Incremental increases in economic burden parallels cardiometabolic risk factors in the US

Figures & data

Table 1 Prevalence of CMRFs by number of risk factors (MEPS 2010–2012)

Prevalence of CMRFsa
Population characteristics	Average MEPS population	Any risk factor	Zero risk factors	One risk factor	Two risk factors	Three or four risk factors
Sample size (n)	–	43,037	30,849	29,647	9,392	3,998
Sex (%)
Male	48.26	50.93	45.38	50.93	50.19	52.67
Female	51.74	49.07	54.62	49.07	49.81	47.33
Age category, years (%)
18–34	30.24	20.39	44.13	28.63	4.32	1.70
35–49	25.59	25.67	25.94	29.61	19.27	13.71
50–64	25.86	29.91	20.66	24.83	39.68	41.75
65–79	13.25	17.87	6.67	11.73	28.11	35.90
80+	5.06	6.15	2.59	5.19	8.63	6.93
Race (%)
White	80.67	80.59	80.94	81.19	79.59	78.75
Black	11.80	13.70	9.02	12.84	15.43	15.53
American Indian	0.74	0.83	0.64	0.85	0.78	0.82
Other	6.79	4.88	9.41	5.12	4.21	4.90
Ethnicity (%)
Hispanic	14.61	15.01	13.87	17.07	10.05	12.53
Non-Hispanic	85.39	84.99	86.13	82.93	89.95	87.47
Region (%)
Northeast	18.30	17.52	18.99	17.62	17.42	17.06
Midwest	21.51	22.17	20.84	21.66	23.12	23.47
South	37.00	38.96	34.47	38.02	40.34	42.18
West	23.19	21.35	25.70	22.71	19.12	17.30
Highest degree completed (%)
No degree	14.71	14.39	14.47	13.43	15.08	19.37
Less than bachelors	56.60	60.17	51.89	59.81	60.62	61.53
Bachelors	18.69	16.50	21.99	17.46	15.69	11.87
Masters, PhD	10.00	8.94	11.65	9.30	8.62	7.23
Family income categoryb (%)
Poor	12.83	12.73	12.41	13.04	10.97	14.74
Near poor	4.54	4.87	3.86	4.74	5.00	5.52
Low income	13.67	14.51	12.33	14.42	14.66	14.76
Middle income	30.21	30.77	29.68	30.58	31.15	31.22
High income	38.75	37.12	41.72	37.22	38.23	33.77
Insurance status (%)
No insurance during year	15.04	13.05	17.30	16.07	7.10	6.32
Private only during year	53.87	49.37	61.61	54.06	43.11	31.94
Public only during year	19.77	23.16	14.26	18.98	29.57	36.80
Public and private during year	11.32	14.42	6.83	10.90	20.22	24.93
Age, years (mean)	46.84	51.16	40.41	46.75	59.46	61.89
BMI, kg/m^2 (mean)	27.75	31.19	23.09	30.43	32.10	34.32
Number of chronic conditions (mean)	1.94	2.63	0.98	1.74	3.98	5.59
Number of chronic conditions excluding CMRFsc (mean)	1.35	1.69	0.87	1.29	2.33	2.95

Notes:

a CMRFs: abdominal obesity (BMI ≥27 kg/m²), elevated blood pressure (at least one ICD-9 code for hypertension – 401.x), elevated triglycerides (having at least one prescription), elevated glucose (at least one ICD-9 code for diabetes [250.xx] and at least one prescription for an antihyperglycemic medication), hyperuricemia (at least one ICD-9 code for gout [274.x] and at least one prescription).

b Family income poverty levels: poor, income less than or equal to poverty line; near poor, income over the poverty line through 125% of poverty line; low income, income over 125% through 200% of poverty line; middle income, income over 200% through 400% of poverty line; high income, income over 400% of poverty line.

c Number of chronic conditions excluding ICD-9 codes: 250, 272, 274, 278, and 401.

Abbreviations: CMRFs, cardiometabolic risk factors; BMI, body mass index; ICD-9, International Classification of Diseases, ninth revision; MEPS, Medical Expenditure Panel Survey.

Table 2 Prevalence of CMRFs by type of risk factor (MEPS 2010–2012)

Population characteristics	Prevalence of CMRFsa
	Average MEPS population	Abdominal obesity	Elevated blood pressure	Elevated triglycerides	Elevated glucose
Sample size (n)	–	36,638	16,830	1,756	6,566
Sex (%)
Male	48.26	51.95	47.77	61.15	50.22
Female	51.74	48.05	52.23	38.85	49.78
Age category, years (%)
18–34	30.24	23.90	2.70	2.53	3.78
35–49	25.59	28.68	14.21	16.60	15.92
50–64	25.86	29.74	37.28	39.20	38.68
65–79	13.25	14.46	32.43	34.96	32.82
80+	5.06	3.22	13.38	6.70	8.80
Race (%)
White	80.67	80.60	79.76	89.67	76.69
Black	11.80	14.36	14.36	3.87	15.94
American Indian	0.74	0.90	0.64	0.54	0.85
Other	6.79	4.14	5.23	5.93	6.52
Ethnicity (%)
Hispanic	14.61	16.38	8.81	9.64	14.75
Non-Hispanic	85.39	83.62	91.19	90.36	85.25
Region (%)
Northeast	18.30	17.14	17.93	17.79	17.03
Midwest	21.51	22.56	22.76	22.03	22.55
South	37.00	38.79	40.52	41.13	41.19
West	23.19	21.50	18.79	19.05	19.24
Highest degree completed (%)
No degree	14.71	14.11	15.73	15.67	20.58
Less than bachelors	56.60	60.84	59.51	58.24	61.05
Bachelors	18.69	16.40	15.56	15.97	11.92
Masters, PhD	10.00	8.65	9.20	10.12	6.45
Family income categoryb (%)
Poor	12.83	13.17	11.58	12.01	14.38
Near poor	4.54	4.82	5.28	4.08	5.86
Low income	13.67	14.36	14.78	12.62	16.39
Middle income	30.21	31.17	30.23	29.52	31.72
High income	38.75	36.48	38.13	41.78	31.65
Insurance status (%)
No insurance during year	15.04	14.67	5.88	4.23	7.70
Private only during year	53.87	53.20	36.16	37.30	32.45
Public only during year	19.77	20.73	33.23	31.41	37.14
Public and private during year	11.32%	11.39	24.73	27.05	22.71
Age, years (mean)	46.84	48.27	62.72	61.06	60.88
BMI, kg/m^2 (mean)	27.75	32.66	30.07	30.71	32.06
Number of chronic conditions (mean)	1.94	2.34	4.39	5.10	5.04
Number of chronic conditions excluding CMRFsc (mean)	1.35	1.54	2.54	3.05	2.61

Notes:

a CMRFs: abdominal obesity (BMI ≥27 kg/m²), elevated blood pressure (at least one ICD-9 code for hypertension – 401.x), elevated triglycerides (having at least one prescription), elevated glucose (at least one ICD-9 code for diabetes [250.xx] and at least one prescription for an antihyperglycemic medication), hyperuricemia (at least one ICD-9 code for gout [274.x] and at least one prescription).

b Family income poverty levels: poor, income less than or equal to poverty line; near poor, income over the poverty line through 125% of poverty line; low income, income over 125% through 200% of poverty line; middle income, income over 200% through 400% of poverty line; high income, income over 400% of poverty line.

c Number of chronic conditions excluding ICD-9 codes: 250, 272, 274, 278, and 401.

Abbreviations: CMRFs, cardiometabolic risk factors; BMI, body mass index; ICD-9, International Classification of Diseases, ninth revision; MEPS, Medical Expenditure Panel Survey.

Table 3 Annual utilization and expenditure estimates by number of CMRFs

Variables	Number of CMRFs
	Average MEPS populationa	Zero risk factors (n=30,849)		One risk factor (n=29,647)		Two risk factors (n=9,392)		Three or four risk factors (n=3,998)
		Unadjusted	Adjusted	Unadjusteda	Adjusted	Unadjusteda	Adjusted	Unadjusteda	Adjusted
Utilizationb Number of outpatient visits	8.11	5.57	Reference group	7.55	1.08 (1.02,1.15)	12.84	1.26 (1.17, 1.35)	17.59	1.55 (1.42, 1.70)
Number of emergency room visits	0.19	0.14	Reference group	0.19	1.15 (1.06,1.24)	0.28	1.37 (1.25, 1.51)	0.31	1.39 (1.22, 1.57)
Number of inpatient visits	0.11	0.07	Reference group	0.10	1.14 (1.04, 1.25)	0.19	1.50 (1.22, 1.69)	0.26	1.77 (1.51, 2.08)
Inpatient length of stay (days)	0.59	0.28	Reference group	0.46	1.16 (0.98,1.37)	0.97	1.50 (1.22, 1.83)	1.44	2.43 (1.86, 3.16)
Number of medications including refills	13.04	5.57	Reference group	10.77	1.42 (1.36, 1.48)	28.49	3.36 (3.18, 3.54)	49.76	5.29 (4.19, 5.72)
Health care expenditure (2014 US dollars)c	$5,465	$3,523	Reference group	$4,763	$417 ($70, $763)	$9,281	$2,326 ($1,864, $2,788)	$13,304	$4,117 ($3,428, $4,807)

Notes:

a Unadjusted estimates are mean.

b Incidence rate ratio and 95% confidence intervals from negative binomial regression models after adjusting for age, sex, race, ethnicity, region, education, number of other chronic conditions, family income, insurance status, eg, after adjusting for all measured variables, those with three or four risk factors on average had a 1.55 higher expected rate of outpatient visits vs those with zero risk factors.

c Adjusted increments annual expenditures and 95% confidence intervals from generalized linear models with log link and gamma family distribution after adjusting for age, sex, race, ethnicity, region, education, number of other chronic conditions, family income, and insurance status.

Abbreviations: CMRFs, cardiometabolic risk factors; MEPS, Medical Expenditure Panel Survey.

Figure 1 Adjusted annual health care expenditures by number of CMRFs for MEPS respondents from 2010 to 2012.

Note: Adjusted expenditures calculated from generalized linear models with log link and gamma family distribution after adjusting for clinical and demographic characteristics.
Abbreviations: CMRFs, cardiometabolic risk factors; MEPS, Medical Expenditure Panel Survey.

Table 4 Employment and absenteeism estimates by number of CMRFs

Variables	Number of CMRFs
	Average MEPS populationa	Zero risk factors (n=30,849)		One risk factor (n=29,647)		Two risk factors (n=9,392)		Three or four risk factors (n=3,998)
		Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
Not employed(% on annualbasis)a	20.7%	19.6%	Reference group	18.3%	0.81 (0.76, 0.87)	26.1%	0.96 (0.87, 1.07)	39.6%	1.38 (1.17, 1.63)
Annual numberof days missedat work due toillness or injuryb	3.56	2.82	Reference group	3.69	1.21 (1.09,1.34)	5.71	1.55 (1.31, 1.82)	6.65	1.75 (1.42, 2.17)

Notes:

a Unadjusted estimates are percentage of working age-group (18–64 years) who were not employed during survey years; adjusted estimates and 95% confidence intervals are odds ratios from logistic regression model after adjusting for age, sex, race, ethnicity, region, education, number of other chronic conditions, and insurance status.

b Unadjusted estimates are mean number of days; adjusted estimates and 95% confidence intervals are incidence rate ratios from negative binomial regression models after adjusting for sex, race, ethnicity, region, education, number of other chronic conditions, and insurance status.

Abbreviations: CMRFs, cardiometabolic risk factors; MEPS, Medical Expenditure Panel Survey.