Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Prev Med. 2010 Nov;51(5):397-402. doi: 10.1016/j.ypmed.2010.08.017. Epub 2010 Sep 7.
All Japanese aged ≥40 years are eligible for free annual health check-ups including blood pressure and cholesterol measurements. It is well known that health check-up screenees are more likely to have healthy lifestyles and better health conditions than non-screenees. Therefore, controlling these factors is required to investigate whether screenees have a lower mortality risk than non-screenees independent of their lifestyles or health conditions.
We followed 48,775 Japanese National Health Insurance beneficiaries aged 40-79 years since 1994 for 11 years. We used Cox proportional hazard models adjusted for possible confounding factors. We also performed propensity for use of the health check-up matched cohort analyses.
Compared to non-screenees, multiple-adjusted hazard ratios (95% confidence intervals) for all-cause and cardiovascular disease mortality among screenees were 0.74 (0.62-0.88) and 0.65 (0.44-0.95) for men and 0.69 (0.52-0.91) and 0.61 (0.36-1.04) for women, respectively. These relations were also observed when we used propensity matched cohort analyses.
This is the first study to show that mortality rates are lower among screenees than non-screenees in Japanese health check-ups when propensity matched cohort analyses were used for adjusting confounding factors. Further prospective studies, including randomized controlled trials, are required to confirm whether screening lowers mortality.
所有 40 岁及以上的日本人都有资格参加免费的年度健康检查，包括血压和胆固醇测量。众所周知，与非筛查者相比，健康检查筛查者更有可能拥有健康的生活方式和更好的健康状况。因此，为了调查筛查者是否比非筛查者具有更低的死亡率，需要控制这些因素，而与他们的生活方式或健康状况无关。
我们从 1994 年开始对 48775 名年龄在 40-79 岁的日本国民健康保险受益人进行了 11 年的随访。我们使用 Cox 比例风险模型调整了可能的混杂因素。我们还进行了倾向评分匹配的健康检查使用队列分析。
与非筛查者相比，筛查者的全因和心血管疾病死亡率的多因素调整风险比（95%置信区间）分别为男性 0.74（0.62-0.88）和 0.65（0.44-0.95），女性为 0.69（0.52-0.91）和 0.61（0.36-1.04）。当使用倾向评分匹配的队列分析时，也观察到了这些关系。
这是第一项研究，表明在使用倾向评分匹配的队列分析调整混杂因素后，在日本健康检查中，筛查者的死亡率低于非筛查者。需要进一步的前瞻性研究，包括随机对照试验，以确认筛查是否降低死亡率。
