Routine Health Checks Don’t Seem to Affect Mortality

Jennifer Garcia

January 14, 2013

General health checks do not reduce mortality, according to a meta-analysis conducted by the Nordic Cochrane Center, Copenhagen, Denmark. Allan V. Prochazka, MD, from the Denver Veterans Affairs Medical Center, and Tanner Caverly, MD, from the University of Colorado School of Medicine, Denver, review these findings in an article published online January 14 in JAMA Internal Medicine (formerly Archives of Internal Medicine).

In a systematic review of 14 randomized controlled trials conducted between 1963 and 1999, researchers evaluated the effect of annual health checkups on morbidity and mortality. The authors defined a general health check as "a visit dedicated solely to preventive counseling and screening tests," excluding visits required for the management of chronic conditions or acute care visits.

The researchers evaluated data from more than 182,000 patients and assessed primary outcomes of all-cause mortality and disease-specific mortality. "Secondary outcomes assessed included morbidity, new diagnoses, hospitalizations, disability, worry, self-reported health, referrals to specialists, and additional visits to general practitioners," the authors write.

The researchers found that general health checks had no significant effect on total mortality (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.95 - 1.03), even when other factors such as inclusion of lifestyle counseling, duration of follow-up, and types of testing were examined. In terms of disease-specific mortality, no significant reduction in cancer mortality (RR, 1.01; 95% CI, 0.92 - 1.12) or cardiovascular mortality (RR, 1.03; 95% CI, 0.91 - 1.17) was found.

Not all trials included data on secondary outcomes; however, the researchers noted an increase in the number of new diagnoses of hypertension, hyperlipidemia, and diabetes mellitus during the health checks.

According to the authors, patients in the United States spend an estimated $322 million a year on laboratory tests as part of general health examinations. The authors speculate that these costs are even larger if downstream testing and overtreatment are considered but note that, despite the lack of support from guideline groups over the years for general wellness visits, a change in this tradition presents a challenge. Increased use of electronic medical records to provide individualized recommendations, as well as promotion of increased discussions between physicians and patients about healthcare costs, may ultimately change this practice.

The review authors point out that during the 40-year time span in which these studies were conducted, changes in medical and therapeutic interventions may have affected the results. They note, however, that "[g]iven the finding that general health checks have never been shown to be effective across this long span of time, the burden of proof should be to demonstrate that current screening tests are more effective than past screenings."

The reviewers also note other study limitations, such as the absence of data on the harms and costs of general checkups as well as lack of discussion of the role that the physician–patient relationship may play in the recommendation and value of these visits.

"Changing beliefs about the value of general health checks — beliefs that have withstood decades of contrary evidence — will continue to be challenging," write Dr. Prochazka and Dr. Caverly. "New initiatives...should eventually shift patients and physicians away from the non–evidence-based yet firmly entrenched practice of the general health checkup," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online January 14, 2013. Abstract

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