According to a recent issue of Health Affairs, all we have to do is completely eliminate five risk factors: smoking, obesity, diabetes, high cholesterol, and hypertension.
Easy, right?
I find it amazing that these risk factors contribute to (potentially, depending on the credibility you lend the study) more than half of all disability in this country. And given that the study (Preventing Disability: The Influence of Modifiable Risk Factors On State and National Disability Prevalence) is written from a non-work comp perspective, I view this as more of challenge in our industry (where we accept the whole person and have relatively little influence over pre-injury behavior).
If the theoretical elimination of all five risk factors is a bridge too far for you, consider a more conservative analysis contained in the study: If each risk factor was reduced to the level of the "best performing" state (i.e., if all states mirrored the nation's lower obesity rate of Colorado), we would observe a decline in disability prevalence of approximately 7%. And disability rates in regions where prevalence is highest (South, Appalachia, and Great Lakes) would drop more than 10% under such a scenario.
But our starting point is grim. In the 18-54 age cohort, nearly 70% of US adults have more than one of the five risk factors. In the 55-64 cohort, it's about 90%. And in the 65-79 category, about 95%.
This isn't just clinical, it's cultural.
Michael
On Twitter @PRIUM1
Showing posts with label obesity. Show all posts
Showing posts with label obesity. Show all posts
Monday, June 12, 2017
Monday, January 26, 2015
Smoking, Obesity, Mental Illness and Chronic Pain
A study published late last year (but which I just now got around to reading...) establishes a clear link between smoking and chronic back pain. I know what you're thinking: file that under "stuff we already knew and didn't need an academic study to prove." But this study is interesting not simply because it establishes a link we all observe daily in workers' compensation claims management; it also focuses on the underlying mechanism that associates the behavior of smoking and the condition we know as chronic back pain.
The study concludes that the risk of sub-acute back pain progressing to chronic back pain is 3X greater among smokers vs. non-smokers. Further, the subjects were subjected to functional MRI scans and it turns out that the relationship between smoking and chronic back pain is "mediated by corticostriatal circuitry involved in addictive behavior and motivated learning." I don't know what that means, exactly, but it's clear that smoking wires the brain in such a way that chronic pain becomes a common outcome of acute injury.
Here's the hard question: What can we do about it? If we know, objectively, that the likelihood of a workplace injury developing into chronic pain is significantly increased due to smoking... what are our options? Some of you have access to fancy algorithms (or predictive models, I think you call them) that will tell you to put a case manager on a claim like this right away. And I think that's great. But what options does the case manager have?
I'm asking because I think this is one of three fundamental issues the workers' compensation medical management world is going to deal with over the next five years.
Most of you are dealing with claims wherein all three of these crucial questions have come together in a perfect storm of complexity, confusion, and cost.
So...
How do we (legally) avoid hiring high risk people in the first place?
How do we prevent them from getting injured once we do employ them?
And the hardest question of all: How do we fix them once they're injured?
We spend so much time focused on the last question. The answers are hard to devise and even harder to implement. I suppose the least we can do is put some focus on the first two questions in an attempt to limit the number of times we have to find answers to the third.
Michael
On Twitter @PRIUM1
The study concludes that the risk of sub-acute back pain progressing to chronic back pain is 3X greater among smokers vs. non-smokers. Further, the subjects were subjected to functional MRI scans and it turns out that the relationship between smoking and chronic back pain is "mediated by corticostriatal circuitry involved in addictive behavior and motivated learning." I don't know what that means, exactly, but it's clear that smoking wires the brain in such a way that chronic pain becomes a common outcome of acute injury.
Here's the hard question: What can we do about it? If we know, objectively, that the likelihood of a workplace injury developing into chronic pain is significantly increased due to smoking... what are our options? Some of you have access to fancy algorithms (or predictive models, I think you call them) that will tell you to put a case manager on a claim like this right away. And I think that's great. But what options does the case manager have?
I'm asking because I think this is one of three fundamental issues the workers' compensation medical management world is going to deal with over the next five years.
- How do we deal with chronic pain in light of smoking?
- How do we deal with chronic pain in light of obesity?
- How do we deal with chronic pain in light of mental/behavioral illness?
Most of you are dealing with claims wherein all three of these crucial questions have come together in a perfect storm of complexity, confusion, and cost.
So...
How do we (legally) avoid hiring high risk people in the first place?
How do we prevent them from getting injured once we do employ them?
And the hardest question of all: How do we fix them once they're injured?
We spend so much time focused on the last question. The answers are hard to devise and even harder to implement. I suppose the least we can do is put some focus on the first two questions in an attempt to limit the number of times we have to find answers to the third.
Michael
On Twitter @PRIUM1
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