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Meta-Analysis
. 2019 Jan 31;1(1):CD009009.
doi: 10.1002/14651858.CD009009.pub3.

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

Lasse T Krogsbøll  1 , Karsten Juhl Jørgensen, Peter C Gøtzsche
Affiliations
Meta-Analysis

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

Lasse T Krogsbøll et al. Cochrane Database Syst Rev. .

Abstract

Background: General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual 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. This is the first update of the review published in 2012.

Objectives: To quantify the benefits and harms of general health checks.

Search methods: We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors 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 for more than one disease or risk factor in more than one organ system.

Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis.

Main results: We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I2 = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I2 = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I2 = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I2 = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I2 = 53%).

Authors' conclusions: General health checks are unlikely to be beneficial.

PubMed Disclaimer

Conflict of interest statement

Lasse T. Krogsbøll: none known

Karsten Juhl Jørgensen: none known

Peter C. Gøtzsche: none known

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
3
3
'Risk of bias; graph: review authors' judgements about each risk of bias item presented as percentages across all included trials
4
4
Funnel plot of comparison 1. Health checks versus control, outcome: 1.1 Total mortality.
1.1
1.1. Analysis
Comparison 1 Health checks versus control, Outcome 1 Total mortality.
1.2
1.2. Analysis
Comparison 1 Health checks versus control, Outcome 2 Total mortality ‐ sensitivity analyses.
1.3
1.3. Analysis
Comparison 1 Health checks versus control, Outcome 3 Total mortality ‐ no. of health checks.
1.4
1.4. Analysis
Comparison 1 Health checks versus control, Outcome 4 Total mortality ‐ lifestyle intervention.
1.5
1.5. Analysis
Comparison 1 Health checks versus control, Outcome 5 Total mortality ‐ length of follow‐up.
1.6
1.6. Analysis
Comparison 1 Health checks versus control, Outcome 6 Total mortality ‐ age of trial.
1.7
1.7. Analysis
Comparison 1 Health checks versus control, Outcome 7 Total mortality ‐ geographical location.
1.8
1.8. Analysis
Comparison 1 Health checks versus control, Outcome 8 Total mortality ‐ examination by physician.
1.9
1.9. Analysis
Comparison 1 Health checks versus control, Outcome 9 Total mortality ‐ selection bias.
1.10
1.10. Analysis
Comparison 1 Health checks versus control, Outcome 10 Total mortality ‐ performance bias.
1.11
1.11. Analysis
Comparison 1 Health checks versus control, Outcome 11 Total mortality ‐ detection bias.
1.12
1.12. Analysis
Comparison 1 Health checks versus control, Outcome 12 Total mortality ‐ incomplete outcome data.
1.13
1.13. Analysis
Comparison 1 Health checks versus control, Outcome 13 Total mortality ‐ contamination.
1.14
1.14. Analysis
Comparison 1 Health checks versus control, Outcome 14 Cancer mortality.
1.15
1.15. Analysis
Comparison 1 Health checks versus control, Outcome 15 Cancer mortality ‐ sensitivity analyses.
1.16
1.16. Analysis
Comparison 1 Health checks versus control, Outcome 16 Cancer mortality ‐ no. of health checks.
1.17
1.17. Analysis
Comparison 1 Health checks versus control, Outcome 17 Cancer mortality lifestyle intervention.
1.18
1.18. Analysis
Comparison 1 Health checks versus control, Outcome 18 Cancer mortality ‐ length of follow‐up.
1.19
1.19. Analysis
Comparison 1 Health checks versus control, Outcome 19 Cancer mortality ‐ age of trial.
1.20
1.20. Analysis
Comparison 1 Health checks versus control, Outcome 20 Cancer mortality ‐ geographical location.
1.21
1.21. Analysis
Comparison 1 Health checks versus control, Outcome 21 Cancer mortality ‐ examination by physician.
1.22
1.22. Analysis
Comparison 1 Health checks versus control, Outcome 22 Cancer mortality ‐ selection bias.
1.23
1.23. Analysis
Comparison 1 Health checks versus control, Outcome 23 Cancer mortality ‐ performance bias.
1.24
1.24. Analysis
Comparison 1 Health checks versus control, Outcome 24 Cancer mortality ‐ detection bias.
1.25
1.25. Analysis
Comparison 1 Health checks versus control, Outcome 25 Cancer mortality ‐ incomplete outcome data.
1.26
1.26. Analysis
Comparison 1 Health checks versus control, Outcome 26 Cancer mortality ‐ contamination.
1.27
1.27. Analysis
Comparison 1 Health checks versus control, Outcome 27 Cardiovascular mortality.
1.28
1.28. Analysis
Comparison 1 Health checks versus control, Outcome 28 Cardiovascular mortality ‐ sensitivity analyses.
1.29
1.29. Analysis
Comparison 1 Health checks versus control, Outcome 29 Cardiovascular mortality ‐ no. of health checks.
1.30
1.30. Analysis
Comparison 1 Health checks versus control, Outcome 30 Cardiovascular mortality lifestyle intervention.
1.31
1.31. Analysis
Comparison 1 Health checks versus control, Outcome 31 Cardiovascular mortality ‐ length of follow‐up.
1.32
1.32. Analysis
Comparison 1 Health checks versus control, Outcome 32 Cardiovascular mortality ‐ age of trial.
1.33
1.33. Analysis
Comparison 1 Health checks versus control, Outcome 33 Cardiovascular mortality ‐ geographical location.
1.34
1.34. Analysis
Comparison 1 Health checks versus control, Outcome 34 Cardiovascular mortality ‐ examination by physician.
1.35
1.35. Analysis
Comparison 1 Health checks versus control, Outcome 35 Cardiovascular mortality ‐ selection bias.
1.36
1.36. Analysis
Comparison 1 Health checks versus control, Outcome 36 Cardiovascular mortality ‐ performance bias.
1.37
1.37. Analysis
Comparison 1 Health checks versus control, Outcome 37 Cardiovascular mortality ‐ detection bias.
1.38
1.38. Analysis
Comparison 1 Health checks versus control, Outcome 38 Cardiovascular mortality ‐ incomplete outcome data.
1.39
1.39. Analysis
Comparison 1 Health checks versus control, Outcome 39 Cardiovascular mortality ‐ contamination.
1.40
1.40. Analysis
Comparison 1 Health checks versus control, Outcome 40 Fatal and non‐fatal ischaemic heart disease.
1.41
1.41. Analysis
Comparison 1 Health checks versus control, Outcome 41 Fatal and non‐fatal stroke.
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References to other published versions of this review

Krogsbøll 2011
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