Participation in health check-ups and mortality using propensity score matched cohort analyses.
OBJECTIVE
All Japanese aged ≥40 years are eligible for free annual health check-ups including blood pressure and cholesterol measurements. It is well known that health check-up screenees are more likely to have healthy lifestyles and better health conditions than non-screenees. Therefore, controlling these factors is required to investigate whether screenees have a lower mortality risk than non-screenees independent of their lifestyles or health conditions.


METHODS
We followed 48,775 Japanese National Health Insurance beneficiaries aged 40-79 years since 1994 for 11 years. We used Cox proportional hazard models adjusted for possible confounding factors. We also performed propensity for use of the health check-up matched cohort analyses.


RESULTS
Compared to non-screenees, multiple-adjusted hazard ratios (95% confidence intervals) for all-cause and cardiovascular disease mortality among screenees were 0.74 (0.62-0.88) and 0.65 (0.44-0.95) for men and 0.69 (0.52-0.91) and 0.61 (0.36-1.04) for women, respectively. These relations were also observed when we used propensity matched cohort analyses.


CONCLUSIONS
This is the first study to show that mortality rates are lower among screenees than non-screenees in Japanese health check-ups when propensity matched cohort analyses were used for adjusting confounding factors. Further prospective studies, including randomized controlled trials, are required to confirm whether screening lowers mortality.
Hozawa
Atsushi
A
Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. hozawa-thk@umin.ac.jp
Kuriyama
Shinichi
S
Watanabe
Ikue
I
Kakizaki
Masako
M
Ohmori-Matsuda
Kaori
K
Sone
Toshimasa
T
Nagai
Masato
M
Sugawara
Yumi
Y
Nitta
Akemi
A
Li
Qiang
Q
Ohkubo
Takayoshi
T
Murakami
Yoshitaka
Y
Tsuji
Ichiro
I
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000706:statistics & numerical data*; D057216:Propensity Score; D016016:Proportional Hazards Models