NHS Health Checks: an observational study of equity and outcomes 2009-2017

Abstract

Background: The NHS Health Check cardiovascular prevention programme is now 10 years old.

Aim: To describe NHS Heath Check attendance, new diagnoses, and treatment in relation to equity indicators.

Design and setting: A nationally representative database derived from 1500 general practices from 2009-2017.

Method: The authors compared NHS Health Check attendance and new diagnoses and treatments by age, sex, ethnic group, and deprivation.

Results: In 2013-2017, 590 218 (16.9%) eligible people aged 40-74 years attended an NHS Health Check and 2 902 598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend compared to others, and females more than males. New diagnoses were more likely in attendees than non-attendees: hypertension 25/1000 in attendees versus 9/1000 in non-attendees; type 2 diabetes 8/1000 versus 3/1000; and chronic kidney disease (CKD) 7/1000 versus 4/1000. In people aged ≥65 years, atrial fibrillation was newly diagnosed in 5/1000 attendees and 3/1000 non-attendees, and for dementia 2/1000 versus 1/1000, respectively. Type 2 diabetes, hypertension, and CKD were more likely in more deprived groups, and in South Asian, Black African, and Black Caribbean ethnic groups. Attendees were more likely to be prescribed statins (26/1000) than non-attendees (8/1000), and antihypertensive medicines (25/1000 versus 13/1000 non-attendees). However, of the 117 963 people with ≥10% CVD risk who were eligible for statins, only 9785 (8.3%) were prescribed them.

Conclusion: Uptake of NHS Health Checks remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and CKD, and to receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, <10% were treated. Policy reviews should consider a targeted approach prioritising those at highest CVD risk for face-to-face contact and consider other options for those at lower CVD risk.

Keywords: NHS Health Check; antihypertensives; cardiovascular disease; statins.

Figure 1.

New diagnoses in attendees and non-attendees 2013–2017 (at or in 12 months following the NHS Health Check or index date). CKD = chronic kidney disease. CVD = cardiovascular disease.