Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study

Chukwuemeka U Osondu; Ehimen C Aneni; Javier Valero-Elizondo; Joseph A Salami; Maribeth Rouseff; Sankalp Das; Henry Guzman; Adnan Younus; Oluseye Ogunmoroti; Theodore Feldman; Arthur S Agatston; Emir Veledar; Barry Katzen; Chris Calitz; Eduardo Sanchez; Donald M Lloyd-Jones; Khurram Nasir

doi:10.1016/j.mayocp.2016.12.026

Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study

Mayo Clin Proc. 2017 Mar 13:S0025-6196(17)30088-5. doi: 10.1016/j.mayocp.2016.12.026. Online ahead of print.

Authors

Chukwuemeka U Osondu¹, Ehimen C Aneni², Javier Valero-Elizondo³, Joseph A Salami⁴, Maribeth Rouseff⁵, Sankalp Das⁵, Henry Guzman⁵, Adnan Younus⁴, Oluseye Ogunmoroti⁴, Theodore Feldman⁶, Arthur S Agatston⁶, Emir Veledar⁷, Barry Katzen⁸, Chris Calitz⁹, Eduardo Sanchez⁹, Donald M Lloyd-Jones¹⁰, Khurram Nasir¹¹

Affiliations

¹ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL.
² Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL.
³ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Cátedra de Cardiología y Medicina Vascular, Tecnológico de Monterrey, Nuevo León, Mexico.
⁴ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL.
⁵ Wellness Advantage Administration, Baptist Health South Florida, Miami, FL.
⁶ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL.
⁷ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL.
⁸ Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL.
⁹ American Heart Association, Dallas, TX.
¹⁰ Department of Preventive Medicine and Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
¹¹ Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, FL; Wellness Advantage Administration, Baptist Health South Florida, Miami, FL; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL; Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD. Electronic address: khurramn@baptisthealth.net.

PMID: 28365099
DOI: 10.1016/j.mayocp.2016.12.026

Abstract

Objective: To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population.

Participants and methods: Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures.

Results: Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles.

Conclusion: Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population.