The association between health risk change and presenteeism change

Improving employee productivity through improved health

OBJECTIVE

The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs.

METHODS

Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs.

RESULTS

Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees.

CONCLUSIONS

Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Reduction in health risks and disparities with participation in an employer-sponsored health promotion program

There is an increasing awareness among employers and health care providers that health care needs to be tailored to address the diversity of the workforce. Population-based data have shown significant differences in health behaviors and health risks among different racial/ethnic groups in the United States. The purpose of this study was to examine health risks and changes in health risks over time in an employed population at a financial services corporation. This large financial services corporation is naturally concerned about any disparities in health among employees. The study population consists of employees who participated in the organization's medical plan and also the annual health risk appraisal questionnaire in both 2009 and 2010. Significant demographic differences exist among the four ethnic groups studied: whites, African Americans, Hispanics, and Asians. At baseline, African American employees had a significantly higher average number of health risks measured by the health risk appraisal, but they also experienced the greatest improvement in health risks by time 2. There were differences in the health risk profiles of the ethnic groups, with certain risk factors being more prevalent among some ethnicities than among others. The health care costs were not significantly different among the groups studied here. It is likely that other large employers may also find health risk differences among employees belonging to various ethnicities. Future research in this field should seek to understand the reasons behind differences in health among ethnic groups and how best to address them so that all employees can achieve a high level of health and wellness.

Association among Working Hours, Occupational Stress, and Presenteeism among Wage Workers: Results from the Second Korean Working Conditions Survey

Objectives

The purpose of the present study was to identify the association between presenteeism and long working hours, shiftwork, and occupational stress using representative national survey data on Korean workers.

Methods

We analyzed data from the second Korean Working Conditions Survey (KWCS), which was conducted in 2010, in which a total of 6,220 wage workers were analyzed. The study population included the economically active population aged above 15 years, and living in the Republic of Korea. We used the chi-squared test and multivariate logistic regression to test the statistical association between presenteeism and working hours, shiftwork, and occupational stress.

Results

Approximately 19% of the workers experienced presenteeism during the previous 12 months. Women had higher rates of presenteeism than men. We found a statistically significant dose–response relationship between working hours and presenteeism. Shift workers had a slightly higher rate of presenteeism than non-shift workers, but the difference was not statistically significant. Occupational stress, such as high job demand, lack of rewards, and inadequate social support, had a significant association with presenteeism.

Conclusions

The present study suggests that long working hours and occupational stress are significantly related to presenteeism.

The prevalence of musculoskeletal disorder and association with productivity loss: a preliminary study among labour intensive manual harvesting activities in oil palm plantation

Production agriculture such as harvesting in oil palm plantation has been frequently associated with MSD and significant loss of productivities. This study tends to evaluate from the viewpoint of health, the association between self-reported prevalence of musculoskeletal disorders and productivities; the impact of musculoskeletal disorders on productivity. A cross-sectional study was conducted among 143 harvesters in oil palm plantation. A general questionnaire was used to collect socio-demographic background data while Nordic Musculoskeletal Questionnaire was used to determine the prevalence of MSD. Expressed in 4 different indicators; daily harvesting quantity, efficiency score, sick leave and presenteeism, the productivity data were analysed for association. There is significant association between reported acute prevalence of MSD (within 7 d) and productivity loss in terms of presenteeism (χ(2)=5.088; p<0.05) as well as quantity of daily harvest (χ(2)=7.406; p<0.01). Logistic regression adjusted for age, BMI and smoking indicate that harvesters with MSD (past seven days) were more likely to be engaged in presenteeism (OR=2.87 95% CI=1.34, 6.14) and had lower daily productivity (OR=2.09 95% CI=1.02, 4.29) compared to harvesters without MSD (past 7 d). This study reveals that oil palm harvesters suffering acute MSD (for the past week) were likely to be still present to work and produce half lesser than their healthy counterparts. Thus, further study with comprehensive surveillance strategy is essential in order to determine the urgency or need of appropriate intervention.

The association between modifiable well-being risks and productivity: a longitudinal study in pooled employer sample

OBJECTIVE

To examine the longitudinal relationship between modifiable well-being risks and productivity.

METHODS

A total of 19,121 employees from five employers participated in baseline and follow-up well-being assessment surveys. Multivariate regressions assessed whether changes in absenteeism, presenteeism, and job performance were associated with changes in 19 modifiable well-being risks.

RESULTS

Over time, a 5% reduction in total count of well-being risks was significantly associated with 0.74% decrease in absenteeism, 2.38% decrease in presenteeism, and 0.24% increase in performance. High blood pressure, recurring pain, unhealthy diet, inadequate exercise, poor emotional health, poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being had greater independent contributions in explaining productivity impairment.

CONCLUSIONS

The often-ignored well-being risks such as work-related and financial health risks provided incremental explanation of longitudinal productivity variations beyond traditional measures of health-related risks.

Leveraging best practices to promote health, safety, sustainability, and stewardship

Strategically leveraging health and safety initiatives with sustainability and stewardship helps organizations improve profitability and positively impact team member and customer attachment to the organization. Collective efficacy enhances the triple bottom line: healthy people, healthy planet, and healthy profits. The HS(3)™ Best Practice Exchanges group demonstrated that collective efficacy can leverage the social cohesion, communication channels, and activities within workplaces to promote a healthy, sustainable work culture. This in turn (1) protects the health and safety of workers, (2) preserves the natural environment, and (3) increases attachment to the organization. Community-based participatory research using the Attach21 survey assessed the progress of these companies in their efforts to integrate health, safety, sustainability, and stewardship. Monthly Best Practice Exchanges promoted collective efficacy by providing support, encouragement, and motivation to share and adopt new ideas.

Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs

Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.

Promoting prevention through the affordable care act: workplace wellness

Public health in the United States can be improved by building workplace "cultures of health" that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public's health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness.

Poor health but not absent: prevalence, predictors, and outcomes of presenteeism

OBJECTIVE

The objective of this study was to examine the prevalence of presenteeism, to develop and test a model of the relationship between workplace factors and presenteeism, and to assess the perceived influence of manager, coworkers, and self on presenteeism.

METHODS

We used survey data collected for 6309 employees from seven different organizations.

RESULTS

Nearly 60% of the sample reported presenteeism during a 3-month period. The model was supported, with presenteeism linking workplace factors and health outcomes to productivity, as predicted. The majority of participants (67%) indicated that the primary pressure to attend work while sick came from themselves. A substantial minority (20%) also indicated the manager as a source of pressure.

CONCLUSIONS

Psychosocial workplace factors are predictive of presenteeism, and efforts to control them, including the use of more effective management, may impact presenteeism rates and the resulting levels of productivity.

Sick at work: presenteeism among nurses in a Portuguese public hospital

Presenteeism refers to attending work despite being ill. This article focuses on this innovative organizational concept. Data from nurses at a major Portuguese public hospital (N=296) reported some major causes of presenteeism, namely lower-back pain, breath infections, migraines and stress. Although females revealed higher prevalence levels for most of the presenteeism causes, no gender differences were found regarding the number of hours people were affected by presenteeism. Moreover, other work variables were correlated-age, perceived health state, number of working hours, income and seniority-with a presenteeism scale (SPS-6) and a Health Condition Index. Most importantly, a negative correlation was found between perceived health status and presenteeism. Additionally, more experienced and highly paid nurses tended to be less affected by presenteeism. Finally, the limitations of this study-as well as some implications of presenteeism on productivity loss-are discussed.

Impact of a Web-based worksite health promotion program on absenteeism

OBJECTIVE

To evaluate the effect of participation in a comprehensive, Web-based worksite health promotion program on absenteeism.

METHODS

Study population consists of Dutch workers employed at a large financial services company. Linear regression was used to assess the impact of program attendance on the difference between baseline and follow-up absenteeism rates, controlling for gender, age, job level, years of employment, and noncompletion of the program.

RESULTS

Data from 20,797 individuals were analyzed; 3826 individuals enrolled in the program during the study period. A 20.3% reduction in absenteeism was shown among program attendees compared with nonparticipants during a median follow-up period of 23.3 months.

CONCLUSIONS

Participating in the worksite health promotion program led to an immediate reduction in absenteeism. Improved psychological well-being, increased exercise, and weight reduction are possible pathways toward this reduction.

Impact of the prevention plan on employee health risk reduction

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).

Economic evaluation of a worksite obesity prevention and intervention trial among hotel workers in Hawaii

OBJECTIVE

Economic evaluation of Work, Weight, and Wellness (3W), a 2-year randomized trial of a weight loss program delivered through Hawaii hotel worksites.

METHODS

Business case analysis from hotel perspective. Program resources were micro-costed (2008 dollars). Program benefits were reduced medical costs, fewer absences, and higher productivity. Primary outcome was discounted 24-month net present value (NPV).

RESULTS

Control program cost $222K to implement over 24 months ($61 per participant), intervention program cost $1.12M ($334). Including overweight participants (body mass index >25), discounted control NPV was -$217K; -$1.1M for intervention program. Presenteeism improvement of 50% combined with baseline 10% productivity shortfall required to generate positive 24-month intervention NPV.

CONCLUSIONS

3W's positive clinical outcomes did not translate into immediate economic benefit for participating hotels, although modest cost savings were observed in the trial's second year.

Work-related stress in Australia: The effects of legislative interventions and the cost of treatment

The Australian Institute of Health and Welfare data published in 2002 shows a continued rise in health care costs to the Australian community due to the growing number of people diagnosed with mental health disorders. Those mental health disorders may originate from a number of sources, including work and non-work-related factors. The so called work-related stress claims in all Australian jurisdictions are the most expensive form of workers compensation claim. In the most part this is due to the lengthy period of absence (duration) and complicated medical care which are characteristic of these claims. In Australia, in the last decade, attempts have been made to reduce the costs of compensable stress-related claims by imposing special legislative thresholds on such claims. This 'back end' approach to cost reduction has resulted in an array of legislative formula designed to exclude work-related stress claims. This article surveys the various legislative provisions dealing with work-related stress claims in Australia and provides an analysis of their effectiveness. A range of options are presented as alternatives to the exclusion of particular forms of work-related stress claims. The use of a corporate citizenship approach to the prevention and management of stress claims is also discussed as a proactive alternative to occupational safety and health legislative provisions and the workers compensation legislative exclusions.

A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback

BACKGROUND

Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees.

EVIDENCE ACQUISITION

The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity.

EVIDENCE SYNTHESIS

The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone.

CONCLUSIONS

The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.

Making the link between health and productivity at the workplace--a global perspective

This paper discusses the relationship between health and productivity at the workplace by providing a global perspective of the current status of the fields of workplace health promotion and health management. The prevailing chronic disease trends coupled with economic pressures have proven a significant challenge for employers and employees alike. While a global growth trend in workplace health promotion can be observed the number of companies which take a proactive and integrated approach to workplace health remains small. Workplace health promotion programs in the United States typically focus on the individual health risks of employees while their European counterparts target work-related hazards, physical and, more recently, psychosocial. A number of specific tools and programs for integrated health management are described, such as self-report instruments to measure presenteeism. The analysis suggests that existing occupational health services strategies are insufficient to address the current challenges. Improved employee health can only be achieved in a sustainable manner when integrating all health-related services within an enterprise and addressing psychosocial and organizational factors as well as individual health issues.

Metabolic syndrome in a workplace: prevalence, co-morbidities, and economic impact

BACKGROUND

Although the prevalence of metabolic syndrome has been studied in nationally representative populations, little is known about its prevalence specifically among working adults. Because corporations are often the primary payers of health-care costs in the United States, they have a vested interest in knowing the impact of metabolic syndrome in employed individuals.

METHODS

A total of 4188 employees (83.4% male, 92.1% Caucasian, average age 40.8 years) of a midwestern U.S. manufacturing corporation participated in a health risk appraisal and biometric screening in 2006 and also used the company's medical plan. Those with metabolic syndrome were compared to those without metabolic syndrome in terms of their 2006 health risks, health conditions, health-care costs, pharmacy costs, short-term disability costs, and a measure of on-the-job productivity loss known as presenteeism.

RESULTS

A total of 30.2% of employees met the criteria for metabolic syndrome and were more likely to also have a variety of additional health risks and health conditions compared to those without metabolic syndrome. For example, 9.4% of those with metabolic syndrome self-reported having diabetes compared to 1.4% of those without metabolic syndrome. Health-care costs, pharmacy costs, and short-term disability costs were significantly higher for those with metabolic syndrome compared to those without metabolic syndrome, and increasing numbers of metabolic syndrome health risks were associated with greater numbers of employees reporting on-the-job productivity losses (presenteeism).

CONCLUSIONS

Because metabolic syndrome is prevalent among the employees of this manufacturing company and is associated with significant economic costs, employers would be wise to address the health risks of employees through health promotion programs and benefit plan designs that help individuals improve their health and receive appropriate health screenings and medical care.

Using a personal health care cost calculator to estimate future expenditures based on individual health risks

OBJECTIVE

To describe the development and application of an innovative Health Improvement Cost Calculator tool designed to help individuals recognize the link between their current health risks, future medical costs, and productivity.

METHODS

We describe how the Calculator was developed using data from studies that tie health care costs and productivity to population health risks, and how changes in risks are projected to reduce future spending for individual workers.

RESULTS

Two simulations of the model illustrate how individuals may realize future economic costs or benefits depending on whether they maintain or change their health-risk profile.

CONCLUSIONS

The Calculator has the potential to be a powerful motivational tool for individuals, especially those heading toward retirement, who are looking to understand the relationships between their health risks, future medical spending, and impacts on productivity.

The association between changes in metabolic syndrome and changes in cost in a workplace population

OBJECTIVE

: To determine whether changes in metabolic syndrome (MetS) risks over time are associated with commensurate changes in health care costs, pharmacy costs and short-term disability costs in an employed population.

METHODS

: A total of 3270 employees of a Midwestern manufacturing corporation participated in a health risk appraisal, biometric screening and in the company's medical plan in 2004, 2005, and 2006. Changes in their MetS risks over time were compared with changes in costs.

RESULTS

: Risks for MetS in this manufacturing population are in a constant state of change. Changes in MetS status over time were associated with commensurate changes in health care, pharmacy, and short-term disability costs. Employees who reduced the greatest number of MetS risks over time had the largest cost decrease (-$437), whereas those who increased the greatest number of risks experienced the largest cost increase (+$1348).

CONCLUSIONS

: If organizations are successful in encouraging the high-risk individuals to reduce their risks while also helping the low-risk employees remain low risk, they will improve the health and vitality of employees while also improving cost and productivity outcomes.

Medical cost associated with prediabetes

In this article, we estimate national health care resource use and medical costs in 2007 associated with prediabetes (PD), defined as either fasting plasma glucose between 100 and 125 or oral glucose tolerance test between 140 and 200. We use Poisson regression with medical claims for an adult population continuously insured between 2004 and 2006 to analyze patterns of health care resource use by PD status. Combining rate ratios that reflect health care use patterns with national PD prevalence rates from the National Health and Nutrition Examination Survey, we calculate etiological fractions to estimate the portion of national health resource use associated with PD. The findings suggest that PD is associated with statistically higher rates of ambulatory visits for hypertension; endocrine, metabolic, and renal complications; and general medical conditions. PD is associated with a slight increase in visit rates for neurological symptoms, peripheral vascular disease, and cardiovascular disease, but the increase is not statistically significant. There is no indication that PD is associated with an increase in emergency visits and inpatient days. Extrapolating these patterns to the 57 million adults with PD in 2007 suggests that national annual medical costs of PD exceed $25 billion, or an additional $443 for each adult with PD. PD is associated with excessive use of ambulatory services for comorbidities known to be related to diabetes. Our findings strengthen the business case for lifestyle interventions to prevent diabetes by adding additional economic benefits that potentially can be achieved by preventing or delaying PD.

Measuring Worker Productivity: Frameworks and Measures

Worker productivity is a combination of time off work (absenteeism) due to an illness and time at work but with reduced levels of productivity while at work (also known as presenteeism). Both can be gathered with a focus on application as a cost indicator and/or as an outcome state for intervention studies. We review the OMERACT worker productivity groups’ progress in evaluating measures of worker productivity for use in arthritis using the OMERACT filter. Attendees at OMERACT 9 strongly endorsed the importance of work as an outcome in arthritis. Consensus was reached (94% endorsement) for fielding a broader array of indicators of absenteeism. Twenty-one measures of at-work productivity loss, ranging from single item indicators to multidimensional scales, were reviewed for measurement properties. No set of at-work productivity measures was endorsed because of variability in the concepts captured, and the need for a better framework for the measurement of worker productivity that also incorporates contextual issues such as job demands and other paid and unpaid life responsibilities. Progress has been made in this area, revealing an ambivalent set of results that directed us back to the need to further define and then contextualize the measurement of worker productivity.

Factors Associated with Incidental Sickness Absence among Employees in One Health Care System

Purpose.

Assess the association of taking incidental sickness absence with health risks and health status.

Design.

Observational.

Setting.

One Midwest health care system.

Subjects.

Individuals who were employed for 2 years (2006–2007) and had completed at least one health risk appraisal (HRA) in 2007 (N = 3790).

Measures.

Outcomes were any incidental sickness absence and absence duration in 2007 measured by an absence tracking system. Health risks and health status were estimated by HRAs. Program participation was captured using 7-year HRA data and 5-year wellness data.

Analysis.

Multivariate, binary logistic regression for the probability of taking any absence day among the overall population as well as four demographic subgroups; proportional odds model for the probability of taking more absence days.

Results.

Different patterns were observed in association with taking incidental sickness absence among age and gender subgroups. Among the overall population, three health risks (smoking overweight, and use of medication for relaxation) were positively associated with taking absence (at least p <. 05 for all three health risks). Participation in a wellness program for more years was also associated with a less likelihood of taking absence (odds ratio, .72; p = .002). Results from the proportional odds model were consistent with results from the binary logistic regression.

Conclusion.

Sickness absence is an important productivity concern of employers. Employers may implement early interventions to focus on preventable causes. Special interventions may target absence-causing risks such as smoking behavior and excess body weight. Study limitation includes a lack of measures for psychosocial work environment.

Use of a normal impairment factor in quantifying avoidable productivity loss because of poor health

OBJECTIVE

Growing evidence demonstrates a relationship between excess health risk and preventable productivity loss. There is a need to quantify how much lost productivity is avoidable through employer-sponsored health management interventions. This study introduced the Normal Impairment Factor (NIF) to recognize the amount of productivity loss that cannot be mitigated through health management interventions.

METHODS

A health assessment questionnaire was administered to 772,750 employees, representing 106 employers within five industry sectors. Researchers used multivariate regression procedures to examine the association between preventable health risks and self-reported productivity loss.

RESULTS

Back pain, mental well being, and stress risk were the strongest predictors of on-the-job productivity loss. A strong association was also detected between the number of health risks and productivity loss ranging from 3.4% for those at lowest risk (the NIF group) to 24.0% loss for those at risk for eight risks.

CONCLUSIONS

This study demonstrated the utility of the NIF in estimating the level of productivity loss that cannot be regained through health management interventions.

Sickness absence management: encouraging attendance or 'risk-taking' presenteeism in employees with chronic illness?

PURPOSE

To investigate the organizational perspectives on the effectiveness of their attendance management policies for chronically ill employees.

METHODS

A mixed-method approach was employed involving questionnaire survey with employees and in-depth interviews with key stakeholders of the organizational policies.

RESULTS

Participants reported that attendance management polices and the point at which systems were triggered, posed problems for employees managing chronic illness. These systems presented risk to health: employees were more likely to turn up for work despite feeling unwell (presenteeism) to avoid a disciplinary situation but absence-related support was only provided once illness progressed to long-term sick leave. Attendance management polices also raised ethical concerns for 'forced' illness disclosure and immense pressures on line managers to manage attendance.

CONCLUSIONS

Participants felt their current attendance management polices were unfavourable toward those managing a chronic illness. The policies heavily focused on attendance despite illness and on providing return to work support following long-term sick leave. Drawing on the results, the authors conclude that attendance management should promote job retention rather than merely prevent absence per se. They outline areas of improvement in the attendance management of employees with chronic illness.

The prevalence of metabolic syndrome in an employed population and the impact on health and productivity

OBJECTIVE

To investigate the prevalence of metabolic syndrome in an employed population and its association with health risks, health perception, illness days, work limitation (presenteeism), and short-term disability (STD).

METHODS

Five thousand five hundred twelve employees of a financial services company responded to an on-site health risk appraisal which included measured waist circumference and biometric results. The metabolic syndrome criteria were based on the 2005 AHA/NHLBI scientific statement on the diagnosis and management of metabolic syndrome. Perceived health, illness days, and presenteeism were self-reported; STD days were obtained from claims data.

RESULTS

In this employee population (61% women, average age 41 years), 22.6% met the criteria for metabolic syndrome and were more likely to report more health risks, poorer health perception, and more absent days due to illness. There was no clear association with presenteeism or STD incidence. However, as the number of metabolic risk factors increased, there was an increase in STD incidence, decrease in health perception, and increase in illness days. No association was found with number of metabolic risk factors and presenteeism.

CONCLUSIONS

Metabolic syndrome was associated with poor perceived health, increased illness days, and an increased trend of STD incidence. Worksite health promotion programs could be useful in helping employees and employers to identify metabolic syndrome risks and take steps to reduce risk and potential productivity losses.

The impact of an integrated population health enhancement and disease management program on employee health risk, health conditions, and productivity

This study evaluated the impact of an integrated population health enhancement program on employee health risks, health conditions, and productivity. Specifically, we analyzed changes in these measures among a cohort of 543 employees who completed a health risk assessment in both 2003 and 2005. We compared these findings with 2 different sets of employees who were not offered health enhancement programming. We found that the DIRECTV cohort showed a significant reduction in health risks after exposure to the program. Relative to a matched comparison group, the proportion of low-risk employees at DIRECTV in 2005 was 8.2 percentage points higher; the proportion of medium-risk employees was 7.1 percentage points lower; and the proportion of high-risk employees was 1.1 percentage points lower (p < 0.001). The most noticeable changes in health risk were a reduction in the proportion of employees with high cholesterol; an improvement in diet; a reduction of heavy drinking; management of high blood pressure; improved stress management; increased exercise; fewer smokers; and a drop in obesity rates. We also found that a majority of employees who improved their risk levels from 2003 to 2005 maintained their gains in 2006. Employees who improved their risks levels also demonstrated relative improvement in absenteeism. Overall, this study provides additional evidence that integrated population health enhancement positively impacts employees' health risk and productivity; it also reinforces the view that "good health is good business."

Working through a migraine: addressing the hidden costs of workplace headaches

The financial and personal impact of migraines in the workplace is substantial. Effective management of workplace migraines includes screening, prevention, and effective treatment. Worksite screeners are available to detect the burden of undiagnosed migraine in the workplace. Decreasing the personal and financial impact of migraines in the workplace requires a variety of strategies predicated on collaborative efforts among workers, occupational health nurses, other providers, and management.

[Economic impact according to health problems of workers]

PURPOSE

The purpose of this study was to examine health problems and to estimate economic impact based on health problems of workers.

METHODS

The subjects of this study consisted of 301 workers who received a group occupational health service. Data was collected from February 1 to March 30, 2006. The questionnaire contained questions based on general characteristics and the Stanford Presenteeism Scale. Data was analyzed with descriptive statistics, t-test using SPSS program.

RESULTS

The primary health conditions as reported by workers were ranked in order as stomach or bowel disorders, back or neck disorders, or liver function disorders. The reason of absenteeism per worker was ranked in order as asthma, or a breathing disorder. The reason of presenteeism was ranked in order as asthma, insomnia or a sleep disorder. The cost of the total economic impact on the workplace in this study was 8,851,838 won. The cost of absenteeism per worker was 8,390 won. The cost of presenteeism per worker was 941,732 won.

CONCLUSION

Presenteeism had a strong correlation to health conditions of the workers. Therefore, improving the work conditions of the workers is very important. If employers improve the health condition of workers, they will benefit from improved productivity in their business.

Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system's TRICARE prime-enrolled population

PURPOSE

To estimate medical and indirect costs to the Department of Defense (DoD) that are associated with tobacco use, being overweight or obese, and high alcohol consumption.

DESIGN

Retrospective, quantitative research.

SETTING

Healthcare provided in military treatment facilities and by providers participating in the military health system.

SUBJECTS

The 4.3 million beneficiaries under age 65 years who were enrolled in the military TRICARE Prime health plan option in 2006.

MEASURES

The findings come from a cost-of-disease model developed by combining information from DoD and civilian health surveys and studies; DoD healthcare encounter data for 4.1 million beneficiaries; and epidemiology literature on the increased risk of comorbidities from unhealthy behaviors.

RESULTS

DoD spends an estimated $2.1 billion per year for medical care associated with tobacco use ($564 million), excess weight and obesity ($1.1 billion), and high alcohol consumption ($425 million). DoD incurs nonmedical costs related to tobacco use, excess weight and obesity, and high alcohol consumption in excess of $965 million per year.

CONCLUSION

Unhealthy lifestyles are significant contributors to the cost of providing healthcare services to the nation's military personnel, military retirees, and their dependents. The continued rise in healthcare costs could impact other DoD programs and could potentially affect areas related to military capability and readiness. In 2006, DoD initiated Healthy Choices for Life initiatives to address the high cost of unhealthy lifestyles and behaviors, and the DoD continues to monitor lifestyle trends through the DoD Lifestyle Assessment Program.