Health risk assessments

Sep 13 2010

At various points in our lives, we're curious about our health risks, wondering about our susceptibility for everything from high cholesterol to a deadly inherited disease. We might want to learn more about our risks when we reach a certain age or experience a bout of bad health; when we hear about a friend or co-worker coping with a dreaded illness; or read the latest headlines about disease research.

People can choose many paths to find out more about their personal risk(s) of disease, including community health screenings, health assessments provided by a doctor or an employer, or online calculators offered by hospitals, insurance providers and nonprofit health groups.

But the information and usefulness of these sources can vary, and may leave you with more questions than answers. For some, these first forays into sorting out personal risks can be more distressing than helpful.

Entering the Realm of Risk

Health risk usually refers to the chance of getting a certain disease during a certain time frame. You're most likely to hear about risks in numbers: a 20 percent chance of developing cancer, or a one in five chance of having a heart attack before age 65. These are estimates based on what is known about the rate or the number of various conditions occurring across groups of people. Sometimes these estimates are broken down by gender, by geographic location and certainly by age.

Numerous studies show that most people—even doctors—have a difficult time understanding risk. It's a task that involves many skills, from understanding mathematical probability to knowing how to evaluate information sources, say Dartmouth researchers Steven Woloshin, M.D., Lisa Schwartz, M.D. and Gilbert Welch, M.D., authors of "Know Your Chances."

Researchers have found that we tend to overestimate the risks of dying from a rare illness, while downplaying our risks of death from common diseases. This bias can lead to fretting about unlikely causes of illness and potential cures, while ignoring controllable behaviors such as diet, exercise and proper medication.

Health Screenings, Calculators and More

You may be concerned about a specific risk, like the chances that you might be likely to have heart disease, in which case you may ask your doctor for a certain test, or seek out that test or screening in a venue like a community health fair. You might search online for more information, or take advantage of a health evaluation program offered by your employer. While some people seek specific risk information through these channels, you also might accidentally turn up risk information that wasn't on your radar.

When Barry Wilhelm signed up for an assessment offered by his workplace, he hoped it would motivate him to change some unhealthy behaviors and put his family's poor health history in perspective. But blood tests offered as part of the plan turned up some startling news: he had hemochromatosis, an iron overload disorder that can lead to organ damage if untreated.

Until the assessment, Wilhelm had no idea that he was walking around with a serious condition. After the blood tests, he scheduled a visit to his regular doctor and began to plan the care that would allow him to lead a normal life.

Online tools that calculate risk—from well-known sites such as RealAge to those offered by groups like the American Heart Association—may offer a glimpse of your health future. Most of these calculators ask a few short questions about your current health status, your tendency toward any known risk factors for a particular disease, and sometimes your family history of disease. It's best to choose a calculator from a reputable source, such as a well-known nonprofit or an established hospital.

Beyond calculators, people may use health risk assessments offered by their workplaces or available for purchase, or get information about health risks from community health screenings or a visit to a doctor.

In many cases, your risk is calculated by comparing your answers to certain health questions or screening results to what's known from research about the characteristics of the people who have the disease and disease risk factors, including any genetic data. But it's important to know exactly where these comparison data are coming from, said Erika Waters, Ph.D., an assistant professor at the Washington University School of Medicine who has studied the content of online risk calculators.

"One thing I like to see is if there is an indication on the Web site that explains where they got their information," she says, "like a note that explains that the risk assessment calculator was developed based on these 15 scientific articles."

Even if the calculator appears to be based on good studies, the findings from those studies or the people that were studied may not be relevant to you, Waters cautions. For instance, a heart disease calculator could give an overall assessment of risk based on excellent studies of men over 65 years old, but their risk factors and health status are different than those for a 40-year- old woman.

"For people concerned about cancer, [online calculators] are good motivators to encourage good health behavior," says oncologist Robert Miller. "For those with cancer, these calculators are quite helpful to allow people to make more informed and better decisions." Miller recommends the National Cancer Institute (NCI) of the National Institutes of Health as a resource. The NCI website section on Cancer Causes and Risk Factors offers a wide range of reliable information about cancer risk including calculators.

Ready for Action

Some health risk assessments have expanded the definition of risk to include the complete health care experience, from a person's social support network to how well you feel your doctor listens to your concerns.

John Wasson, M.D. a geriatrics researcher at Dartmouth Medical School, helped create the How's Your Health? assessment, which allows users to look at their health in a broad way that includes follow up and specially tailored advice for different age groups.

"People usually hate the idea of health risk assessment," Wasson says. "They don't like being told, yet again, that they're overweight. They like to get patted on the head, but most of the time they get kicked in the butt."

The best risk assessments offer further information or other resources to help users follow up, says Waters at Washington University. Without strategies to reduce your risk, "you're kind of at a loss."

Understanding Risk

Online, check out the "risk" resources in the Prepared Patient Forum's 411 directory.

SOURCE Center for Advancing Health