Estimated savings in U.S. dental expenditures, 1979-89.

The American public saved more than $39 billion (1990 dollars) in dental expenditures from 1979 through 1989 in contrast to the substantial increases in expenditures in other sectors of the U.S. health care system that have pushed the system to the brink of major reform. The dental savings were estimated after controlling for the influence of economic factors, such as changes in prices, insurance, and income, as well as noneconomic factors that could influence the extent of dental disease in the U.S. population. Results of the analysis confirm the importance of both economic and noneconomic factors in the determination of the savings in dental expenditures.     

Estimated dietary flavonoid intake and major food sources of U.S. adults

Estimating flavonoid intake is a first step toward documenting the protective effects of flavonoids against risk of chronic diseases. Although flavonoids are important dietary sources of antioxidants, insufficient data on the comprehensive food composition of flavonoids have delayed the assessment of dietary intake in a population. We aimed to estimate the dietary flavonoid intake in U.S. adults and its sociodemographic subgroups and to document major dietary sources of flavonoids. We expanded the recently released USDA Flavonoid Database to increase its correspondence with the 24-h dietary recall (DR) of the NHANES 1999-2002. We systematically assigned a particular food code to all foods that were prepared or processed similarly. This expanded database included 87% of fruits and fruit juices, 86% of vegetables, 75% of legumes, and, overall, 45% of all foods reported by the 24-h DR of the NHANES 1999-2002. Estimated mean daily total flavonoid intake, 189.7 mg/d, was mainly from flavan-3-ols (83.5%), followed by flavanones (7.6%), flavonols (6.8%), anthocyanidins (1.6%), flavones (0.8%), and isoflavones (0.6%). The flavonoid density of diets increased with age (P < 0.001) and income (P < 0.05). It was higher in women (P < 0.001), Caucasians (P < 0.001), and vitamin supplement users (P < 0.001) and lower in adults with high levels of nonleisure time physical activity (P < 0.01) compared with their counterparts. The greatest daily mean intake of flavonoids was from the following foods: tea (157 mg), citrus fruit juices (8 mg), wine (4 mg), and citrus fruits (3 mg). The proposed relation between flavonoid intake and the prevention of chronic diseases needs further investigation using the estimates introduced in this study.     

U.S.-incurred costs of wild poliovirus infections in a camp with U.S.-bound refugees--Kenya, 2006

Routine predeparture vaccinations are not required for U.S.-bound refugees, a policy that potentially leaves U.S. communities vulnerable to importation of vaccine-preventable diseases. During October-December 2006, an outbreak of poliomyelitis associated with wild poliovirus type 1 (WPV1) occurred in a camp occupied by refugees awaiting resettlement to the United States. This report describes the costs of domestic and international activities borne by U.S. federal and state governments, U.S.-funded organizations, and U.S. voluntary agencies during their response to this outbreak. Requiring predeparture polio vaccinations for U.S.-bound refugees might reduce the risk for poliovirus importation and reduce the costs associated with responses to polio outbreaks among refugees.     

The attributable annual health costs of U.S. occupational lead poisoning

Background: U.S. occupational lead standards have not changed for decades, while knowledge about lead’s health effects has grown substantially.

Objective: The objective of this analysis was twofold: to estimate the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers and, more broadly, to develop methods for a fuller valuation of health damages.

Methods: I combined data voluntarily reported to NIOSH on the number of highly exposed workers with published literature on the health effects of lead in adults to estimate the potential health benefits of lowering the U.S. occupational limit. I developed simple algorithms for monetizing more fully both the direct medical and indirect (productivity) damages associated with those high lead exposures.

Results: I estimated direct medical costs of $141 million (2014US$) per year for 16 categories of health endpoints, and combined direct and indirect costs of over $392 million (2014US$) per year for the 10,000 or so U.S. workers with high occupational lead exposures.

Conclusions: Reducing allowable occupational lead limits produces annual societal benefits of almost $40,000 per highly exposed worker. Given underreporting of actual exposures and the omission of important health effects, this is likely a severe underestimate.     

The relationship between obesity and injuries among U.S. adults

PURPOSE: To quantify the relationship between body mass index (BMI) and rates of medically attended injuries by mechanism (overall, fall, motor vehicle, and sport-related) and by nature (strain/sprain, lower extremity fracture, and dislocations), and between BMI and injury treatment costs. DESIGN: Cross-sectional analysis. SETTING. The noninstitutionalized population of the United States. SUBJECTS: The 1999-2000, 2000-2001, and 2001-2002 waves of the Medical Expenditure Panel Survey, a large, nationally representative dataset, were combined to create the analysis sample. The final sample included 42,304 adults. MEASURES. Medically attended injury rates by mechanism and nature of injury and related treatment costs. ANALYSIS: Logistic regressions were used to separately estimate the odds of sustaining any injury by mechanism or by nature for overweight (25 < BMI : 29.9) and three categories of obese individuals compared with those who were normal weight. A second set of regressions tested whether, given that an injury occurred, obese individuals had greater injury treatment costs. RESULTS. Slightly more than one in five adults sustain an injury each year that requires medical treatment. The odds of sustaining an injury are 15% (overweight) to 48% (Class III obesity) greater among those with excess weight. Conditional on sustaining an injury, BMI did not have a significant impact on injury treatment costs. CONCLUSION: Our findings show a clear association between BMI and the probability of sustaining an injury. If increasing BMI is causing the rise in injury rates, then the incidence of injuries, including those related to falls, sprains/strains, lower extremity fractures, and joint dislocations, are likely to increase as the prevalence of obesity increases.     

Built environment and obesity by urbanicity in the U.S.

Based on the data from the Behavioral Risk Factor Surveillance System 2012, this study examines the association of neighborhood built environments with individual physical inactivity and obesity in the U.S. Multilevel modeling is used to control for the effects of individual socio-demographic characteristics. Neighborhood variables include built environment, poverty level and urbanicity at the county level. Among the built environment variables, a poorer street connectivity and a more prominent presence of fast-food restaurants are associated with a higher obesity risk (especially for areas of certain urbanicity levels). Analysis of data subsets divided by areas of different urbanicity levels and by gender reveals the variability of effects of independent variables, more so for the neighborhood variables than individual variables. This implies that some obesity risk factors are geographically specific and vary between men and women. The results lend support to the role of built environment in influencing people׳s health behavior and outcome, and promote public policies that need to be geographically adaptable and sensitive to the diversity of demographic groups.     

Vaccine delivery to newly arrived refugees and estimated costs in selected U.S. clinics, 2015

BackgroundNewly arrived refugees are offered vaccinations during domestic medical examinations. Vaccination practices and costs for refugees have not been described with recent implementation of the overseas Vaccination Program for U.S.-bound Refugees (VPR). We describe refugee vaccination during the domestic medical examination and the estimated vaccination costs from the US government perspective in selected U.S. clinics.MethodsSite-specific vaccination processes and costs were collected from 16 clinics by refugee health partners in three states and one private academic institution. Vaccination costs were estimated from the U.S. Vaccines for Children Program and Medicaid reimbursement rates during fiscal year 2015.ResultsAll clinics reviewed overseas vaccination records before vaccinating, but all records were not transferred into state immunization systems. Average vaccination costs per refugee varied from $120 to $211 by site. The total average cost of domestic vaccination was 15% less among refugees arriving from VPR- vs. nonVPR-participating countries during a single domestic visit.ConclusionOur findings indicate that immunization practices and costs vary between clinics, and that clinics adapted their vaccination practices to accommodate VPR doses, yielding potential cost savings.     

Population growth and economic development: two new U.S. perspectives

This report compares the research paths of economic development reports by the US National Academy of Sciences (NAS) and the American Assembly of Columbia University. The NAS group, made up principally of economists and demographers, refrained from recommending population reduction targets, in contrast to the stronger terms of its 1971 report. A 1965 report by the Assembly spoke of population as a serious negative influence for economic development, political stability, and world peace, while the new report speaks of negative socioeconomic effects, and of the limiting of a person's right to control family size. The NAS agenda was established before the US delegation to the UN population conference in Mexico City retreated from declaring population growth to be a necessarily negative influencer of socioeconomic progress. The Assembly took the position that possible benefits of population growth would be far outweighed by factors such as resource depletion and women's health. The NAS maintained that growth might provide incentives for institutional adjustments (market development, investment in education) and control of growth should not be considered a substitute for such interventions. Both reports agree that control of fertility is a human right, but the NAS report examined the question of the acceptable degree of compulsion to be used to encourage couples. The Assembly objected to limiting access to family planning by defunding abortion programs oversease. Differences exist between the 2 reports in questins such as the negative impact of 1950's population growth, the synergistic effect of growth on many areas of human activity, the extent to which welfare of future generations is considered relevant today, and the adequacy of pure economic analysis in assessing need. Much study of population/development linkages is still required.     

Economic costs of obesity to self-insured employers

OBJECTIVE:: To quantify the direct and indirect costs of obesity within a cohort of commercially insured employees in the United States. METHOD:: Health plan claims, self-reported health risk assessment, and productivity data (Thomson MarketScan) from 2003 to 2005 were used to identify employees. Two-part regression models were used to compare body mass index (BMI) groups to estimate the incremental direct and indirect costs, conditional on expenditure, associated with elevated BMI. RESULTS:: Regression-adjusted incremental direct medical costs associated with being overweight, obese, and severely obese were estimated to be $147.11, $712.34, and $1977.43, respectively. Adjusted incremental indirect costs due to paid absence associated with being overweight, obese, and severely obese were estimated at $1403.81, $1511.24, and $1414.09, respectively. CONCLUSIONS:: Overall adjusted direct and indirect costs were higher for workers with elevated BMI relative to those of normal weight.