Published in Population Health Management

Author(s): William M. Gandy, EdD; Carter Coberley, PhD; James E. Pope, MD; and Elizabeth Y. Rula, PhD

The goal of this study was to determine the relationship between individual well-being and risk of a hospital event in the subsequent year. The authors hypothesized an inverse relationship in which low well-being predicts higher likelihood of hospital use. The study specifically sought to understand how well-being segments and demographic variables interact in defining risk of a hospital event (inpatient admission or emergency room visit) in an employed population. A retrospective study design was conducted with data from 8835 employees who completed a Well-Being Assessment questionnaire based on the Gallup-Healthways Well-Being Index. Cox proportional hazards models were used to examine the impact of Individual Well-Being Score (IWBS) segments and member demographics on hazard ratios (HRs) for a hospital event during the 12 months following assessment completion. Significant main effects were found for the influence of IWBS segments, sex, education, and relationship status on HRs of a hospital event, but not for age. However, further analysis revealed significant interactions between age and IWBS segments (P=0.005) and between age and sex (P<0.0001), indicating that the effects for IWBS segments and sex on HRs of a hospital event are mediated through their relationship with age. Overall, the strong relationship between low well-being and higher risk of an event in employees ages 44 years and older is mitigated in younger age groups. These results suggest that youth attenuates the risk engendered in poor well-being; therefore, methods to maintain or improve well-being as individuals age presents a strong opportunity for reducing hospital events. (Population Health Management 2014;17:13–20)

Key Takeaways:

  • In an employee population, well-being score segments were significantly predictive of risk for a hospital admission or an emergency room visit, and the level of risk imposed by lower well-being depended on the employee’s age.
  • Among young employees (< 44 years), those in the highest well-being segment had half the risk of a hospital event compared with those in the lowest well-being segment.
  • Among the older employee group (≥45 years), those in the highest well-being segment were 64% less likely to have a hospital event compared with those in the lowest well-being segment.
  • Results support the need for programs to maintain and improve well-being across all ages as a strategy to prevent hospital admissions and ER visits and avoid the associated healthcare and productivity costs.