Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University.
Environ Health Prev Med. 2022;27:1. doi: 10.1265/ehpm.21-00292.
Cancer prevention is a crucial challenge in preventive medicine. Several studies have suggested that voluntary health check-ups and recommendations from health professionals are associated with increased participation in cancer screening. In Japan, it is recommended that individuals aged 40-74 years should undergo annual health check-ups; however, the compliance to this recommendation is approximately <50%. According to the national survey, individuals who do not undergo annual health check-ups are at a higher risk for cancer. However, to the best of our knowledge, no previous study has investigated the association between the use of health check-ups and the incidence rate of cancer. We hypothesised that not undergoing periodic health check-ups and/or less use of outpatient medical services are predictors for advanced cancer.
To explore the relationship between health check-up or outpatient service utilisation and cancer incidence, this retrospective cohort study used data at two time points-baseline in 2014 and endpoint in 2017-from the National Health Insurance (NHI) claims and cancer registry. A multivariable logistic regression analysis was performed to investigate whether cancer diagnosis was associated with health check-up or outpatient service utilisation.
A total of 72,171 participants were included in the analysis. The results of the multivariable logistic regression showed that individuals who skipped health check-ups had a higher risk of cancer diagnosis (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.40). Moreover, not undergoing health check-ups increased the risk of advanced-stage cancer (OR, 1.78; 95% CI, 1.29-2.44). Furthermore, increased rate of outpatient service utilisation was negatively associated with advanced cancer diagnosis.
This is the first study reporting that not undergoing health check-ups is a predictor of cancer diagnosis and advanced cancer stage. Primary prevention strategies for NHI members who do not undergo health check-ups must be reassessed. Moreover, future research should examine secondary prevention strategies, such as health education and recommendations from health professionals to facilitate adequate utilisation of preventive health services.
癌症预防是预防医学中的一个重要挑战。多项研究表明，自愿体检和健康专业人士的建议与增加癌症筛查的参与度有关。在日本，建议年龄在 40-74 岁的个人每年进行健康检查；然而，对这一建议的遵守率约为<50%。根据全国性调查，不进行年度健康检查的人患癌症的风险更高。但是，据我们所知，以前没有研究调查过健康检查的使用与癌症发病率之间的关系。我们假设，不进行定期健康检查和/或较少使用门诊医疗服务是癌症进展的预测因素。
为了探讨健康检查或门诊服务利用与癌症发病率之间的关系，这项回顾性队列研究使用了国家健康保险（NHI）理赔和癌症登记处的两个时间点的数据-2014 年的基线和 2017 年的终点。多变量逻辑回归分析用于调查癌症诊断是否与健康检查或门诊服务利用相关。
共有 72171 名参与者纳入分析。多变量逻辑回归的结果表明，跳过健康检查的人患癌症的风险更高（比值比[OR]，1.21；95%置信区间[CI]，1.04-1.40）。此外，不进行健康检查会增加晚期癌症的风险（OR，1.78；95%CI，1.29-2.44）。此外，门诊服务利用率的增加与晚期癌症诊断呈负相关。
这是第一项报告不进行健康检查是癌症诊断和晚期癌症分期的预测因素的研究。必须重新评估不进行健康检查的 NHI 成员的初级预防策略。此外，未来的研究应检查二级预防策略，如健康教育和健康专业人士的建议，以促进充分利用预防保健服务。
