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Annual health checks do not reduce mortality, says Cochrane review

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7001 (Published 16 October 2012) Cite this as: BMJ 2012;345:e7001
  1. Jacqui Wise
  1. 1London

General health checks do not reduce morbidity or mortality and should not be included as part of a public health programme, say Cochrane researchers who carried out a systematic review of the evidence.

The review, published in the Cochrane Library, included 14 trials involving 182 880 people.1 Nine of the trials studied the risk of death and included 155 899 participants. Health checks had no effect on the risk of death or on the specific risk of death from cardiovascular disease or cancer.

Neither did the researchers find an effect on the risk of illness, although one trial found an increased number of people that health checks identified as having hypertension and high cholesterol concentrations, and one trial found an increased number with chronic disease.

The review did not find that health checks had an effect on the number of admissions to hospital, disability, worry, the number of referrals to specialists, additional visits to doctors, or absence from work, but most of these outcomes were poorly studied.

None of the trials compared the total number of new prescriptions, but two of four trials found an increased number of people using drugs for high blood pressure. Two of four trials found that health checks made people feel healthier, but the researchers said that this result was not reliable.

“From the evidence we’ve seen, inviting patients to general health checks is unlikely to be beneficial,” said the lead researcher, Lasse Krogsbøll, of the Nordic Cochrane Centre in Copenhagen. “One reason for this might be that doctors identify additional problems and take action when they see patients for other reasons.”

Another reason for the lack of effect may be that people at high risk of developing disease may not attend general health checks when invited to do so. Another problem identified by the researchers was that most of the trials were old, making the results less applicable to today’s settings. They said that any further research should focus on the individual components of health checks and better targeting of conditions such as kidney disease and diabetes.

The researchers said that health checks could lead to unnecessary treatment and cause harm by diagnosing conditions that would not cause symptoms or death.

“What we’re not saying is that doctors should stop carrying out tests or offering treatment when they suspect there may be a problem. But we do think that public healthcare initiatives that are systematically offering general health checks should be resisted,” said Krogsbøll.

Private healthcare companies widely promote annual health checks, but the Cochrane researchers said that this practice is not supported by the best available evidence.

Peter Mace, assistant medical director at Bupa Health and Wellbeing UK, said, “Bupa health assessments aim to help people to stay healthy, and our doctors work closely with people to address areas of risk that are specific to them. As far as possible, our health assessments are based on the latest research and medical evidence and are tailored to health risks that are associated with gender and age. We do not carry out tests that give ambiguous or meaningless results or that do not give people a clear opportunity to make a positive lifestyle change.

“We will be working with the results of this review and other current research to further develop the health assessments we offer, particularly to target specific areas of clinical risk and provide effective interventions that help people to stay healthy.”

Notes

Cite this as: BMJ 2012;345:e7001

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