Professor Thomas Cox CBE

GENERAL HEALTH CHECKS IN ADULTS  FOR REDUCING MORBIDITY & MORTALITY FROM DISEASE

In October 2012, The Cochrane Library published a Review on General Health Checks in Adults for Reducing Morbidity and Mortality from Disease by Krogsbøll, Jørgensen, Grønhøj Larsen and Gøtzsche (2012). The Review focused on randomized trials studying more than one screening intervention in multiple organ systems. It excluded those trials enrolling only older populations (people aged over 65 years). All studies evaluated asymptomatic populations that were unselected for disease or risk factors. All studies compared groups of people under 65 years without symptoms who received general health checks with groups who did not. The Review included 14 studies and collectively 182,880 participants. The main conclusion from the Review was that general health checks in the community setting do not reduce overall or disease-specific mortality. The relative risk of death was reported as 0.99 (95% confidence interval 0.95, 1.03). General health checks were also reported either to have no effect on outcomes such as patient worry, unscheduled physician visits, hospital admissions, and absences from work, or that estimates of effect were unreliable (self-reported health, disability).

The design characteristics of the studies include in the Review are important and often ignored when its findings are used to dismiss the value of screening per se. The misuse of the Krogsbøll Review was somewhat anticipated in an Editorial by Stephanie Thompson and  Marcello Tonelli published by the Cochrane Library in the same month as the Review. The Editorial attempts to provide a balanced view of the possible benefits and risks of screening and, most importantly points out that the Review does not apply to screening interventions prompted by clinical judgment or patient concern. Sadly, such cautions do not always appear to have been heeded by those intent on denying the utility of screening processes per se.

See:

Krogsbøll, Jørgensen, Grønhøj Larsen and Gøtzsche (2012). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews 2012 Oct 17;(10):CD009009. DOI:10.1002/14651858.CD009009.pub2

Thompson and Tonelli (2012) General health checks in adults for reducing morbidity and mortality from disease.disease. Cochrane Library Editorial. http://www.thecochranelibrary.com/details/editorial/2723031/General-health-checks-in-adults-for-reducing-morbidity-and-mortality-from-diseas.html.