Open Access Open Badges Research article

Clustering of risk factors for non-communicable disease and healthcare expenditure in employees with private health insurance presenting for health risk appraisal: a cross-sectional study

Tracy L Kolbe-Alexander1*, Jaco Conradie2 and Estelle V Lambert1

Author Affiliations

1 Department of Human Biology, UCT Faculty of Health Sciences, UCT/MRC Research Unit for Exercise Science and Sports Medicine, University of Cape Town, P.O. Box 115, Newlands, Cape Town 7725, South Africa

2 Discovery Health, Johannesburg, South Africa

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BMC Public Health 2013, 13:1213  doi:10.1186/1471-2458-13-1213

Published: 21 December 2013



The global increase in the prevalence of NCD’s is accompanied by an increase in risk factors for these diseases such as insufficient physical activity and poor nutritional habits. The main aims of this research study were to determine the extent to which insufficient physical activity (PA) clustered with other risk factors for non-communicable disease (NCD) in employed persons undergoing health risk assessment, and whether these risk factors were associated with higher healthcare costs.


Employees from 68 companies voluntarily participated in worksite wellness days, that included an assessment of self-reported health behaviors and clinical measures, such as: blood pressure (BP), Body Mass Index (BMI), as well as total cholesterol concentrations from capillary blood samples. A risk-related age, ‘Vitality Risk Age’ was calculated for each participant using an algorithm that incorporated multiplicative pooled relative risks for all cause mortality associated with smoking, PA, fruit and vegetable intake, BMI, BP and cholesterol concentration. Healthcare cost data were obtained for employees (n = 2 789).


Participants were 36 ± 10 years old and the most prevalent risk factors were insufficient PA (67%) and BMI ≥ 25 (62%). Employees who were insufficiently active also had a greater number of other NCD risk factors, compared to those meeting PA recommendations (chi2 = 43.55; p < 0.0001). Moreover, employees meeting PA guidelines had significantly fewer visits to their family doctor (GP) (2.5 versus 3.11; p < 0.001) than those who were insufficiently PA, which was associated with an average cost saving of ZAR100 per year (p < 0.01). Furthermore, for every additional year that the ‘Vitality Risk Age’ was greater than chronological age, there was a 3% increased likelihood of at least one additional visit to the doctor (OR = 1.03; 95% CI = 1.01 – 1.05).


Physical inactivity was associated with clustering of risk factors for NCD in SA employees. Employees with lower BMI, better self-reported health status and readiness to change were more likely to meet the PA guidelines. These employees might therefore benefit from physical activity intervention programs that could result in improved risk profile and reduced healthcare expenditure.

Clustering of risk factors; Physical activity; Healthcare expenditure