Association of the NHS Health Check with all-cause mortality: a longitudinal cohort study in primary care

Jasjot Saund; Hiten Dodhia; Jacopo Vanoli; Pierre Masselot; Stephen O’Neill

doi:10.3399/BJGP.2025.0451

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Figure 1. Standardised mean differences (SMDs) between exposure groups for each variable before (red) and after (blue) applying weighting. Red dashed line indicates 0.1 SMD. BMI = body mass index. IMD = Index of Multiple Deprivation. PCN = primary care network. SLE = systemic erythematous lupus.
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Figure 2. Estimated adjusted survival curve from weighted Cox proportional hazards model. Baseline covariates balanced include: sex; body mass index; ethnicity; main spoken language; smoking status; primary care network; enrolment period; family history of chronic heart disease; Index of Multiple Deprivation quintile; age; alcohol intake; and history of cancer, rheumatoid arthritis, serious mental illness, systemic lupus erythematous, or liver disease.

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Table 1. Absolute risk of death after 10 years from index date stratified by exposure group and 5-year age category^a

			Predicted 10-year absolute risk of death
Index age, years	Patients, n ^b	Deaths, n ^b	No NHS-HC group, %	NHS-HC group, %	Adjusted HR (95% CI)
40–44	99 300	784	1.2	0.8	0.79 (0.66 to 0.96)
45–49	24 268	591	2.2	1.5	0.67 (0.54 to 0.84)
50–54	15 167	591	3.6	2.5	0.71 (0.57 to 0.88)
55–59	9150	509	5.0	3.5	0.76 (0.62 to 0.95)
60–64	5850	527	7.4	5.4	0.72 (0.58 to 0.88)
65–69	3117	461	12.5	8.8	0.57 (0.43 to 0.75)
70–74	1793	414	18.1	12.9	0.54 (0.39 to 0.74)

^aAdjusted HRs in age interaction model. ^b n = total number of individuals in each age category (unweighted count); Deaths = total observed deaths in that age category over the full study period (unweighted, not split by exposure group, since NHS-HC attendance is time-varying). No NHS-HC and NHS-HC columns show the model-predicted 10-year absolute risk of death from the weighted, propensity-adjusted, age-stratified Cox model, using the pooled adjusted HR; they are not equal to Deaths ÷ n, which reflects crude, unadjusted mortality over variable follow-up time rather than a fixed 10-year horizon. HR = hazard ratio. NHS-HC = NHS Health Check.

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Table 2. Baseline characteristics compared between NHS-HC and no NHS-HC group in dataset before weighting

Characteristic^a	Overall,n = 158 645	No NHS-HC group,n = 116 056	NHS-HC group,n = 42 589	P-value
Year of birth, mean (SD)	1968.69 (9.92)	1969.34 (10.04)	1966.92 (9.36)	<0.001
Sex, female	76 526 (48.2)	55 315 (47.7)	21 211 (49.8)	<0.001
IMD quintile				<0.001
1 (most deprived)	29 065 (18.3)	21 582 (18.6)	7483 (17.6)
2	71 760 (45.2)	52 738 (45.4)	19 022 (44.7)
3	44 136 (27.8)	31 875 (27.5)	12 261 (28.8)
4	11 414 (7.2)	8211 (7.1)	3203 (7.5)
5 (least deprived)	2270 (1.4)	1650 (1.4)	620 (1.5)
Smoking status				0.038
Never	106 151 (66.9)	77 444 (66.7)	28 707 (67.4)
Former	3428 (2.2)	2530 (2.2)	898 (2.1)
Current	49 066 (30.9)	36 082 (31.1)	12 984 (30.5)
Enrolment				<0.001
2009–2011	67 159 (42.3)	44 086 (38.0)	23 073 (54.2)
2012–2014	23 992 (15.1)	17 018 (14.7)	6974 (16.4)
2015–2017	23 009 (14.5)	17 121 (14.8)	5888 (13.8)
2018–2020	23 599 (14.9)	19 542 (16.8)	4057 (9.5)
2021–2024	20 886 (13.2)	18 289 (15.8)	2597 (6.1)
Family history of CHD	2401 (1.5)	978 (0.8)	1423 (3.3)	<0.001
Ethnicity				<0.001
White	95 298 (60.1)	70 575 (60.8)	24 723 (58.1)
Black	37 345 (23.5)	25 997 (22.4)	11 348 (26.6)
Asian	11 491 (7.2)	8571 (7.4)	2920 (6.9)
Mixed	7136 (4.5)	5368 (4.6)	1768 (4.2)
Other	7375 (4.6)	5545 (4.8)	1830 (4.3)
Primary care network				<0.001
1	13 699 (8.6)	7422 (6.4)	6277 (14.7)
2	11 164 (7.0)	8211 (7.1)	2953 (6.9)
3	25 378 (16.0)	19 787 (17.0)	5591 (13.1)
4	25 069 (15.8)	18 356 (15.8)	6713 (15.8)
5	12 269 (7.7)	9118 (7.9)	3151 (7.4)
6	22 320 (14.1)	17 303 (14.9)	5017 (11.8)
7	13 297 (8.4)	9960 (8.6)	3337 (7.8)
8	15 751 (9.9)	11 983 (10.3)	3768 (8.8)
9	19 698 (12.4)	13 916 (12.0)	5782 (13.6)
BMI				<0.001
Normal weight	69 505 (43.8)	51 451 (44.3)	18 054 (42.4)
Obese	30 932 (19.5)	22 628 (19.5)	8304 (19.5)
Overweight	55 225 (34.8)	39 663 (34.2)	15 562 (36.5)
Underweight	2983 (1.9)	2314 (2.0)	669 (1.6)
Alcohol, units per week				<0.001
None	48 601 (30.6)	34 972 (30.1)	13 629 (32.0)
>35	3393 (2.1)	2464 (2.1)	929 (2.2)
1–14	93 051 (58.7)	69 066 (59.5)	23 985 (56.3)
15–35	13 600 (8.6)	9554 (8.2)	4046 (9.5)
Index age, years				<0.001
40–54	138 735 (87.4)	101 730 (87.7)	37 005 (86.9)
55–64	15 000 (9.5)	10 375 (8.9)	4625 (10.9)
65–74	4910 (3.1)	3951 (3.4)	959 (2.3)
Cancer	2742 (1.7)	2026 (1.7)	716 (1.7)	0.394
Serious mental illness	3245 (2.0)	2441 (2.1)	804 (1.9)	0.008
Rheumatoid arthritis	617 (0.4)	432 (0.4)	185 (0.4)	0.086
Systemic erythematous lupus	213 (0.1)	155 (0.1)	58 (0.1)	0.961
Liver disease	728 (0.5)	559 (0.5)	169 (0.4)	0.030
Main spoken language not English	37 322 (23.5)	28 068 (24.2)	9254 (21.7)	<0.001

^aData are n (%) unless otherwise specified. BMI = body mass index. CHD = coronary heart disease. IMD = Index of Multiple Deprivation. NHS-HC = NHS Health Check. SD = standard deviation.

Supplementary Data

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