Abstract
BackgroundLittle is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics.MethodsOver 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18–64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status.ResultsIn total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35–49 (67.9%) and 50–64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking.ConclusionsTwo in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular.Registryclinicaltrials.gov: NCT01291693.
Highlights
Modifiable behavioral health risk factors (HRFs), tobacco smoking, at-risk alcohol use, unbalanced diet and physical inactivity, are major contributors to the development of non-communicable diseases and to all-cause deaths [1,2,3]
As indicated by non-overlapping 95% confidence intervals (CI) in Table 1, statistically significantly differences in single HRFs were found across different medical departments, socio-demographic and socio-economic subgroups (p < 0.01)
The higher the level of school education was, the lower was the occurrence of smoking (51.0% versus 38.4% versus 26.6%), inactivity (78.1% versus 66.6% versus 47.4%) and/ or overweight (65.7, 63.2% versus 48.5%), but the occurrence of alcohol was higher in patients with the highest compared to those with medium level of school education (24.7% versus 19.7%)
Summary
Modifiable behavioral health risk factors (HRFs), tobacco smoking, at-risk alcohol use, unbalanced diet and physical inactivity, are major contributors to the development of non-communicable diseases and to all-cause deaths [1,2,3]. A total of 16 specific combinations of the four major modifiable HRFs are possible and observed in the general population [11,12,13]. Co-occurring HRFs may have an additive but more than a multiplicative effect on disease incidence and/ or mortality as was found for example for alcohol and smoking concerning various cancers [17, 18]. Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics
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