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Am J Health Promot. 2000 Sep-Oct;15(1):45-52.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

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  • 1StayWell Company, St. Paul, MN, USA.

Erratum in

  • Am J Health Promot 2001 Jan-Feb;15(3):191.



To assess the relationship between modifiable health risks and total health care expenditures for a large employee group.


Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period.


The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers.


Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis.


Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures.


Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures.


Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

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