Faculty of Medicine, University of Southampton, Southampton, UK
Faculty of Medicine, University of Southampton, Southampton, UK.
BMJ Open. 2019 Sep 20;9(9):e029420. doi: 10.1136/bmjopen-2019-029420.
To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC).
This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015.
151 general practices in Hampshire, England, UK.
366 005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC.
NHS HC invitation.
HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10% and >20%, smokers, and total cholesterol (TC) >5.5 mmol/L and >7.5 mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT).
HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5 mmol/L (4.1%-7.0%, p<0.001) and >7.5 mmol/L (0.3%-0.4% p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95% CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5 mmol/L (3.72, 3.57 to 3.89) and >7.5 mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10% plus statin and >20% plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation.
HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.
评估国民保健制度（NHS）健康检查（HC）的吸收率、风险因素检测和管理。
这是一项准随机对照试验，参与者根据出生年份被分配到五个队列中。四个队列被邀请参加 2011 年 4 月至 2015 年 3 月之间的 NHS HC。
英国汉普郡的 151 家普通诊所。
366005 名出生于 1940 年 4 月 1 日至 1976 年 3 月 31 日，有资格接受 NHS HC 的参与者。
NHS HC 邀请。
HC 出勤率和绝对百分比变化以及（1）检测心血管疾病（CVD）10 年风险>10%和>20%、吸烟者、总胆固醇（TC）>5.5mmol/L 和>7.5mmol/L 的比值比（OR）；（2）诊断高血压、2 型糖尿病、慢性肾病（CKD）和心房颤动（AF）；（3）使用他汀类药物、抗高血压药、降糖药和尼古丁替代疗法（NRT）的新干预措施。
2011/2012 年至 2014/2015 年期间，HC 出勤率从 12%上升至 30%（p<0.001）。HC 邀请增加了 CVD 风险>10%（2.0%-3.6，p<0.001）和>20%（0.1%-0.6%，p<0.001-0.392）、TC>5.5mmol/L（4.1%-7.0%，p<0.001）和>7.5mmol/L（0.3%-0.4%，p<0.001）、高血压（0.3%-0.6%，p<0.001-0.003）和他汀类药物（0.2%-0.9%，p<0.001-0.017）和抗高血压药物（0.1%-0.6%，p<0.001-0.205）的干预措施。在检测吸烟者、NRT 或糖尿病、AF 或 CKD 方面，没有一致的差异。多变量分析显示，HC 邀请与检测 CVD 风险>10%（OR 8.01，95%CI 7.34-8.73）和>20%（5.86，4.83-7.10）、TC>5.5mmol/L（3.72，3.57-3.89）和>7.5mmol/L（2.89，2.46-3.38）、高血压（1.33，1.20-1.47）和糖尿病（1.34，1.12-1.61）有关。CVD 风险>10%加他汀类药物和>20%加他汀类药物的 OR 分别为 2.90（2.36-3.57）和 2.60（1.92-3.52），高血压加抗高血压药物的 OR 为 1.33（1.18-1.50）。与 AF、CKD、降糖药或 NRT 均无关联。几种危险因素的检测因贫困程度而异呈反比关系。
HC 邀请增加了心血管风险因素的检测，但相应的循证干预措施增加幅度较小。
