Attending a health check linked to 32% lower mortality in a deprived London borough

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 0.63–0.74)

A longitudinal cohort study in the British Journal of General Practice used primary care records for 158 645 adults eligible for the NHS Health Check in one inner-London borough between 2009 and 2023. Four in ten were from Black, Asian, mixed or other ethnic groups, and nearly two-thirds lived in the most deprived areas of England.

After propensity weighting for sociodemographic, geographic and behavioural factors, attending at least one check was associated with lower all-cause mortality (adjusted HR 0.68, 95% CI 0.63–0.74). The ten-year absolute difference grew with age and was largest at 70–74 years (18.1% against 12.9%).

The association is strong, but people who attend health checks differ from those who do not in ways records do not capture, and the authors acknowledge residual confounding. Randomised evidence for general health checks has been less encouraging. The practical lesson is to make sure the patients least likely to attend are actively invited, since they carry the most risk.

• Actively invite eligible patients who have never attended a cardiovascular risk check.
• Older eligible adults showed the largest absolute difference in mortality.
• Use the check to act on blood pressure, lipids, diabetes risk and smoking, not just to record them.
• Healthy-volunteer bias means the true benefit is likely smaller than the 32% figure.

Why it matters

Structured risk checks may matter most in deprived, diverse populations where risk is highest and attendance lowest.

Don't overread it

This was observational; people who attend checks are healthier in ways that adjustment cannot fully remove.

The statistics, in plain English

An adjusted hazard ratio of 0.68 means a 32% lower rate of death among attenders. Propensity weighting balances measured differences between groups but not unmeasured ones such as health-seeking behaviour.

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