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Absenteeism due to health-related causes results in an estimated $65 billion in lost wages annually, according to a newly released report titled "The Health Status of the United States Workforce." This report is the first of its kind to evaluate the overall health status of American workers, and the rather discouraging results have strong implications for case managers working to increase productivity and reduce lost work days for American employers.
The high level of undiagnosed and uncontrolled chronic conditions in the workplace greatly increases the risk of serious illness in America’s work force, says the report’s primary author, Robin P. Hertz, PhD, occupational epidemiologist and senior director of outcomes research and population studies for Pfizer Pharmaceutical Group in New York City. "As many as 90,000 heart attacks and vascular events among workers each year in the U.S. may be due to elevated blood pressure and cholesterol, based on projections from the Framingham Heart Study equations," she notes. "Smoking, another major risk factor, may be associated with as many as 74,000 cases of acute coronary events per year in the work force."
The report is one of several in the "Pfizer Facts" series and is the result of several years spent analyzing the data from the National Comorbidity Survey (NCS), 1990-1992, from the Institute for Social Research at the University of Michigan in Ann Arbor and two large national studies conducted by the Centers for Disease Control and Prevention in Atlanta — the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994, released in 1997, and the National Health Interview Survey (NHIS), released in 1996. Approximately 8,000 people were interviewed for the NCS survey. NHANES III is a representative survey of roughly 34,000 people, and NHIS is a nationally representative survey of roughly 24,000 households representing 63,000 people.
These are very large data sets, notes Hertz. "We culled the data sets down to Americans between the ages of 18 and 64, who account for the majority of employed persons in the United States," she explains, adding that 118 million Americans between the ages of 18 and 64 are employed, accounting for 73% of the adult population in that age group.
"Most studies linking health and productivity are limited to a single disease and small populations," says Hertz. "Analysis of major national surveys has enabled us to expand our knowledge base and communicate new information that will serve the interests of both employers and employees."
Overall, injury remains the leading cause of lost work days in men and the second-leading cause of lost work days in women. Annually, injuries account for 1,820 lost work days for every 1,000 men and 1,194 lost work days for every 1,000 women. Respiratory disease and symptoms rank first for women and second for men, with 1,454 lost work days for every 1,000 women and 937 lost work days for every 1,000 men.
Hertz says many employers, risk managers, and payers focus solely on reducing and managing occupational hazards that cause injury, and few understand and address the prevalence of disease in the work force. "One of my concerns as an occupational epidemiologist," she says, "is this need to look at the overall health status of the working population and find out what medical conditions workers are bringing into the workplace which impact lost work days and productivity."
Among the more interesting findings in "The Health Status of the United States Workforce" are:
1. Cardiovascular risk.
• Workers under age 55 who have heart disease are eight times more likely to experience reduced productivity than workers without heart disease.
• An estimated 37 million American workers have high cholesterol. More than 65% of Americans with high cholesterol are not adequately controlled. More than 40% of those with high cholesterol have not been diagnosed. These high rates of undiagnosed and uncontrolled disease put the worker and the employer at a disadvantage, notes Hertz.
• An estimated 18 million workers have high blood pressure. More than 75% of those with high blood pressure are not adequately controlled. Another 35% of those with high blood pressure have not yet been diagnosed.
• Ischemic heart disease (IHD) affects only 3% of American workers, but Hertz hypothesizes this low prevalence in the work force may be a reflection of the severe disability imposed by IHD, which forces workers to retire or apply for disability. More than 60% of nonemployed adults with IHD report that limitations associated with their disease prevent them from working. Of those who remain employed, 34% report that their disease limits the kind or amount of work they perform.
2. Migraines. American workers who suffer migraine headaches miss three times as many work days as workers without migraines. Workers under age 55 with migraine are twice as likely to be unable to be fully productive as workers under 55 who don’t have migraines.
3. Mental health. Nearly 10% of American workers between the ages of 18 and 39 screen positive for major depression, but only 12% of these workers are treated with antidepressant medications. In addition, 2% of employed men and 5% of employed women have attempted suicide.
4. Back, joint, muscle, tendon, and bone disorders.
• More than 13 million Americans, or 11% of the work force, report having arthritis. American workers with arthritis are absent from work three times as often as workers without arthritis. Absenteeism is highest among workers between the ages of 35 and 44, the age group least likely to receive prescription medication for arthritis. In addition, arthritis poses a three- to fourfold higher risk of diminished work productivity and accounts for 24% of the reported conditions in this category.
5. Acute illness.
• Infectious diseases and respiratory, musculoskeletal, and digestive disorders account for 57% of total annual lost work days. As workers age, chronic conditions such as arthritis and heart disease become more prominent causes of lost work days and lost productivity, notes Hertz.
• Pneumonia and influenza are associated with more lost work days than any other respiratory disease. More than 700 days are lost to pneumonia/influenza each year for every 1,000 women in the work force and just less than 500 days each year are lost for every 1,000 men in the work force. Annually, acute respiratory infection accounts for 524 lost work days in for every 1,000 women in the work force and 287 days for every 1,000 men in the work force.
• Almost 5 million workers, or 4% of the total work force, have diabetes. Workers under age 55 with diabetes are six times more likely to report work limitations than workers without diabetes.
• Diabetes is more prevalent among men than women. Hertz stresses, however, that underdiagnosis is a problem among both employed men and women in the work place. More than 40% of American workers with diabetes are undiagnosed. Roughly 60% of working women between the ages of 18 and 34 are undiagnosed diabetics; 57% of men between the ages of 18 and 34 are undiagnosed. Of women age 45-55, 55% are undiagnosed, and among men age 35-44, 55% are undiagnosed.
Remaining competitive in the marketplace necessitates finding solutions for increasing productivity and encouraging employee retention, says Hertz. Pfizer hopes the report will increase awareness of disease prevalence in the work force and act as "a call to action" for employers and health care professionals to develop and support wellness, disease management, and prevention programs that target the problem areas identified by this analysis of these large national data sets, she says. "The report is an effort to understand health issues facing employers and employees and to encourage the development of programs and policies that lead to proper risk management, treatment, and prevention," she explains.