, Am J Clin Nutr 200378526s
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Difference in Years of Life Between High and Low
Health Risk
Frazier, Arch Intern Med. 20011611645
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Low vs High Health Risks and Life Expectancy
(cumulative)
Age
Frazier et al,Arch Intern Med. 20011611645
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Real and Possible Changes in Life Span (7th Day
Adventists)
?
?
Fraser et al. Arch Intern Med, 20011611645-1652
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Real and Possible Changes in Life Span (Mormon
High Priests and wives)
?
?
Mormon High Priests and Wives, Enstrom, UCLA, 1989
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What Can I Expect if I Reduce My Health Risks?
10 to 20 years of extended, high-quality living
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And

• Improved quality of life
• Reduced Chronic Disease
• Less medications
• Less Hospital time
• Fewer Surgical procedures
• Postponed disability (Compression of Morbidity)

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Compression of Morbidity
Morbidity
Lifespan in years
76
0
Chronic disability
Ann Intern Med, 2003139455-459
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Compression of Morbidity
Morbidity
Lifespan in years
0
?
76
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Chronic disability
87
Reductions of Near Death Morbidity
Morbidity
Lifespan in years
Morbidity
Lifespan in years
88
With a Healthy Lifestyle

• Life span can increase
• Chronic disability can be delayed from 7-12 years
• The amount of near death morbidity is reduced by
  75
• Health care costs are also dramatically reduced

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Randomized Results
www.aldana.byu.edu