title: Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study.
abstract: OBJECTIVE
  To determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs.
  
  
  METHODS
  Cohort study of a 3% random sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010.
  
  
  RESULTS
  In primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003-2004 compared to those who did not were 0.58 (95% CI: 0.53-0.63), 0.62 (95% CI: 0.60-0.64), 0.82 (95% CI: 0.78-0.85), 0.84 (95% CI: 0.75-0.93), 0.84 (95% CI: 0.79-0.89), and 0.73 (95% CI: 0.67-0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders.
  
  
  CONCLUSIONS
  Participation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs.
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea. Electronic address: elf2128@gmail.com.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea. Electronic address: alfadur2j@gmail.com.
authors.forename: Juhee
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea; JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea. Electronic address: dwshin.snuh@gmail.com.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Seoul National University Hospital, Republic of Korea. Electronic address: splee0624@gmail.com.
authors.forename: Seung-Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Social & Preventive Medicine, School of Medicine, Inha University, Republic of Korea. Electronic address: cyberdoc73@gmail.com.
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: JW Lee Center for Global Medicine, College of Medicine, Seoul National University, Republic of Korea. Electronic address: juhwan.oh328@gmail.com.
authors.forename: Juhwan
authors.initials: J
authors.lastname: Oh
authors.affiliation: Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea. Electronic address: seesky1@gmail.com.
authors.forename: Hyung-Kook
authors.initials: HK
authors.lastname: Yang
authors.affiliation: Health Insurance Review and Assessment Research Institute, Health Insurance Review and Assessment Service, Seoul, Republic of Korea. Electronic address: huilove@snu.ac.kr.
authors.forename: Soo-Hee
authors.initials: SH
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. Electronic address: mdsky75@gmail.com.
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Son
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea. Electronic address: sohyun.chun@gmail.com.
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Chun
authors.affiliation: Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. Electronic address: belong@snu.ac.kr.
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, USA; Department of Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: eguallar@gmail.com.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012923:Social Class
keywords: Cardiovascular diseases; Mortality; Risk factors; Screening