Community health worker intervention improves health of patients with multiple chronic diseases
Over 65% of health care spending is associated with care for individuals with multiple chronic conditions. While community health worker (CHW) interventions have been shown to improve chronic disease outcomes within a disease-specific context, little is known regarding the efficacy in patients with multiple chronic conditions. This was the focus of a recently published NHLBI-funded study.
The study included 302 participants with two or more of the following chronic conditions: obesity, diabetes, hypertension, and tobacco dependence. Participants were randomized to two groups: goal-setting with primary care provider or goal-setting plus support from a CHW. The CHW worker intervention lasted six months and consisted of three stages: action planning, tailored support, and connection with long-term support.
Results of the study revealed that compared to goal-setting alone, the CHW intervention significantly improved chronic disease outcomes, mental health, and quality of care of participants. In addition, hospitalizations at one-year follow-up were reduced by 28% in the CHW intervention. These results provide evidence that a CHW intervention can improve clinical outcomes in an outpatient setting. Integrating CHW interventions within routine clinical care may also be a cost-effective strategy for population health management.
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. 2017. Community health worker support for disadvantaged patients with multiple chronic diseases: A randomized clinical trial. Am J Public Health 107(10):1660-7
Paid sick leave reduces mortality risk in US working adults
Working adults in the United States with paid sick leave have a 22% lower risk of all-cause mortality within 4.5 years according to a recent study by a NHLBI-supported researcher.
The study used data from 2000 – 2002 National Health Interview Survey and linked mortality files from the National Death Index through 2011. The final sample included 60,918 adults between the ages of 18 and 85 who reported being employed in the past week. Presence of paid sick leave was modeled as the primary outcome with adjustments made for a variety of covariates including age, gender, education, income, and history of chronic conditions.
Results revealed workers with paid sick leave had 22%, 14%, and 10% significantly lower risk of all-cause mortality after a follow-up period of 4.5, 6.5, and 11.1 years, respectively. In addition, paid sick leave was significantly associated with a 24% lower risk of heart disease mortality and 35% lower risk of death from unintentional injuries.
These results are the first to demonstrate a significant protective association between the presence of paid sick leave and mortality. Thus, policies providing paid sick leave should be considered as a way to reduce the burden of mortality in United States working adults.
Kim D. 2017. Paid sick leave and risks of all-cause and cause-specific mortality among adult workers in the USA. Int J Environ Res Public Health 14(10):E1247.
Childhood Socioeconomic status modifies genetic variant for body mass index
The heritability of body mass index (BMI) is estimated between 40 – 70%; however, only 2.7% of BMI variation is explained by genetic variants. Environmental factors may account for the unexplained variation in BMI heritability given their influence on obesity status. This is the focus of a new NIA-funded study which examines whether psychosocial environments modify the effect of genetic variants on BMI.
The discovery sample included data from the Health and Retirement Study. Measures included childhood and adulthood socio-economic status, trait and state anger, chronic burden, stressful life events, positive and negative social support, and depressive symptoms. Results were replicated using data from the Multi-Ethnic Study of Atherosclerosis.
Findings suggest that childhood social-economic status modifies the genetic effect of rs9540493 gene/region on BMI in European Americans and African Americans. In European Americans, negative social support, chronic burden, and state anger were also found to modify the relationship of the gene/region on BMI.
This is the first study to examine how social/psychosocial factors modify genetic effects on BMI using gene/region based methods. These results provide insight into the gene-environment interaction effect on BMI and obesity etiology.
Zhao W, Ware EB, He Z, Kardia SLR, Faul JD, Smith JA. 2017. Interaction between social/psychosocial factors and genetic variants on body mass index: A gene-environment interaction analysis in a longitudinal setting. Int J Environ Res Public Health 14(10):E1153.