Socioeconomic disparities in health behaviors of insured workers

Background: Over 100 million individuals in the U.S. are employed and have health insurance. Although studies show employed and insured persons have better health outcomes and lower mortality, little attention has been directed at the health behaviors of insured workers and whether socioeconomic disparities exist among this group. Design: Cross-sectional analysis of data from the 2004 and 2005 Behavioral Risk Factor Surveillance System. Participants were employed and insured adults (n=159,755) aged 18 to 64 years. Methods: Means and frequency analyses. Multivariate logistic regression was used to assess the independent effects of income, education, cost-as-a-barrier, and no personal doctor on each health behavior. We controlled for age, sex, race/ethnicity, education, income, cost-as-a-barrier, and no personal doctor. Results: Among employed and insured adults, rates of not using clinical preventive services according to recommendations were: breast cancer screening, 22%; cervical cancer screening, 8%; cholesterol screening, 15%; colon cancer screening, 49%; and influenza vaccination, 74%. Rates for engaging in lifestyle-related risks were: binge drinking, 17%; heavy drinking, 5%; inadequate fruit and vegetable consumption, 77%; inadequate physical activity, 49%; and smoking, 20%. In multivariate analyses, lower income, lower education, cost-as-a-barrier and no personal doctor were each associated with significantly decreased use of nearly all recommended clinical preventive services (p-values<.01). Lower education and no personal doctor were positively associated with lifestyle-related risks (p-values<.01). Conclusions: Working, insured adults are not meeting recommendations for health behaviors. Significant disparities based on socioeconomic status exist among this group. Employers should consider these disparities when designing preventive health programs and benefits.