Takeuchi Masato, Shinozaki Tomohiro, Kawakami Koji
Department of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
JAMA Netw Open. 2024 Dec 2;7(12):e2451813. doi: 10.1001/jamanetworkopen.2024.51813.
Type 2 diabetes and hypertension are obesity-related, noncommunicable diseases becoming increasingly common worldwide. In 2008, Japan launched a nationwide universal health checkup program, Specific Health Checkup (SHC), for the primary prevention of obesity-related diseases, but its effectiveness has been understudied.
To investigate the association of the SHC program with incident diabetes and hypertension, using a target trial emulation framework.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from a longitudinal health care database involving both checkup history and medical encounter records in Japan. Individuals aged 40 to 74 years, without diabetes or hypertension, and without a prior checkup history, were eligible. Individuals were repeatedly assessed for eligibility from April 1, 2008, to March 31, 2020, to assemble sequential cohorts of 78 620 SHC participants and 214 554 nonparticipants. Statistical analysis was conducted from June 8 to December 30, 2023.
The composite risk of incident type 2 diabetes or hypertension over a period of up to 10 years, defined as the combination of a newly documented diagnosis and use of relevant medications. A propensity score-weighted survival analysis was conducted to adjust for baseline variables. A series of sensitivity analyses and a negative outcome control analysis were conducted using depression as a benchmark.
Sequential cohorts consisted of 78 620 SHC participants (median age, 46 years [IQR, 41-53 years]; 62.7% women) and 214 554 nonparticipants (median age, 49 years [IQR, 44-55 years]; 82.0% women) from 153 084 unique persons, each of whom entered the study cohort a mean (SD) of 1.9 (1.5) times. Within a median follow-up of 4.2 years (IQR, 2.7-6.3 years), the primary end point occurred among 11.2% of all individuals (10.6% of the SHC participants and 11.4% of the nonparticipants), with a lower hazard ratio (HR) among the SHC recipients (HR, 0.90; 95% CI, 0.89-0.92); the difference in cumulative incidence at 10 years was -1.6% (95% CI, -1.8% to -1.3%). The sensitivity analyses showed similar results. The negative control analysis suggested the potential for residual confounding (HR, 1.05; 95% CI, 1.02-1.07); the bias-calibrated HR was 0.86 (95% CI, 0.84-0.89) for the primary outcome.
In this cohort study, within a median of 4.2 years of follow-up, SHC recipients had a 9.8% lower risk of incident diabetes and hypertension (13.8% in the bias-calibrated analysis). The cost-effectiveness of the SHC and its transportability to other regions are unclear, requiring future investigations.
2型糖尿病和高血压是与肥胖相关的非传染性疾病，在全球范围内日益普遍。2008年，日本启动了一项全国性的全民健康检查计划，即特定健康检查（SHC），用于肥胖相关疾病的一级预防，但其有效性尚未得到充分研究。
使用目标试验模拟框架，研究SHC计划与新发糖尿病和高血压之间的关联。
设计、设置和参与者：这项回顾性队列研究使用了来自日本一个纵向医疗保健数据库的数据，该数据库包含检查历史和医疗就诊记录。年龄在40至74岁之间、无糖尿病或高血压且无前检查史的个体符合条件。从2008年4月1日至2020年3月31日，对个体进行反复资格评估，以组建由78620名SHC参与者和214554名非参与者组成的连续队列。统计分析于2023年6月8日至12月30日进行。
长达10年期间新发2型糖尿病或高血压的综合风险，定义为新记录的诊断和使用相关药物的组合。进行倾向评分加权生存分析以调整基线变量。使用抑郁症作为基准进行了一系列敏感性分析和阴性结局对照分析。
连续队列由来自153084名独特个体的78620名SHC参与者（中位年龄46岁[四分位间距，41 - 53岁]；62.7%为女性）和214554名非参与者（中位年龄49岁[四分位间距，44 - 55岁]；82.0%为女性）组成，每个人平均（标准差）进入研究队列1.9（1.5）次。在中位随访4.2年（四分位间距，2.7 - 6.3年）内，主要终点在所有个体的11.2%中出现（SHC参与者中的10.6%和非参与者中的11.4%），SHC接受者的风险比（HR）较低（HR，0.90；95%置信区间，0.89 - 0.92）；10年时累积发病率差异为 - 1.6%（95%置信区间， - 1.8%至 - 1.3%）。敏感性分析显示了类似结果。阴性对照分析表明存在残余混杂的可能性（HR，1.05；95%置信区间，1.02 - 1.07）；主要结局的偏差校正HR为0.86（95%置信区间，0.84 - 0.89）。
在这项队列研究中，在中位4.2年的随访期内，SHC接受者发生糖尿病和高血压的风险降低了9.8%（偏差校正分析中为13.8%）。SHC的成本效益及其在其他地区的可推广性尚不清楚，需要未来进行调查。
