Positive Impact of Health Check-Ups and Guidance in the General Population: A Database-Based Cohort Study in Japan

Despite ongoing debate, the effectiveness of health check-ups as a general population health approach has not been conclusively determined. This retrospective cohort study aimed to evaluate the effect of a health check-up program on various health parameters over a long-term period in accordance with a long-standing practice of health check-ups and guidance in Japan.

Data from 3 prefectures in the Kanto region, encompassing individuals receiving health check-ups (aged 40-74 years) between 2008 and 2018, were obtained from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Health outcomes were tracked and analyzed using statistical models, stratifying by stages of behavioral change. The exposures of interest were health guidance (active support and motivational support) and whether or not health check-ups were skipped.

The analysis suggests that receiving active or motivational support was associated with reductions in metabolic syndrome indicators among participants with multiple visits (n=2,372,239). In the year after active support, risk reductions were observed for systolic blood pressure ≥130 mmHg (-17% in both sexes), triglycerides ≥150 mg/dL (-27% in both sexes), HbA1c ≥5.6% (-20.7% in men and -17.8% in women), BMI ≥25 (-41.2% and -49.3% in men and women, respectively). Although the magnitude of effect on each indicator was about half that of active support, receiving motivational support was similarly associated with improvements in most indicators. Analysis based on a fuzzy regression discontinuity design provides robustness of the results. When individuals missed health check-ups, the risks of hypertension and high triglycerides were increased by 5%-10% and 5%-20%, respectively. Significant associations were also observed with a reduced risk for the need for antihyperlipidemic medication as well as cardiovascular disease onset and either cerebrovascular or cardiovascular disease onset in men and a reduced risk of cerebrovascular disease onset in women after active support. In addition, undergoing regular check-ups-defined as receiving health check-ups at every opportunity versus 2 times or fewer within 5 years-was associated with a reduced risk of high blood pressure, high triglycerides, elevated HbA1c, and high BMI in both men and women, particularly in individuals covered by national healthcare insurance.

Study findings suggest that the health guidance in the Japan's specific health check-up programs in a general population is associated with improved health outcomes. Regular engagement also appears to be linked to sustained health benefits, highlighting the importance of strategies to enhance the long-term participation.