Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Prev Med. 2021 Dec;153:106757. doi: 10.1016/j.ypmed.2021.106757. Epub 2021 Aug 1.
General health checks to detect cardiovascular risk factors form part of routine health care in many countries. Cardiovascular disease and dementia share a number of risk factors; however it remains unclear whether general health checks can reduce the incidence of dementia. We used longitudinal data from the Japan Gerontological Evaluation Study with up to 6.4 years follow-up (from 2010 to 2016). A total of 31,012 disability-free adults aged 65-74 were included. The outcome variable was dementia onset certified under the national long-term care insurance system. The treatment variable was defined as having health checks within the past 12 months prior to the baseline survey in 2010. After multiple imputation, we performed propensity score matching (PSM) to exclude off-support individuals who were the least likely to have health checks. We also performed inverse probability treatment weighting (IPTW) to estimate the effect of the treatment if everyone within the population was compliant to health checks. The hazard ratios for dementia onset among those reporting health checks within the previous year was 0.89 (95% confidence interval (CI): 0.78, 1.02) in the PSM analysis and 0.84 (95% CI: 0.75, 0.95) in the IPTW analysis. We then estimated the effect of health checks on 5-year incident dementia. The 5-year cumulative incidence difference based on the PSM analysis was -0.0046 (95%CI: -0.0101, 0.0009), while that based on the IPTW analysis was -0.0046 (95%CI, -0.0090, -0.0002). The PSM and IPTW approaches yielded similar findings that the incidence of dementia was lower among people having health checks.
一般健康检查可用于发现心血管疾病危险因素，这是许多国家常规保健的一部分。心血管疾病和痴呆症有许多共同的危险因素；然而，一般健康检查是否能降低痴呆症的发病率仍不清楚。我们使用了日本老年人评估研究的纵向数据，随访时间长达 6.4 年（2010 年至 2016 年）。共有 31,012 名无残疾的 65-74 岁成年人被纳入研究。结局变量为在全国长期护理保险制度下确诊的痴呆症发病。治疗变量定义为在 2010 年基线调查前的过去 12 个月内进行了健康检查。在多次插补后，我们进行倾向评分匹配（PSM）排除不太可能进行健康检查的脱保人群。我们还进行了逆概率处理权重（IPTW）估计，如果人群中每个人都符合健康检查要求，治疗的效果。在 PSM 分析中，报告在过去一年中进行了健康检查的人群中痴呆症发病的风险比为 0.89（95%置信区间（CI）：0.78，1.02），在 IPTW 分析中为 0.84（95%CI：0.75，0.95）。然后我们估计了健康检查对 5 年发病痴呆症的影响。PSM 分析的 5 年累计发病率差异为-0.0046（95%CI：-0.0101，0.0009），而 IPTW 分析的差异为-0.0046（95%CI：-0.0090，-0.0002）。PSM 和 IPTW 方法得出的结论相似，即进行健康检查的人群中痴呆症的发病率较低。
