General health checks in adults for reducing morbi: mortality from disease (Review) Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gotzsche PC THE COCHRANE COLLABORATION® ‘Thisisa reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cachrane Library 2012, Iesue 10 beeptfonewthecochsanelibrary.com WILEY Publishers Since 1807 eral health checa In adults for reducing mari and moreaty rom dseaze (Review) Cepprigh© 2012 The Cochrane Callsboration Publihed by John Wiley & Sens, Lid{Iotervention Review] General health checks in adults for reducing morbi mortality from disease Lasse T Keogaball!, KestenJubl Jorgensen!, Christian Gronhoj Lasea!, Peter C "The Nore Cochrane Cente, Rigshospitalet, Copenhagen, Denmask ‘Contac address: Lase'T Krogsboll, The Nordic Cochrane Centre, Rigshospitalet, Blegslamsvej 9, 7811, Copenhagen, 2100, Denmark ‘krogiball@ gmail.com, Iek@eochrane dk, Editorial group: Cochrane Effective Practice and Organisation of Pablication status and date: New; published in ese 10, 2012, Review content assessed as up-to-date: 4 July 2012 Group, Citation: Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gosche PC. General health checks in adults for reducing, mor- bidity and mortality ftom diseate, Cichrane Databare of Syrtemasic Revieor 2012, Issue 10, Axe, No> CD003009, DOI 10.1002/14651858.C1D009009.pub2 Copyright © 2012 The Cochrane Collaboration, Published by John Wiley & Sons, Led ABSTRACT Background CGencral helth checks are common clemente of health care in some counties. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality: Most ofthe commonly used steehing tet offered in general health checks have been incompletely studied. Alo, sercening leads to incteased use of diagnostic and therapeutic interventions, which can be harmfil as ‘well as beneficial. eis, therefore, important co assess whether general health checks do more good chan harm. Objectives ‘We aimed to quantify the benefits and harons of general health checks with an emphasis on patentrelevant outcomes such as morbidity and mortality rather than on surogace outcomes such as blood pressure and serum cholesterol level. Search methods ‘Wesearched The Cichrane Library, the Cochrane Central Register of Controlled ils (CENTRAL), the Cochrane Effective Practice and (Organisation of Care (EPOC) Tals Register, MEDLINE, EMBASE, Healthstat, CINAHL, Clinical ils gov and WHO International (Clinical Tals Registry Placform (ICTRP) to July 2012. Two authors screened titles and abstracts, assessed papers for eligibility and read reference lists. One author used citation tracking (Web of Knowledge) and asked tilts about additional seus Selection criteria ‘We included randomised trials comparing health checks with no health checks in adults unselected for diseate or tsk faerrs. We did not include geriatric trials, We defined health checks as screening general populations for more chan one dzease o rik factor in mote than one organ system, Data collection and analysis “Two authors independently exacted data and assessed the risk ofbias in che wale. We contacted authors for addtional ourcomes ot tral details when necessary Fer mortality ourcomes we analysed the cutcomes we did a qualitative synthesis at metsanalysis was not feasible, alts with random-effecs model meta-analysis, and for other “General health check in adults for reducing morbidity and roraly from dzeare (Review) Copyright ©2012 The Cochrane Calaboration, Published by John Wiley & Sone, LidMain result ‘We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine eis provided data on coral morality 5,899 participants, 11,940 deaths), median follow-up time nine yeas, giving a risk ratio of 0.99 (95% confidence interval (C1) 0.95, o 1.03). Fight tals provided data on cardiovaselar mortality (152,435 participants, 4567 death), vsk ratio 1.03 (959% CI 0.91 co 1.17) and eight wials on cancer morcaliy (139.290 participants, 3663 death) is 1 (95% C10.92 co 1.12). Subgroup and sensitivity analyser didnot alter these ndings ‘We didnot find an lect on clinical events or other measures of morbidity bur one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one tris ound an inreased occurence of sll reported chron diseate, One tal found 22094 incteae inthe total number of new diagnoses per participant over sx years compared tothe control group. No cal compared of prescriptions, bur two out of four trials found an increased ‘of four tral found small beneficial effects on self repored health, but thir eoull be due to repo blinded. We did not find an effet on admission to hospital, disability, worey, additional visi bur mot of these ourcomes were pootly studied. We did nor ind useful results on the number ofrferale co specialists, che number of follow-up tite after positive rrecning revue, or the amount of surgery ber of people using ancibypercensve drugs. Two ing bias athe trials were not the physician, or absence from work, ‘Authore conclusions Genctal health checks did not reduce motbidity or mortality, neither overall nor for cardiovacular or cancer causes, although the ew diagnoses was increased, Imporranc harmful outcomes, such asthe numberof follow-up disgnoscic procedure of short rm peychological effects, were often not studied or reported and many sials had methodological participants and deaths ineluded, the long followup periods wed, and considering that cardiovascular and eaneet mortality wete not ced, geneal health checks ae unlikely ro be beneficial urbe oblems. With the large number of PLAIN LANGUAGE SUMMARY General health checks for reducing illness and mortality Genetal health checks involve multiple tests i a person who dees not fe ill with the purpose of finding disease eaty, preventing disease from developing, or providing reassurance. Health check ate common people health checks intikvely make sense, but experience from screening programmes for individual diseases have shown thatthe benefit may be smaller than expected and the harms greater: One possible harm from health checks isthe diagnosis and treatment of conditions tha were not destined to cause sympcoms or death. Their diagnosis will therefore be superfluous and carey the ik of ‘unnecessary treatment. st of health care in some countries, To many ‘We identified 16 randomised wials which had compared a group of adults offered general health checks to a group not offered heath checks, Rerlte were available from 14 wal, including 182,880 participants, Nine tral seadied the risk of death and inckuded 155,899 participants and 11,940 deaths, Thete was no effect on the risk of death, or onthe risk of death due to cardiovascular dieeses of cance Wedd not find an effect on the tsk of illness but one trial found an increased numberof people identified with igh bload pressure and high cholesterol, and one ported the roal numberof new diagnoses per participant and found 2 20% increase ove sx eats compared tothe control group. No tials compared the total number of new prescriptions but reo out of four ras found an increased number of people using drugs for high blood pressure. Two out off tials found chat health checks made people feel somewhat healthier, but eis result is not zlable. We di not find that health checks had an sffecton the number of admissions to hospital disability. wory, he numberof referrals to specialists, additional visits to che physician, orabsence from work, but mast of these outcomes were poorly studied. None ofthe trials reported on the number of followup ests afer postive screening results, ot the amount of surgery wed, tial found an increased number with chronic diseases, One wil (One reazon for the apparent lack ofefect may be chat primary cate physicians already identify and intervene when they suspect 3 patien to beat high tsk of developing disease when they se them for other reasons. Alo, those a high tsk of developing disease may not attend general health checke when invited, Mose ofthe trials were old, which makes t 1 rele less applicable to today's settings beae the teatments sed for conditions and tsk actors have changed “With the large number of participants and deaths inluded, che [ong follow-up periods sed in the tials, and considering that death fiom cardiovascular dizeaes and cancer were not reduced, general health checks ate unlikely to be beni “General health check in adults for reducing morbidity and roraliy rom dzeare (Review) Copyright ©2012 The Cochrane Calaboration, Published by John Wiley & Sone, Lid“General health check in adults for reducing morbidity and roraly from dzeare (Review) Copyright ©2012 The Cochrane Calaboration, Published by John Wiley & Sone, Lid