Annual health checks do not reduce mortality, says Cochrane review

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

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.”
BMJ 2012; 345 doi: (Published 17
October 2012)

Jacqui Wise