Cochrane for Clinicians

Putting Evidence into Practice

General Health Checks in Adults for Reducing Disease-Related Morbidity and Mortality

 

Am Fam Physician. 2019 Dec 1;100(11):676-677.

Author disclosure: No relevant financial affiliations.

Clinical Question

Do general health checks in adults reduce illness and death?

Evidence-Based Answer

General health check visits have no benefit on cardiovascular morbidity or on total, cardiovascular, or cancer-related mortality. There is also no evidence that they cause patient harm.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

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SUMMARY TABLE

General Health Checks in Adults for Reducing Disease-Related Morbidity and Mortality

Outcomes Illustrative comparative risksRelative risk (95% CI)Participants (studies)Quality of evidence
Assumed risk without health checksCorresponding risk with health checks (95% CI)

Overall mortality Follow-up: 4 to 30 years

68 per 1,000

68 per 1,000 (66 to 70)

1.00 (0.97 to 1.03)

233,298 (11)

High

Cancer-related mortality Follow-up: 4 to 22 years

26 per 1,000

26 per 1,000 (24 to 29)

1.01 (0.92 to 1.12)

139,290 (8)

High

Cardiovascular mortality Follow-up: 4 to 30 years

32 per 1,000

34 per 1,000 (30 to 37)

1.05 (0.94 to 1.16)

170,227 (9)

Moderate

Fatal and nonfatal ischemic heart disease Follow-up: 4 to 30 years

66 per 1,000

65 per 1,000 (62 to 68)

0.98 (0.94 to 1.03)

164,881 (4)

High

Fatal and nonfatal stroke Follow-up: 4 to 30 years

29 per 1,000

30 per 1,000 (28 to 34)

1.05 (0.95 to 1.17)

107,421 (3)

Moderate

SUMMARY TABLE

General Health Checks in Adults for Reducing Disease-Related Morbidity and Mortality

Outcomes Illustrative comparative risksRelative risk (95% CI)Participants (studies)Quality of evidence
Assumed risk without health checksCorresponding risk with health checks (95% CI)

Overall mortality Follow-up: 4 to 30 years

68 per 1,000

68 per 1,000 (66 to 70)

1.00 (0.97 to 1.03)

233,298 (11)

High

Cancer-related mortality Follow-up: 4 to 22 years

26 per 1,000

26 per 1,000 (24 to 29)

1.01 (0.92 to 1.12)

139,290 (8)

High

Cardiovascular mortality Follow-up: 4 to 30 years

32 per 1,000

34 per 1,000 (30 to 37)

1.05 (0.94 to 1.16)

170,227 (9)

Moderate

Fatal and nonfatal ischemic heart disease Follow-up: 4 to 30 years

66 per 1,000

65 per 1,000 (62 to 68)

0.98 (0.94 to 1.03)

164,881 (4)

High

Fatal and nonfatal stroke Follow-up: 4 to 30 years

29 per 1,000

30 per 1,000 (28 to 34)

1.05 (0.95 to 1.17)

107,421 (3)

Moderate

Practice Pointers

General health checks for adults 18 to 64 years of age are designed to identify patients at risk of certain diseases. The goal is early detection and prevention of associated adverse outcomes, although with screening there is always the risk of overdiagnosis. This Cochrane review was designed to evaluate the morbidity and mortality benefits and risks associated with general health checks.

This review involved 15 trials that evaluated outcomes for 251,891 patients.1 Studies included interventions such as screening for more than one disease (or risk factor) or a lifestyle intervention in more than one organ system, performed by any health care professional. In each of the studies, the control consisted of either no screenings or lifestyle interventions. Five of the study settings were in general practice, nine were in medical/research centers, and one was in the workplace. Trials were excluded if participants were 65 years and older, or if they included participants with known diseases or risk factors. Overall, the trials were judged to be at low risk of selection and allocation bias; some studies were judged to have moderate to high risk of attrition bias and outcome detection. Harms of the intervention were not reported but potentially include worry, excessive follow-up testing, and harm from subsequent treatment.

Several different outcomes of general health checks were reported; 11 trials with 233,298 participants evaluated mortality, and the authors found no significant difference between the control and intervention groups. When the authors evaluated the impact of general health checks on cancer-related mortality, they found eight trials that demonstrated no benefit vs. control.

Author disclosure: No relevant financial affiliations.

References

1. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2019;(1):CD009009.

2. Hylton K, Thompson K, Kearney M, et al. NHS Health Check – best practice guidance. October 2019. Accessed October 23, 2019. https://www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/

3. Code of Federal Regulations. Title 42 Public Health, Part 410, Subpart B. 410.15: Annual wellness visits providing personalized prevention plan services: conditions for and limitations on coverage. Accessed March 30, 2019. https://www.ecfr.gov/cgi-bin/text-idx?SID=b88181e2130f26ae6c4741f95a518bbf&mc=true&node=se42.2.410_115&rgn=div8

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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