Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the US. Emerging employer-sponsored work health programs (WHP) and Digital Health Intervention (DHI) provide monitoring and guidance based on participants’ health risk assessments, but with uncertain success. DHI–mobile technology including online and smartphone interventions–has previously been found to be beneficial in reducing CVD outcomes and risk factors, however its use and efficacy in a large, multisite, primary prevention cohort has not been described to date. We analyzed usage of DHI and change in intermediate markers of CVD over the course of one year in 30,974 participants of a WHP across 81 organizations in 42 states between 2011 and 2014, stratified by participation log-ins categorized as no (n = 14,173), very low (<12/yr, n = 12,260), monthly (n = 3,360), weekly (n = 651), or semi-weekly (at least twice per week). We assessed changes in weight, waist circumference, body mass index (BMI), blood pressure, lipids, and glucose at one year, as a function of participation level. We utilized a Poisson regression model to analyze variables associated with increased participation. Those with the highest level of participation were slightly, but significantly (p<0.0001), older (48.3±11.2 yrs) than non-participants (47.7±12.2 yr) and more likely to be females (63.7% vs 37.3% p<0.0001). Significant improvements in weight loss were demonstrated with every increasing level of DHI usage with the largest being in the semi-weekly group (-3.39±1.06 lbs; p = 0.0013 for difference from weekly). Regression analyses demonstrated that greater participation in the DHI (measured by log-ins) was significantly associated with older age (p<0.001), female sex (p<0.001), and Hispanic ethnicity (p<0.001). The current study demonstrates the success of DHI in a large, community cohort to modestly reduce CVD risk factors in individuals with high participation rate. Furthermore, participants previously underrepresented in WHPs (females and Hispanics) and those with an increased number of CVD risk factors including age and elevated BMI show increased adherence to DHI, supporting the use of this low-cost intervention to improve CVD health.
Highlights
Cardiovascular disease (CVD) is the primary contributor to increased morbidity, mortality, and rising health care associated costs in the United States
The current results demonstrate that an employer-initiated health program utilizing digital health across multiple employers across the US effectively reduces CVD risk factors over one year of use
We report a significant association between Digital Health Intervention (DHI) use and the female gender and older participants
Summary
Cardiovascular disease (CVD) is the primary contributor to increased morbidity, mortality, and rising health care associated costs in the United States. We have recently demonstrated reductions in CV risk factors and Framingham Risk Scores (FRS) at a single employer using a DHI as a WHP after only 90 days [7]; longer follow up and larger cohorts are needed to fully quantify these effects. This is especially pertinent that data are emerging indicating an overall cardiovascular morbidity and mortality benefit seen with DHI [8,9]. The current study was designed to extend our previous observations, and evaluate potential predictors of use, and the success associated with use, of a WHP DHI
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