NHS health checks linked to reduced risk of heart, brain, kidney and liver disease

NHS health checks linked to reduced risk of heart, brain, kidney and liver disease

In a recent study published in the journal BMC MedicineResearchers compared rates of new diagnoses among individuals in the UK Biobank (UKBB) who underwent a National Health Service (NHS) health assessment with those who did not.

NHS Care Assessment is a preventive initiative started in 2009 to assess cardiovascular disease risk and assist primary prevention. It can detect those at risk of cardiovascular disease, diabetes, stroke or kidney disease. Healthy individuals ages 40 to 74 are welcome to join their team of primary care physicians for routine physical exams, health-related consultations and blood tests. However, there is limited research on the association between this program and long-term health outcomes and disease prevention efficacy, as well as subsequent outcomes.

NHS health checks linked to reduced risk of heart, brain, kidney and liver diseaseStudy: Attending NHS health checks is associated with reduced risk of multi-organ disease: a matched cohort study from UK Biobank. Image credit: doliux/Shutterstock

About the study

In the current observational case-control study, researchers used UKBB data to identify individuals who had received an NHS medical assessment and tracked new diagnoses during follow-up.

UKBB included 48,602 medical assessment participants identified through linked primary care data. The team matched participants on several sociodemographic, medical and lifestyle covariates to 48,602 people with no documented medical assessment. They obtained diagnoses from medical records over nine years of follow-up, including diabetes, hypertension, stroke, hypercholesterolemia, myocardial infarction, dementia, heart failure, atrial fibrillation, alcoholic liver disease, fatty liver disease, liver failure, hepatic Cirrhosis, acute hepatitis or chronic kidney disease, cardiovascular mortality, and all-cause death.

The study sample included 140,899 individuals, with seven geographic areas missing or below the age range for health assessment. The team excluded an additional 20,256 people (9.0%) due to preexisting kidney, liver, brain or heart disease. In addition, they excluded 66,135 individuals (31%) due to statin use or previous history of hypertension or diabetes.

To avoid confounding effects, the team matched one-to-one controls with NHS medical assessment participants (cases) via nearest neighbor propensity score matching. The team assigned high-quality matches to more than 95% of cases, excluding unmatched individuals. To identify individuals who had received an NHS medical assessment, they searched clinical primary care data from April 2006 to December 2022, yielding 283,536 results. They defined the exposure period as January 1, 2008, to June 30, 2016, with the exposure date being the first reported NHS assessment parameter. They examined baseline existing conditions using self-report and data linked to primary care and hospital records.

Study outcomes include hypertension, diabetes, hyperlipidemia, stroke, myocardial infarction, all-cause dementia, atrial fibrillation, heart failure, acute or chronic kidney disease (stages 3 to 5), alcoholic liver disease, fatty liver disease, cirrhosis, liver disease failure, cardiovascular death, and all-cause death. The team carried out Cox survival and alignment starting Cox regression models including all outcomes excluding outcome events in the first year after NHS medical assessment. In a sensitivity analysis, they repeated the aligned onset Cox model with hierarchical periods.

result

The findings showed that health screening beneficiaries had higher rates of diagnoses of high cholesterol, high blood pressure and chronic kidney disease than their matched peers in the first two years after the screening. However, over time, NHS Medical Assessment beneficiaries experienced a significant reduction in the risk of multi-organ disease, as well as reductions in cardiovascular mortality and all-cause mortality.

Summary of NHS health checks for UK Biobank participants.  A Summary of the overall sample of UK Biobank participants with primary care services (n = 140,772).  B Geographic location summary.  C Sample characteristics by geographical region.Proportion of deprivation is the proportion of the sample below the UK median socio-economic deprivation, based on Townsend deprivation scores and quintiles reported in the 2011 CensusSummary of NHS health checks for UK Biobank participants. A Summary of the overall sample of UK Biobank participants with primary care services (n = 140,772). Second Geography summary. C Sample characteristics by geographic region.Proportion of deprivation is the proportion of the sample below the UK median socio-economic deprivation, based on Townsend deprivation scores and quintiles reported in the 2011 Census

The sample population (n=140,899) included 66,573 (47%) people who received at least one NHS medical assessment invitation between January 2008 and June 2016. Of the participants, 50,984 (77% of invitees and 36% of the total sample) received an NHS medical assessment. The majority of participants had one NHS medical assessment (88%), while 11% had two and 1.4% had at least three. The study sample was primarily white, physically active, and drank alcohol at least once a day.

The team found significant differences in outcomes between cases and controls, including all-cause dementia (1.2% vs. 1.4%), myocardial infarction (1.9% vs. 2.2%), and acute kidney injury (4.0% vs. 5.3%). Early event time effects were less pronounced in regression models with consistent onset.Covariate-adjusted models show significantly lower rates of dementia from any cause among NHS Medical Assessment participants [19% lower hazard ratio (HR), 0.8]atrial fibrillation (reduced by 9%, HR, 0.9), myocardial infarction (reduced by 15%, HR, 0.85), acute kidney injury (HR, 0.8, reduced by 23%), liver cirrhosis (HR, 0.7, reduced by 44%), Cardiovascular death and death from any cause (HR, 0.8, 23% reduction).

Findings suggest that NHS medical assessment is a proactive prevention program that reduces long-term disease outcomes across multiple organ systems, independent of risk reduction measures. It reduces cardiovascular and any-cause death as well as the incidence of brain, heart, kidney and liver disease. However, it increases the risk of chronic kidney disease, high cholesterol, and high blood pressure. Better detection and treatment of risk factors, regular reinforcement of healthy behaviors, and disease management may have long-term benefits.

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