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Gender-Specific Effects of Modifiable Health Risk Factors on Coronary Heart Disease and Related Expenditures

Wasserman, Jeffrey PhD; William Whitmer, R. MBA; Bazzarre, Terry L. PhD; Kennedy, Sean T. BS; Merrick, Nancy MD; Goetzel, Ron Z. PhD; Dunn, Rodney L. MS; Ozminkowski, Ronald J. PhD, and theHERO Research Committee

Journal of Occupational and Environmental Medicine: November 2000 - Volume 42 - Issue 11 - p 1060-1069
Original Articles

There is a general lack of health-related research focusing on gender-specific differences within a working population. This research attempts to address that void. Our study relied on the Health Enhancement Research Organization (HERO) database, which consists of claims, enrollment information, and health risk data for 39,999 employees of six large employers. The research objective was to determine the gender-specific association between coronary heart disease (CHD) and (1) the prevalence of modifiable health risks and (2) medical expenditures. To accomplish this, the International Classification of Diseases, 9th Revision–Clinical Modification and Current Procedural Terminology codes were used to identify 2452 employees with CHD within the HERO database. These individuals made up the study group, which included 66% male and 34% female participants. Health risk data were obtained from voluntary participation in a health risk appraisal and biometric evaluation provided by the employers. Health risks evaluated were tobacco use, hypertension, obesity, elevated cholesterol, high blood glucose, sedentary lifestyle, stress, depression, and excessive use of alcohol. Descriptive and multivariate statistical techniques were used to analyze the HERO database. We found that obesity was the most consistent predictor of CHD. It was number one (of 10 health risks) in the male and female group, number two in the male-only group, and number one in the female-only group. High stress was the second most consistent predictor. There was no such consistency relative to medical expenditures. This lack of consistency across the male and female groups relative to the association between health risks and medical expenditures was demonstrated for nearly all other health risks evaluated. This study suggests that within a group of employees with CHD, there are important similarities and differences between men and women with respect to the prevalence of risk factors and the association between health risks and medical expenditures.

From The MEDSTAT Group, Santa Barbara, Calif. (Dr Wasserman, Mr Kennedy, Dr Merrick), Washington, D.C. (Dr Goetzel), and Ann Arbor, Mich. (Dr. Ozminkowsky, Mr Dunn); the Health Enhancement Research Organization (HERO), Birmingham, Ala. (Mr Whitmer); and the American Heart Association, Dallas, Tex. (Dr Bazzarre).

The HERO Research Committee members are David Anderson, PhD, Nadine Caputo, MPH, Mark Dundon, MBA, Roger Greenlaw, MD, Elizabeth Howze, ScD, Wendy Lynch, PhD, and Nico Pronk, PhD.

Address correspondence to: Mr R. William Whitmer, The Health Enhancement Research Organization (HERO), 3500 Blue Lake Drive, Suite 270, Birmingham AL 35243. e-mail

Copyright © by American College of Occupational and Environmental Medicine

© 2000 Lippincott Williams & Wilkins, Inc.