Interest in health screening as a predictor of long-term overall mortality: multilevel analysis of a Japanese national cohort study.
BACKGROUND
In Japan, screening programmes have been widely implemented as a public health practice. We investigated the effect of the area-level interest in health screening on mortality using data from a large cohort in Japan.


METHODS
A baseline survey was conducted between 1988 and 1990 among 110,792 residents of 45 areas, aged 40-79 years. Area-level interest in health screening was defined as the proportion of people with high and moderate interest in health screening in an area. Multilevel Poisson regression was employed in a two-level structure of individuals nested within the areas. During 15 years of follow-up (1,035,617 person-years), 13,184 deaths were observed.


RESULTS
The reduction in mortality rate was (a) 2% in both men (p=0.009) and women (p=0.038) for each percent increase in area-level interest in screening, and (b) 10% in men (p=0.001) and 9% in women (p=0.001) for individual attendance to screening in the year before follow-up. There was no interaction between area-level interest in screening, individual-level attendance at screening and overall mortality.


CONCLUSIONS
Area-level and individual interest for health screening appear to be independent predictor of 15-year mortality in this national Japanese study. The present findings may support public health practices to promote knowledge and participation in screening programmes.
Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan. zenq@med.uoeh-u.ac.jp
Yoshihisa
Y
Fujino
Naohito
N
Tanabe
Kaori
K
Honjo
Sadao
S
Suzuki
Hiroyasu
H
Iso
Akiko
A
Tamakoshi
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016012:Poisson Distribution; D015980:Public Health Practice