A first health check-up at 75–84 was associated with less disability or death, but the result was uncertain

Design

Sequential target trial emulation in a population cohort

Population

3,096 community-dwelling adults aged 75–84 without disability in rural Japan

Primary outcome

5-year functional disability (care level ≥3) or death

Effect

20.6% vs 26.7%; RD −6.1 points (−11.6 to 0.9); RR 0.77 (0.57–1.03)

This target trial emulation used a population cohort in a rural Japanese city to compare adults aged 75–84 without disability who attended a first Elderly Health Check-up with those who did not, over 5 years. It included 3,096 people contributing 21,484 person-trials.

The 5-year risk of significant functional disability or death was 20.6% with attendance and 26.7% without (risk difference −6.1 percentage points, 95% CI −11.6 to 0.9; RR 0.77, 0.57–1.03). For death alone the difference was −3.7 points and for disability alone −5.4 points, with intervals crossing no effect.

The authors say plainly that this neither supports expanding nor stopping the programme. Emulation reduces but cannot remove the healthy-attender effect — people who choose to attend check-ups differ from those who do not.

• Do not assume routine check-ups prevent disability in the very old on current evidence
• Focus check-ups on actionable geriatric issues: falls, medications, vision, hearing, continence, nutrition, cognition
• Reach out to older adults who do not attend, as they may be at higher risk

Why it matters

Programmes for older adults are expanding, and this is a careful test of whether a routine check-up changes outcomes.

Don't overread it

Observational and inconclusive — the interval includes no benefit, and healthy-attender bias is likely.

The statistics, in plain English

The risk ratio of 0.77 suggests about a quarter lower risk, but the interval (0.57 to 1.03) includes no effect. Target trial emulation structures observational data like a trial, but cannot randomise, so people who choose check-ups may be healthier in ways not measured.

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