Intervention Review

General health checks in adults for reducing morbidity and mortality from disease

  1. Lasse T Krogsbøll*,
  2. Karsten Juhl Jørgensen,
  3. Christian Grønhøj Larsen,
  4. Peter C Gøtzsche

Editorial Group: Cochrane Effective Practice and Organisation of Care Group

Published Online: 17 OCT 2012

Assessed as up-to-date: 4 JUL 2012

DOI: 10.1002/14651858.CD009009.pub2

How to Cite

Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD009009. DOI: 10.1002/14651858.CD009009.pub2.

Author Information

  1. Rigshospitalet, The Nordic Cochrane Centre, Copenhagen, Denmark

*Lasse T Krogsbøll, The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 7811, Copenhagen, 2100, Denmark. ltk@cochrane.dk. l.t.krogsboll@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2012

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

Background

General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm.

Objectives

We aimed to quantify the benefits and harms of general health checks with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood pressure and serum cholesterol levels.

Search methods

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE, EMBASE, Healthstar, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (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 trialists about additional studies.

Selection criteria

We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening general populations for more than one disease or risk factor in more than one organ system.

Data collection and analysis

Two authors independently extracted data and assessed the risk of bias in the trials. We contacted authors for additional outcomes or trial details when necessary. For mortality outcomes we analysed the results with random-effects model meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible.

Main results

We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (155,899 participants, 11,940 deaths), median follow-up time nine years, giving a risk ratio of 0.99 (95% confidence interval (CI) 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths), risk ratio 1.03 (95% CI 0.91 to 1.17) and eight trials on cancer mortality (139,290 participants, 3663 deaths), risk ratio 1.01 (95% CI 0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings.

We did not find an effect on clinical events or other measures of morbidity but one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one trial found an increased occurence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. No trials compared the total number of prescriptions, but two out of four trials found an increased number of people using antihypertensive drugs. Two out of four trials found small beneficial effects on self-reported health, but this could be due to reporting bias as the trials were not blinded. We did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. We did not find useful results on the number of referrals to specialists, the number of follow-up tests after positive screening results, or the amount of surgery.

Authors' conclusions

General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

General health checks for reducing illness and mortality

General health checks involve multiple tests in a person who does not feel ill with the purpose of finding disease early, preventing disease from developing, or providing reassurance. Health checks are a common element of health care in some countries. To many people health checks intuitively make sense, but experience from screening programmes for individual diseases have shown that the benefits may be smaller than expected and the harms greater. One possible harm from health checks is the diagnosis and treatment of conditions that were not destined to cause symptoms or death. Their diagnosis will, therefore, be superfluous and carry the risk of unnecessary treatment.

We identified 16 randomised trials which had compared a group of adults offered general health checks to a group not offered health checks. Results were available from 14 trials, including 182,880 participants. Nine trials studied the risk of death and included 155,899 participants and 11,940 deaths. There was no effect on the risk of death, or on the risk of death due to cardiovascular diseases or cancer. We did not find an effect on the risk of illness but one trial found an increased number of people identified with high blood pressure and high cholesterol, and one trial found an increased number with chronic diseases. One trial reported the total number of new diagnoses per participant and found a 20% increase over six years compared to the control group. No trials compared the total number of new prescriptions but two out of four trials found an increased number of people using drugs for high blood pressure. Two out of four trials found that health checks made people feel somewhat healthier, but this result is not reliable. We did not find that health checks had an effect on the number of admissions to hospital, disability, worry, the number of referrals to specialists, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. None of the trials reported on the number of follow-up tests after positive screening results, or the amount of surgery used.

One reason for the apparent lack of effect may be that primary care physicians already identify and intervene when they suspect a patient to be at high risk of developing disease when they see them for other reasons. Also, those at high risk of developing disease may not attend general health checks when invited. Most of the trials were old, which makes the results less applicable to today's settings because the treatments used for conditions and risk factors have changed.

With the large number of participants and deaths included, the long follow-up periods used in the trials, and considering that death from cardiovascular diseases and cancer were not reduced, general health checks are unlikely to be beneficial.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

利用一般的成人健康檢查降低疾病罹病率與死亡率

背景

一般健康檢查在某些國家是常見的健康照護方式。其目的是找出疾病與風險因子,以便減少罹病率與死亡率,但常見篩檢項目尚未被清楚研究,此外因篩檢異常而增加的診斷與治療介入可能有利益也有弊害。因此需評估一般健康檢查的利與弊。

目標

我們希望能定量分析一般健康檢查的益處與害處,並著重於與病患有關的評估指標(例如罹病率與死亡率),而非替代性評估指標(例如血壓與血清膽固醇濃度)。

搜尋策略

我們搜尋Cochrane文獻資料庫(The Cochrane Library)、Cochrane對照試驗中央登記系統(the Cochrane Central Register of Controlled Trials,簡稱CENTRAL)、Cochrane有效的實務與照護機構(the Cochrane Effective Practice and Organisation of Care,簡稱EPOC)試驗登記系統、MEDLINE、EMBASE、Healthstar、CINAHL、ClinicalTrials.gov與世界衛生組織(WHO)國際臨床試驗登記平台(International Clinical Trials Registry Platform,簡稱ICTRP)(至2012年7月的資料)。由兩位作者篩選文獻標題與摘要、評估文獻是否符合納入條件,並檢閱參考文獻清單,由一位作者使用文獻引用追蹤系統(知識網[Web of Knowledge]),並詢問試驗人員是否有更多其他試驗。

選擇標準

我們納入針對未篩選疾病或危險因子的成人受試者,比較有或無健康檢查之影響的隨機試驗,我們未納入針對老年人進行的試驗。我們的健康檢查係定義為:為一般大眾篩選一個以上器官系統之一種以上的疾病或危險因子。

資料收集與分析

由兩位作者獨立擷取資料與評估試驗偏差風險,若有必要,我們亦會直接洽詢作者以瞭解其他結果或試驗細節。我們是以隨機效應模型的綜合分析進行死亡評估指標的結果分析,由於其他評估指標不適用綜合分析,因此我們進行定性總結評估。

主要結論

我們納入16項試驗,其中14項具有評估指標結果的資料(總共182,880位受試者)。9項試驗提供整體死亡之相關資料(155,899位受試者,11,940個死亡病例),追蹤時間中位數為9年,風險比為0.99(95%信賴區間[CI]:0.95至1.03),8項試驗提供心血管原因死亡之相關資料(152,435位受試者,4567個死亡病例),風險比為1.03(95% CI:0.91至1.17),8項試驗提供癌症死亡之相關資料(139,290位受試者,3663個死亡病例),風險比為1.01 (95% CI:0.92至1.12)。這些發現在子群與靈敏度分析中皆未改變。

我們未發現健康檢查對臨床事件或其他罹病測量值有影響,但是有一項試驗發現在進行篩選時,高血壓與高膽固醇血症的發生率增加,另一項試驗則發現病患自我填報的慢性疾病發生率增加,還有一項試驗發現在6年期間,每一位受試者的新診斷總數較對照組增加20%。無任何試驗曾進行處方總數之比較,但是在4項試驗中有2項發現使用抗高血壓藥物的人數增加,亦有4項試驗中有2項發現健康檢查對病患自我填報的健康狀況具有小幅助益,但是可能為通報性偏倚,因為這些試驗均未設盲。我們未發現健康檢查會影響住院、失能、憂慮、額外就醫或工作請假,但是這些評估指標大部分未經適當的研究,我們也未發現健康檢查對轉診到專科醫師的病患人數、陽性篩選結果後之追蹤檢驗數目或手術量有幫助。

作者結論

一般健康檢查無法降低罹病率或死亡率(無論是整體死亡率、或心血管或癌症原因死亡),卻會增加新的疾病診斷數目,而部分重要的有害評估指標(例如追蹤診斷程序的數目或短期的心理作用)通常未進行研究或報告,且許多試驗的方法皆有問題。由於試驗中納入的受試者人數與死亡個例極多,並已進行長期追蹤,加上考量心血管與癌症死亡率皆未降低,因此一般健康檢查不太可能具有助益功效。

 

一般語言總結

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 一般語言總結

利用一般的成人健康檢查降低疾病罹病率與死亡率

利用一般的成人健康檢查降低疾病罹病率與死亡率

一般的健康檢查係旨於儘早為沒有感覺生病者發現疾病、預防疾病,或為了安心而進行的多項目檢測。健康檢查在某些國家的健康照護計畫中是常有的項目,許多人的直覺亦會認為健康檢查具有意義,但是從個別疾病之篩檢計畫得到的經驗顯示,其益處可能不如預期,害處卻較預期大。健康檢查的可能害處之一為:會診斷出一些不會引發症狀或死亡的狀況並加以治療,因此,其診斷可能非必要,卻使病患承受接受不必要的治療風險。

我們找到16項比較成人受試者接受與不接受一般健康檢查的隨機試驗,有14項試驗提供了結果,總計有182,880位受試者,有9項試驗研究死亡風險,總共有155,899位受試者與11,940個死亡病例。健康檢查對死亡風險或心血管疾病或癌症導致的死亡風險皆無影響,我們亦未發現健康檢查對疾病風險有影響,但是有一項試驗發現,診斷出高血壓與高膽固醇血症的人數增加,另一項試驗則發現慢性疾病罹患人數增加,還有一項試驗報告每一位受試者的新診斷總數,發現6年期間較對照組增加20%。沒有試驗比較新的處方籤總數,但是在4項試驗中有2項發現使用高血壓藥物的人數增加,而4項試驗中有2項發現,健康檢查會讓人有較健康的感覺,不過此結果不可靠。我們未發現健康檢查對住院人數、失能、憂慮、轉診至專科醫師的人數、額外就醫或工作請假有影響,而這些評估指標大部分均未經適當的研究證實。所有試驗皆未報告獲得陽性篩檢結果之後的追蹤檢測數目或手術使用量。

一般的健康檢查明顯缺乏效果的原因之一,為基層照護醫師因其他原因為病患看病時,若懷疑病患為某種疾病的高危險群,通常會為病患進行診斷並給予介入措施,而且屬於某種疾病之高危險群者可能不會受邀參加一般健康檢查。大部分的試驗皆為以前完成的試驗,這些結果較不適用於當今的狀況,因為某些疾病狀況使用的治療與危險因子已經改變。

考量到試驗中納入的受試者人數與死亡個例極多,並已進行長期追蹤,且心血管與癌症死亡率亦未降低,因此一般健康檢查不太可能具有助益功效。

譯註

East Asian Cochrane Alliance 翻譯
翻譯由 台灣衛生福利部/台北醫學大學實證醫學研究中心 資助