Association of the NHS Health Check with all-cause mortality: a longitudinal cohort study in primary care.

Abstract (English)

BACKGROUND: Cardiovascular disease (CVD) prevention is a policy priority because of widening inequalities and increasing preventable deaths. The NHS Health Check (NHS-HC) programme aims to promote early detection and prevention of CVD but has a wider-reaching impact owing to targeting multiple risk factors. Although programme evaluations demonstrate improvements in detection and surrogate markers, research on mortality outcomes remain limited, particularly using representative, real-world data. AIM: To evaluate the effectiveness of NHS-HCs in reducing all-cause mortality. DESIGN AND SETTING: Longitudinal cohort study in an inner-city London borough. METHOD: Data from electronic primary care records were analysed for 158 645 eligible participants (2009-2023). Survival was modelled using a Cox proportional hazards model with time-varying exposure. All-cause mortality risk was compared between those attending ≥1 NHS-HC (<i>n</i> = 42 589) and those who did not (<i>n</i> = 116 056). Sociodemographic, geographic, and behavioural factors were adjusted using propensity score weighting. RESULTS: Of the 158 645 participants, 63 347 (39.9%) were of Black, Asian, mixed, or other ethnicity, and 100 825 (63.6%) lived in the two most deprived quintiles in England. Attendance at ≥1 NHS-HC was associated with lower mortality (adjusted hazard ratio 0.68, 95% confidence interval = 0.63 to 0.74), indicating a 32% reduction in risk. Ten-year absolute mortality risk reduction increased with age, with the largest difference among those aged 70-74 years (18.1% versus 12.9%). Sensitivity analyses supported these findings. CONCLUSION: This study suggests significant long-term survival benefit associated with the NHS-HC, supporting continued investment in and optimisation of the programme to provide population health benefits. Findings were robust to missing data assumptions and COVID-19, although residual confounding cannot be ruled out.