Krogsbøll Lasse T, Jørgensen Karsten Juhl, Grønhøj Larsen Christian, Gøtzsche Peter C
The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark.
Cochrane Database Syst Rev. 2012 Oct 17;10:CD009009. doi: 10.1002/14651858.CD009009.pub2.
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.
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.
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.
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.
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.
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.
在一些国家，一般健康检查是医疗保健的常见组成部分。其目的是检测疾病及疾病风险因素，以降低发病率和死亡率。一般健康检查中提供的大多数常用筛查测试尚未得到充分研究。此外，筛查会导致诊断和治疗干预措施的使用增加，这些干预措施可能有害也可能有益。因此，评估一般健康检查是否利大于弊很重要。
我们旨在量化一般健康检查的益处和危害，重点关注与患者相关的结果，如发病率和死亡率，而非替代结果，如血压和血清胆固醇水平。
我们检索了截至2012年7月的考克兰图书馆、考克兰对照试验中央登记册（CENTRAL）、考克兰有效实践与护理组织（EPOC）试验登记册、医学索引（MEDLINE）、荷兰医学文摘数据库（EMBASE）、健康之星（Healthstar）、护理学与健康领域数据库（CINAHL）、临床试验.gov以及世界卫生组织国际临床试验注册平台（ICTRP）。两位作者筛选标题和摘要，评估论文的入选资格并阅读参考文献列表。一位作者使用引文追踪（Web of Knowledge）并向试验者询问其他研究。
我们纳入了将健康检查与未进行健康检查的情况进行比较的随机试验，受试者为未被选择患有疾病或风险因素的成年人。我们未纳入老年试验。我们将健康检查定义为在多个器官系统中针对一种以上疾病或风险因素对一般人群进行筛查。
两位作者独立提取数据并评估试验中的偏倚风险。必要时，我们会联系作者获取额外的结果或试验细节。对于死亡率结果，我们使用随机效应模型荟萃分析来分析结果，对于其他结果，由于无法进行荟萃分析，我们进行了定性综合分析。
我们纳入了16项试验，其中14项有可用的结果数据（182,880名参与者）。9项试验提供了全因死亡率数据（155,899名参与者，11,940例死亡），中位随访时间为9年，风险比为0.99（95%置信区间（CI）0.95至1.03）。8项试验提供了心血管疾病死亡率数据（152,435名参与者，4567例死亡），风险比为1.03（95%CI 0.91至1.17），8项试验提供了癌症死亡率数据（139,290名参与者，3663例死亡），风险比为1.01（95%CI 0.92至1.12）。亚组分析和敏感性分析未改变这些结果。我们未发现对临床事件或其他发病率指标有影响，但一项试验发现筛查会增加高血压和高胆固醇血症的发生率，另一项试验发现自我报告的慢性病发生率增加。一项试验发现，与对照组相比，每位参与者在六年内新诊断总数增加了20%。没有试验比较处方总数，但四项试验中的两项发现使用抗高血压药物的人数增加。四项试验中的两项发现对自我报告的健康有小的有益影响，但这可能是由于报告偏倚，因为试验未设盲。我们未发现对住院、残疾、担忧、额外就医次数或缺勤有影响，但这些结果大多研究不足。我们未找到关于转诊至专科医生的数量、筛查结果呈阳性后的后续检查数量或手术量的有用结果。
一般健康检查并未降低发病率或死亡率，无论是总体上还是心血管疾病或癌症病因方面，尽管新诊断的数量有所增加。重要的有害结果，如后续诊断程序的数量或短期心理影响，往往未被研究或报告，而且许多试验存在方法学问题。鉴于纳入了大量参与者和死亡病例，采用了较长的随访期，并且考虑到心血管疾病和癌症死亡率并未降低，一般健康检查不太可能有益。
