Abstract
BackgroundThe NHS Health Check cardiovascular prevention programme is now 10 years old.AimTo describe NHS Heath Check attendance, new diagnoses, and treatment in relation to equity indicators.Design and settingA nationally representative database derived from 1500 general practices from 2009–2017.MethodThe authors compared NHS Health Check attendance and new diagnoses and treatments by age, sex, ethnic group, and deprivation.ResultsIn 2013–2017, 590 218 (16.9%) eligible people aged 40–74 years attended an NHS Health Check and 2 902 598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend compared to others, and females more than males. New diagnoses were more likely in attendees than non-attendees: hypertension 25/1000 in attendees versus 9/1000 in non-attendees; type 2 diabetes 8/1000 versus 3/1000; and chronic kidney disease (CKD) 7/1000 versus 4/1000. In people aged ≥65 years, atrial fibrillation was newly diagnosed in 5/1000 attendees and 3/1000 non-attendees, and for dementia 2/1000 versus 1/1000, respectively. Type 2 diabetes, hypertension, and CKD were more likely in more deprived groups, and in South Asian, Black African, and Black Caribbean ethnic groups. Attendees were more likely to be prescribed statins (26/1000) than non-attendees (8/1000), and antihypertensive medicines (25/1000 versus 13/1000 non-attendees). However, of the 117 963 people with ≥10% CVD risk who were eligible for statins, only 9785 (8.3%) were prescribed them.ConclusionUptake of NHS Health Checks remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and CKD, and to receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, <10% were treated. Policy reviews should consider a targeted approach prioritising those at highest CVD risk for face-to-face contact and consider other options for those at lower CVD risk.
Highlights
The NHS Health Check identified important new diagnoses of hypertension, type 2 diabetes, chronic kidney disease and our study reports increased diagnosis of atrial fibrillation and dementia in people age 65 years and older
Black and South Asian ethnic groups were more likely to be identified with disease
The largest group of attendees were under 50 years accounting for 286,550 (48.6%) NHS Health Check attendances in 2013-17 and 132,590 (44.1%) of attendees in 2009-13
Summary
Public Health England has highlighted the need to address equity of provision and inequalities and the aim of this current study was to compare NHS Health Checks 2009-13 with the period 2013-17, and assess changes in attendance by age, gender, ethnic and socioeconomic group and new diagnosis of type 2 diabetes, hypertension, chronic kidney disease, dementia and atrial fibrillation and new statin and antihypertensive treatment.
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