Review: General health checks in adults do not reduce all-cause, cardiovascular, or cancer mortality

Lim LS. — Tue, 15 Jan 2013 00:00:00 GMT

Question

What are the benefits and harms of general health checks in adults in primary care or community settings?

Review scope

Included studies compared general health checks (screening for > 1 disease or risk factor in > 1 organ system) with no health checks in adults in primary care or community settings. Trials targeting older persons or persons with specific diseases or known risk factors were excluded. Outcomes included all-cause and disease-specific mortality, morbidity, and hospitalizations.

Review methods

MEDLINE, EMBASE/Excerpta Medica, CINAHL, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov (to Jul 2012); Cochrane Effective Practice and Organisation of Care Review Group Specialised Register and HealthSTAR (to 2010); Web of Knowledge; systematic reviews identified in the Database of Abstracts of Reviews of Effectiveness; and reference lists were searched for randomized controlled trials (RCTs). Investigators were contacted. 14 RCTs (n = 182 880, age range 18 to 74 y, follow-up range 1 to 22 y) met selection criteria and reported outcome data: 5 used cluster randomization and 9 randomized individuals. 5 RCTs were done in general practice settings, 8 in the community, and 1 in the workplace. Other than mortality, outcomes were not consistently reported across studies.

Main results

Meta-analysis showed that general health checks did not reduce all-cause, cardiovascular (CV), or cancer mortality compared with no health checks (Table). 5 of 7 RCTs found that general health checks did not reduce morbidity, 1 found that health checks increased prevalence of chronic conditions at 7 years, and 1 found that health checks were associated with higher rates of self-reported high blood pressure and high cholesterol at 1 year. 5 RCTs reported hospitalization data (≥ 1 admission during follow-up, admission rates, or days hospitalized): None found a benefit with general health checks.

Conclusions

General health checks do not reduce all-cause, cardiovascular, or cancer mortality in primary care and community populations. Limited data exist to evaluate their effects on other outcomes.General health checks vs no health checks in adults in primary care or community settings*Outcomes†Number of trials (n)Illustrative risks‡At 4 to 22 y of follow-upRRR (95% CI)NNT (CI)All-cause mortality9 (155 899)7.4% vs 7.5%1% (−3 to 5)Not significantRRI (CI)NNH (CI)Cardiovascular mortality8 (152 435)3.8% vs 3.7%3% (−9 to 17)Not significantCancer mortality8 (139 290)2.1% vs 2.1%1% (−8 to 12)Not significant*Abbreviations defined in Glossary. RRR, RRI, and CI calculated from risk ratios in article using a random-effects model.†Quality of evidence was high (all-cause and cancer mortality) or moderate (cardiovascular mortality) based on Grading of Recommendations Assessment, Development, and Evaluation criteria (4 grades: very low, low, moderate, and high quality).‡Treatment group risk (based on relative risk and median control group risk across studies) vs median control group risk as reported in the article “Summary of Findings” table.

Annals of Internal Medicine: Cancer Survivorship Topic Collection

Review: General health checks in adults do not reduce all-cause, cardiovascular, or cancer mortality