Exercise and risk of death, working from home, anxiety screening and COVID update
September 23, 2022
Today, as autumn begins, I’ll review data from a study showing association of more exercise with lower rates of death from heart disease, cancer, and all causes, discuss a study on employee perspectives on remote work, talk about what the proposed new anxiety screening recommendations mean for employers, and offer a brief COVID-19 update.
1. Those who take more daily steps are less likely to die of heart disease or cancer
Researchers in the United Kingdom studied 78,500 people ages 40-79 by giving them an accelerometer for a week to calculate steps taken, and then watching for a median of seven years to see if they died of cancer or heart disease. There were statistically significantly fewer deaths from all causes, cancer, and heart disease in those who had more steps until 10,000 steps a day, after which additional steps were not associated with further decrease in risk. This is a strong study because of its size and robust adjustment for other risks of death such as age or smoking. However, a week of accelerometer monitoring might not have represented usual exertion, and the population was non-diverse. Overall, this adds to evidence that exercise is good for overall health.
Dose response association of steps and overall mortality
Source: del Polo Cruz, et al, JAMA Int Med, 9/12/22 LINK
Shaded area is 95% confidence interval - risk of death is about 40% lower in those who took 10,000 steps daily.
Implications for employers:
- This study shows that those who exercise more have lower mortality. Other research has shown exercise is associated with better mental health and better productivity.
- Many employers offer subsidies for gym or other physical fitness memberships.
- Some employers offer financial incentives for exercise, although the evidence that this changes behavior is scant.
- Employers can also make it easier for employees at the workplace to exercise. For some employers this means providing an on-site gym, but for others it can be as simple as being sure that it is safe to cross a nearby street, or encouraging walking meetings.
2. Employees globally are enthusiastic about working from home
Researchers surveyed over 35,000 respondents in 27 countries to ask about their experience and attitudes toward working from home. The survey panel was not necessarily knowledge workers, although in developing countries the requirement to do the survey on a mobile phone or computer meant that respondents likely had above average education and wealth.
Overall, employees reported they were more productive when working from home, and that the pandemic made them and their friends feel more positive toward working from home. They also reported a mismatch between their enthusiasm about working from home and their employers’ plans. Here is data from the US respondents (2079) and the Canadian respondents (895):
These results are similar to those in Global Benefits Attitude Survey, conducted by my company WTW, which included over 9500 respondents in the US. We also found that employees whose preferences for remote or in-person work were better aligned with their employers reported fewer days lost to absenteeism and presenteeism, were more engaged, and were less likely to seek to leave their current employer.
Source: WTW 2022 Global Benefit Attitudes Survey LINK
Implications for employers:
- Many employees globally, including in the US and Canada, hope to work more days at home in the future than their employers are now planning.
- Companies can benefit from increased productivity, engagement and satisfaction from those employees who prefer remote work
- The tight labor market makes it likely that more workers will continue to be able to work from home.
3. US Preventive Services Task Force considers recommendation to screen for anxiety
The US Preventive Services Task Force (USPSTF) released preliminary guidance recommending that providers screen their patients for anxiety. These recommendations are open for public comment now, and will be finalized later this year. USPSTF recommendations for preventive care must be covered without cost sharing by employer sponsored health plans.
Anxiety has increased substantially over the course of the Pandemic. 8.1% of Americans reported that they had signs of generalized anxiety in 2019; this number increased to 37.2% in November, 2020, and remains elevated at 28.3% in a pulse survey fielded from July 27-August 3, 2022 by the Centers for Disease Control and Prevention (CDC).
The two-question screening tool for anxiety asks how many days in the last two weeks the respondent has been “feeling nervous, anxious or on edge” or “not able to stop or control worrying.” Even though that seems simple, it will be difficult to incorporate into existing preventive visits, where physicians already feel overwhelmed. The practice where I get care uses its patient portal to send out a two-question depression survey along with a more extensive ‘social determinants of need’ questionnaire to assess whether I faced insecurity around food, housing, safety or finances. I think this would be the best way to incorporate anxiety screening into clinical care, although patients without access to mobile phones are less likely to use such electronic portals.
Implications for employers
- Employees suffering from anxiety miss more work and are less productive, and regular assessments can help patients get help more quickly
- These assessments will not likely increase medical cost, as they will probably be embedded in existing visits. Allowable charges for add-on codes for mental health evaluation are very low.
- Provide easy access points to EAP and other mental health resources and communicate these widely. Cognitive Behavioral Therapy (CBT) can often be helpful, and is available through some digital platforms.
4. COVID-19 update
Data published this week in the New England Journal of Medicine shows that adults who were given a bivalent COVID-19 vaccine (the BA.1 version available in the UK, not the BA.4/5 version available in the US) had higher levels of antibodies than those who got a booster with only the original strain. There were no adverse safety events. Here’s a review of why the bivalent vaccine is excellent news to continue to lessen the impacts of COVID-19 on our lives and workplaces.
President Biden told an interviewer this week that the “pandemic is over,” although in the next sentence, he said “We still have a problem with COVID. We're still doing a lotta work on it.” Many public health advocates objected to this characterization, given that transmission rates remain high in 77% of counties, and on average over 400 people a day are dying of COVID-19. As I mentioned last week, these deaths are highly concentrated in those over 70 and those with immune compromise. Most of us have substantial immunity at this point; we might get sick, but are highly unlikely to be hospitalized or die. Workplace transmission is much less likely to lead to severe illness now compared to a year or more ago. I believe that employers should continue to promote vaccination. Get your bivalent COVID-19 and influenza shots this fall! Employers should also continue to offer mask-friendly workplaces, allow remote work where this works for the business, and improve ventilation where feasible, which lowers risk of all respiratory disease as well as increases productivity.