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Elderly Health Check-Up and Functional Disability or Death in Adults 75 to 84 Years: A Target Trial Emulation
Ryohei Yamamoto1, Hajime Yamazaki1, Hiroaki Nakagawa2
1Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Hospital, Fukushima, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Objectives:
To estimate the effect of initial Elderly Health Check-up (EHC) attendance on the 5-year risk of functional disability or death in community-dwelling older adults in a setting where preventing entry into long-term care (LTC) is a primary health-policy goal.
Design:
Sequential target trial emulation using a population-based cohort.
Setting And Participants:
Community-dwelling adults aged 75 to 84 years without functional disability and without recent EHC participation, drawn from the Sukagawa Study, a population-based cohort in Sukagawa City, a rural municipality with an aging population in Fukushima Prefecture, Japan, between April 2018 and March 2021.
Methods:
We compared initial EHC attendance within a 3-month grace period with nonattendance. The primary outcome was a composite of incident functional disability (LTC certification at care-need level ≥3) or death over 5 years; secondary outcomes were each component, with death treated as dependent censoring for disability. Five-year risks were estimated by inverse probability-weighted pooled logistic regression with 95% CIs.
Results:
The cohort included 21,484 person-trials from 3096 unique individuals (1001 EHCs, 20,483 non-EHCs). The 5-year composite risk was 20.6% (EHC) vs 26.7% (non-EHC): risk difference, -6.1 percentage points (pp; 95% CI, -11.6 to 0.9); risk ratio, 0.77 (95% CI, 0.57-1.03). Corresponding risk differences were -3.7 pps (95% CI, -10.4 to 3.9) for all-cause mortality and -5.4 pps (95% CI, -12.9 to 0.1) for functional disability alone.
Conclusions And Implications:
The evidence is uncertain about the effect of initial EHC participation on the 5-year risk of functional disability or death; the point estimate is compatible with a modest benefit, but the 95% CI included the null. These findings neither support expansion nor justify discontinuation of the EHC program for preventing entry into LTC, and call for replication in additional cohorts before policy changes are considered.
