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Kranz RM, Kettler C, Koeder C, Husain S, Anand C, Schoch N, Englert H. Health Economic Evaluation of a Controlled Lifestyle Intervention: The Healthy Lifestyle Community Program (Cohort 2; HLCP-2). Nutrients 2023; 15:5045. [PMID: 38140304 PMCID: PMC10745766 DOI: 10.3390/nu15245045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Non-communicable diseases (NCD) are associated with high costs for healthcare systems. We evaluated changes in total costs, comprising direct and indirect costs, due to a 24-month non-randomized, controlled lifestyle intervention trial with six measurement time points aiming to improve the risk profile for NCDs. Overall, 187 individuals from the general population aged ≥18 years were assigned to either the intervention group (IG; n = 112), receiving a 10-week intensive lifestyle intervention focusing on a healthy, plant-based diet; physical activity; stress management; and community support, followed by a 22-month follow-up phase including monthly seminars, or a control group (CG; n = 75) without intervention. The complete data sets of 118 participants (IG: n = 79; CG: n = 39) were analyzed. At baseline, total costs per person amounted to 67.80 ± 69.17 EUR in the IG and 48.73 ± 54.41 EUR in the CG per week. The reduction in total costs was significantly greater in the IG compared to the CG after 10 weeks (p = 0.012) and 6 months (p = 0.004), whereas direct costs differed significantly after 10 weeks (p = 0.017), 6 months (p = 0.041) and 12 months (p = 0.012) between the groups. The HLCP-2 was able to reduce health-related economic costs, primarily due to the reduction in direct costs.
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Affiliation(s)
- Ragna-Marie Kranz
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany
| | - Carmen Kettler
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Christian Koeder
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Sarah Husain
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Corinna Anand
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Nora Schoch
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Heike Englert
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
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Attridge M. Profile of Small Employers in the United States and the Importance of Employee Assistance Programs During the COVID-19 Pandemic. Am J Health Promot 2022; 36:1229-1236. [PMID: 36003013 PMCID: PMC9412145 DOI: 10.1177/08901171221112488d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mark Attridge
- Attridge Consulting, Inc, Minneapolis, MN, USA
- Mark Attridge, Attridge Consulting, Inc, Minneapolis, MN, USA.
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3
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Henke RM. Knowing Well, Being Well: well-being born of understanding: Supporting Workforce Mental Health During the Pandemic. Am J Health Promot 2022; 36:1213-1244. [PMID: 36003017 PMCID: PMC9523433 DOI: 10.1177/08901171221112488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Attridge M, Dickens SP. Onsite screening and enhanced EAP counseling improves overall health, depression, and work outcomes: Four-wave longitudinal pilot study at a community health center in Vermont. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2021. [DOI: 10.1080/15555240.2021.1971537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mark Attridge
- Attridge Consulting, Inc, Minneapolis, Minnesota, USA
| | - Steven P. Dickens
- Invest EAP Centers for Wellbeing, State of Vermont Division of Vocational Rehabilitation, Burlington, Vermont, USA
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Hanson GC, Rameshbabu A, Bodner TE, Hammer LB, Rohlman DS, Olson R, Wipfli B, Kuehl K, Perrin NA, Alley L, Schue A, Thompson SV, Parish M. A Comparison of Safety, Health, and Well-Being Risk Factors Across Five Occupational Samples. Front Public Health 2021; 9:614725. [PMID: 33614583 PMCID: PMC7892612 DOI: 10.3389/fpubh.2021.614725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/06/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to present safety, health and well-being profiles of workers within five occupations: call center work (N = 139), corrections (N = 85), construction (N = 348), homecare (N = 149), and parks and recreation (N = 178). Methods: Baseline data from the Data Repository of Oregon's Healthy Workforce Center were used. Measures were compared with clinical healthcare guidelines and national norms. Results: The prevalence of health and safety risks for adults was as follows: overweight (83.2%), high blood pressure (16.4%), injury causing lost work (9.9%), and reported pain (47.0%). Young workers were least likely to report adequate sleep (46.6%). Construction workers reported the highest rate of smoking (20.7%). All of the adult workers reported significantly lower general health than the general population. Conclusion: The number of workers experiencing poor safety, health and well-being outcomes suggest the need for improved working conditions.
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Affiliation(s)
- Ginger C. Hanson
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Anjali Rameshbabu
- Oregon Healthy Workforce Center, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Todd E. Bodner
- OHSU-PSU School of Public Health, Portland State University, Portland, OR, United States
| | - Leslie B. Hammer
- Oregon Healthy Workforce Center, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Diane S. Rohlman
- Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
| | - Ryan Olson
- Oregon Healthy Workforce Center, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Brad Wipfli
- OHSU-PSU School of Public Health, Portland State University, Portland, OR, United States
| | - Kerry Kuehl
- School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Nancy A. Perrin
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Lindsey Alley
- Oregon Healthy Workforce Center, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Allison Schue
- College of Osteopathic Medicine, Western University of Health Sciences, Lebanon, OR, United States
| | - Sharon V. Thompson
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Pronovost PJ, Urwin JW, Beck E, Coran JJ, Sundaramoorthy A, Schario ME, Muisyo JM, Sague J, Shea S, Runnels P, Zeiger T, Topalsky G, Wilhelm A, Palakodeti S, Navathe AS. Making a Dent in the Trillion-Dollar Problem: Toward Zero Defects. ACTA ACUST UNITED AC 2021. [DOI: 10.1056/cat.19.1064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Peter J. Pronovost
- Chief Clinical Transformation and Quality Officer, University Hospitals, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA
| | - John W. Urwin
- Clinical Fellow in Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric Beck
- Chief Operating Officer, University Hospitals, Cleveland, Ohio, USA
| | - Justin J. Coran
- Senior Data Scientist, University Hospitals, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Mark E. Schario
- Vice President, Population Health, and President of University Hospitals Quality Care Network, University Hospitals, Cleveland, Ohio, USA
| | - James M. Muisyo
- Data Scientist, Analytics, University Hospitals, Cleveland, Ohio, USA
| | - Jonathan Sague
- Vice President, UH Ventures Clinical Operations, University Hospitals, Cleveland, Ohio, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Susan Shea
- Senior Actuarial Analyst, University Hospitals, Cleveland, Ohio, USA
| | - Patrick Runnels
- Chief Medical Officer, Population Health-Behavioral Health, and Director of Population Health Education, University Hospitals, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Todd Zeiger
- Vice President, UH Primary Care Institute, University Hospitals, Cleveland, Ohio, USA
| | - George Topalsky
- Vice President, UH Primary Care Institute, University Hospitals, Cleveland, Ohio, USA
| | | | - Sandeep Palakodeti
- Chief Medical Officer, Population Health, University Hospitals, Cleveland, Ohio, USA
| | - Amol S. Navathe
- Assistant Professor of Health Policy and Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Urwin JW, Pronovost PJ, Navathe AS. Wasteful Health Care Spending in the United States. JAMA 2020; 323:895. [PMID: 32125396 DOI: 10.1001/jama.2019.22255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John W Urwin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Peter J Pronovost
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amol S Navathe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Kanerva N, Lallukka T, Rahkonen O, Pietiläinen O, Lahti J. The joint contribution of physical activity, insomnia symptoms, and smoking to the cost of short-term sickness absence. Scand J Med Sci Sports 2018; 29:440-449. [PMID: 30480836 DOI: 10.1111/sms.13347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
Physical inactivity has been associated with both insomnia symptoms and smoking. Further, they are all independently associated with increased sickness absence (SA) from work. However, joint contribution of either physical activity (PA) with insomnia symptoms or with smoking to SA and, especially, their direct cost for the employer is poorly understood. Therefore, we aimed to examine these joint associations with short-term (<15 days) SA cost. The Helsinki Health Study is a cohort of midlife employees of the City of Helsinki, Finland (baseline n = 8960, response rate 67%). During 2000-2002, the participants were mailed a survey questionnaire that gathered information on health behavior and sociodemographic characteristics. SA, salary, and time of employment were followed up through the employer's personnel register between 2002 and 2016 for those with a written consent to the use of their register data (78% of the participants). Individual salary data were used to calculate the direct cost of short-term SA. Data were analyzed with a two-part model. Inactive participants with frequent insomnia symptoms had 2526€ (95% CI 1736€-3915€) higher cost of short-term SA than vigorously active participants without insomnia symptoms. Furthermore, inactive smokers had 4166€ (95% CI 2737€-5595€) higher cost for the employer over the follow-up than vigorously active non-smokers. In conclusion, this study showed that PA and insomnia symptoms as well as PA and smoking are jointly associated with short-term SA cost. The results emphasize encouraging employers to improve work environments so that they promote active lifestyle, good sleep, and non-smoking in order to reduce the cost of SA.
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Affiliation(s)
- Noora Kanerva
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Mundell BF, Luetmer MT, Kremers HM, Visscher S, Hoppe KM, Kaufman KR. The risk of major cardiovascular events for adults with transfemoral amputation. J Neuroeng Rehabil 2018; 15:58. [PMID: 30255813 PMCID: PMC6156832 DOI: 10.1186/s12984-018-0400-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is well-known that the risk of cardiac disease is increased for those with lower-limb amputations, likely as a result of the etiology of the amputation. Using a longitudinal population-based dataset, we examined the association between transfemoral amputation (TFA) status and the risk of experiencing a major cardiac event for those undergoing either dysvascular or traumatic amputations. The association of receiving a prosthesis with the risk of experiencing a major cardiac event was also examined. METHODS Study Population: All individuals with TFA (N 162), i.e. knee disarticulation and transfemoral amputation, residing in Olmsted County, MN, between 1987 and 2014. Each was matched (1:10 ratio) with non-TFA adults on age, sex, and duration of residency. DATA ANALYSIS A competing risk Cox proportional hazard model was used to estimate the relative likelihood of an individual with a TFA experiencing a major cardiac event in a given time period as compared to the matched controls. The cohort was divided by amputation etiology: dysvascular vs trauma/cancer. Additional analysis was performed by combining all individuals with a TFA to look at the relationship between prosthesis receipt and major cardiac events. RESULTS Individuals with a dysvascular TFA had an approximately four-fold increased risk of a cardiac event after undergoing an amputation (HR 3.78, 95%CI: 3.07-4.49). These individuals also had an increased risk for non-cardiac mortality (HR 6.27, 95%CI: 6.11-6.58). The risk of a cardiac event was no higher for those with a trauma/cancer TFA relative to the able-bodied controls (HR 1.30, 95%CI: 0.30-5.85). Finally, there was no difference in risk of experiencing a cardiac event for those with or without prosthesis (HR 1.20, 95%CI: 0.55-2.62). CONCLUSION The high risk of initial mortality stemming from an amputation event may preclude many amputees from cardiovascular disease progression. Amputation etiology is also an important factor: cardiac events appear to be more likely among patients with a dysvascular TFA. Providing a prosthesis does not appear to be associated with a reduced risk of a major cardiac event following amputation.
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Affiliation(s)
| | - Marianne T Luetmer
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Sue Visscher
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kurtis M Hoppe
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Largo-Wight E, Wlyudka PS, Merten JW, Cuvelier EA. Effectiveness and feasibility of a 10-minute employee stress intervention: Outdoor Booster Break. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2017. [DOI: 10.1080/15555240.2017.1335211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Erin Largo-Wight
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
| | - Peter S. Wlyudka
- Department of Mathematics and Statistics, University of North Florida, Jacksonville, Florida, USA
| | - Julie W. Merten
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
| | - Elizabeth A. Cuvelier
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
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Aaron KJ, Colantonio LD, Deng L, Judd SE, Locher JL, Safford MM, Cushman M, Kilgore ML, Becker DJ, Muntner P. Cardiovascular Health and Healthcare Utilization and Expenditures Among Medicare Beneficiaries: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. J Am Heart Assoc 2017; 6:JAHA.116.005106. [PMID: 28151403 PMCID: PMC5523785 DOI: 10.1161/jaha.116.005106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Better cardiovascular health is associated with lower cardiovascular disease risk. Methods and Results We determined the association between cardiovascular health and healthcare utilization and expenditures in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included 6262 participants ≥65 years with Medicare fee‐for‐service coverage for the year after their baseline study visit in 2003‐2007. Cardiovascular health at baseline was assessed using the American Heart Association's Life's Simple 7 (LS7) metric, which includes 7 factors: cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose. Healthcare utilization and expenditures were ascertained using Medicare claims in the year following baseline. Overall, 17.2%, 31.1%, 29.0%, 16.4% and 6.4% of participants had 0 to 1, 2, 3, 4, and 5 to 7 ideal LS7 factors, respectively. The multivariable‐adjusted relative risk (95% confidence interval [CI]) for having any inpatient and outpatient encounters comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors were 0.55 (0.39, 0.76) and 1.00 (0.98, 1.02), respectively. Among participants with 0 to 1 and 5 to 7 ideal LS7 factors, mean inpatient expenditures were $3995 and $1250, respectively, mean outpatient expenditures were $5166 and $2853, respectively, and mean total expenditures were $9147 and $4111, respectively. After multivariable adjustment, the mean (95% CI) cost difference comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors was −$2551 (−$3667, −$1435) for inpatient, −$2410 (−$3089, −$1731) for outpatient, and −$5016 (−$6577, −$3454) for total expenditures. Conclusions Better cardiovascular health is associated with lower risk for inpatient encounters and lower inpatient and outpatient healthcare expenditures.
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Affiliation(s)
- Kristal J Aaron
- Department of Medicine, University of Alabama at Birmingham, AL
| | | | - Luqin Deng
- Department of Epidemiology, University of Alabama at Birmingham, AL
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, AL
| | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, AL.,Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL
| | - Monika M Safford
- Department of Medicine, University of Alabama at Birmingham, AL.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mary Cushman
- Departments of Medicine and Pathology, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL
| | - David J Becker
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, AL
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