Abstract
Aims/hypothesisHealth check programmes for chronic disease have been introduced in a number of countries. However, there are few trials assessing the benefits and harms of these screening programmes at the population level. In a post hoc analysis, we evaluated the effect of population-based screening for type 2 diabetes and cardiovascular risk factors on mortality rates and cardiovascular events.MethodsThis register-based, non-randomised, controlled trial included men and women aged 40–69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk score questionnaire. Individuals at moderate-to-high risk were invited to visit their GP for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other general practices in Denmark constituted the retrospectively constructed no-screening (control) group. Outcomes were mortality rate and cardiovascular events (cardiovascular disease death, non-fatal ischaemic heart disease or stroke). The analysis was performed according to the intention-to-screen principle.ResultsAmong the screening group, 27,177 (18%) individuals attended for assessment of diabetes status and cardiovascular risk. Of these, 1,533 were diagnosed with diabetes. During a median follow-up of 9.5 years, there were 11,826 deaths in the screening group and 141,719 in the no-screening group (HR 0.99 [95% CI 0.96, 1.02], p = 0.66). There were 17,941 cardiovascular events in the screening group and 208,476 in the no-screening group (HR 0.99 [0.96, 1.02], p = 0.49).Conclusions/interpretationA population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012.
Highlights
As governments seek to apply the principles of prevention to chronic disease, health check programmes have been proposed or introduced in a number of countries, including the UK and the USA [1, 2]
Conclusions/interpretation A population-based stepwise screening programme for type 2 diabetes and cardiovascular risk factors among all middle-aged adults in Denmark was not associated with a reduction in rate of mortality or cardiovascular events between 2001 and 2012
Data are presented as n (%) ATC codes: glucose-lowering medication (A*); lipid-lowering medication (C10*); anti-hypertensive medication (CO7*, CO8*, C09*) a Denominator population based on participants who were alive on 1 January for each year prescriptions for anti-hypertensive medication throughout the follow-up period. In this population-based sample of nearly two million middleaged Danish adults, a single round of screening for type 2 diabetes and cardiovascular risk assessment was not associated with a reduction in the rates of all-cause mortality or cardiovascular events between 2001 and 2012
Summary
As governments seek to apply the principles of prevention to chronic disease, health check programmes have been proposed or introduced in a number of countries, including the UK and the USA [1, 2]. These usually include assessment and management of risk factors for chronic disease, most of which are related to cardiovascular disease (CVD). A Cochrane review of randomised trials comparing health checks with no health checks in adult populations found that they did not reduce morbidity, all-cause mortality or cardiovascular-related mortality rates, the number of new diagnoses increased [10]. INTER-99 reported no effect and the Västerbotten Intervention Programme, which combined screening with a wider public health promotion programme, reported mortality rate reductions [9, 11]
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