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A More Generalizable Method to Evaluate the Association Between Commonly Reported Health Risks and Health Care Expenditures Among Employers of All Sizes

White, John DPM, MS; Hartley, Stephen K. BS; Musich, Shirley PhD; Hawkins, Kevin PhD; Ozminkowski, Ronald J. PhD

Journal of Occupational and Environmental Medicine: October 2013 - Volume 55 - Issue 10 - p 1179–1185
doi: 10.1097/JOM.0b013e31829b2833
Original Articles

Objective: To evaluate the association between health risks and health care expenditures for employers of all sizes, generalizing to all employees, even those who did not complete a health risk assessment (HRA).

Methods: Health risk assessments were obtained from 169,693 insured employees and spouses. Total health care expenditures were measured before HRA completion. Propensity score weighting, adjusting for HRA nonresponse, and multivariate regression analyses were used to estimate the relationship between health risks and health care expenditures.

Results: These at-risk categories were significantly associated with increased health care expenditures: elevated blood pressure, body weight and cholesterol, medication/drug use for relaxation, physical inactivity, and stress.

Conclusions: The large sample size, the use of data from small firms, and generalizability made this study unique. Targeted programs that promote management of health risks could result in health care cost savings for employers of all sizes.

From OptumHealth (Drs White and Ozminkowski and Mr Hartley), Golden Valley, Minn; OptumInsight (Drs Musich and Hawkins), Ann Arbor, MI.

Address correspondence to: John White, DPM, MS, Health and Wellness, Optum, PO Box 9472, NC975-1000, Minneapolis, MN 55440 (

This study was sponsored by OptumHealth. J.W., S.H., and R.J.O. are employees of OptumHealth. K.H. and S.M. are employees of OptumInsight.

The authors declare no conflicts of interest.

Copyright © 2013 by the American College of Occupational and Environmental Medicine