- Design
- Longitudinal cohort with propensity score weighting
- Population
- 158,645 eligible adults in an inner-London borough, 2009–2023
- Primary outcome
- All-cause mortality
- Effect
- Adjusted HR 0.68 (95% CI 0.63 to 0.74) for ≥1 check vs none
This cohort used primary care records for 158,645 eligible adults in an inner-London borough between 2009 and 2023; 40% were from Black, Asian, mixed or other ethnic groups and 64% lived in the two most deprived quintiles. It compared 42,589 who attended at least one NHS Health Check with 116,056 who did not, using propensity weighting. It was published in the British Journal of General Practice in August.
Attendance was associated with lower all-cause mortality (adjusted HR 0.68, 95% CI 0.63 to 0.74). Ten-year absolute mortality differences were largest at ages 70 to 74 (18.1% versus 12.9%). Sensitivity analyses supported the finding.
This is encouraging for structured cardiovascular risk checks in a diverse, deprived population. But the people who accept an invitation are likely healthier and more engaged than those who do not, and a 32% lower death rate from a single check is larger than the risk factors it addresses could plausibly explain on their own.
- Invite eligible patients actively; attendance is lowest in those at highest risk.
- Make sure a check leads to action: statin offer, blood pressure treatment, smoking support.
- Record ethnicity, since South Asian patients need risk scores that account for it.
- Follow up abnormal results rather than filing them.
Why it matters
It is some of the first mortality evidence for a population health check in a deprived, multi-ethnic setting.
Don't overread it
This was observational; healthier people are more likely to attend, which can explain much of the gap.
The statistics, in plain English
An HR of 0.68 means attenders died at about two-thirds the rate of non-attenders. Propensity weighting balances the recorded differences between groups but not unrecorded ones such as health literacy or motivation, which also affect survival. The authors acknowledge residual confounding cannot be ruled out.
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