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Evaluation of the NHS Health Checks in England 2013-2017

Status

Completed

Title

Evaluation of the NHS Health Checks in England 2013-2017

What were the objectives of the study?

Adults in England are entitled to a free NHS Health Check to find out whether they are at risk of heart disease, stroke, diabetes, kidney disease, or dementia, and they are offered support to reduce the chance of developing these conditions. Everyone aged 40-74 who is not already being treated for these conditions can have an NHS Health Check every 5 years. It is unclear how many people are having NHS Health Checks, and which people are most likely to attend. The NHS Health Check programme started in 2009 and research found the numbers of people having NHS Health Checks was increasing over time, reaching 30% in 2012. The current study will use data up to 2017 to see whether this trend has continued. We will look at the characteristics of patients who had an NHS Health Check, such as age, sex and ethnicity, to see if any groups are missing out. We will look at whether people with severe mental illness are attending NHS Health Checks. Finally, we will look at people who are at high risk of developing diabetes and work out if interventions to reduce this risk are likely to be effective.

How was the research done?

This study builds on previous work that looked at uptake of NHS Health Checks between 2009 and 2013. The current study will use the QResearch database to work out how many people were eligible for a health check between 2013 and 2017, and how many of these people actually had a NHS Health Check in each year of the study. We will describe the characteristics of people who did and did not attend. We will determine the number of patients who receive different medical diagnoses, treatments, or lifestyle advice as a result of having an NHS Health Check. We will also calculate the likelihood that patients will develop diabetes over time using an existing tool, see how well the tool predicts the development of diabetes, and work out how best it could be applied in clinical practice.

Chief Investigator

Julia Hippisley-Cox

Lead Applicant Organisation Name

Sponsor

University of Oxford

Location of research

University of Oxford

Date on which research approved

01-Mar-2017

Project reference ID

Q103 / OX6

Generic ethics approval reference

18/EM/0400

Are all data accessed are in anonymised form?

Yes

Brief summary of the dataset to be released (including any sensitive data)

The cohort include adults aged 40-74 years between 2009 and 2017. Variables includes diagnoses and medication relevant to the NHS Health Checks from GP data linked to mortality and hospital data

What were the main findings?

In 2013-17, 590,218 eligible people age 40-74 years attended an NHS Health Check (16.9%) and 2,902,598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend and women more than men. New diagnoses were more likely in attendees than non-attendees; hypertension 25/1000 attendees vs 9/1000 in non-attendees; type 2 diabetes 8/1000 vs 3/1000; chronic kidney disease 7/1000 vs 4/1000. In people aged 65 or older, new atrial fibrillation was 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, South Asian and black African/Caribbean ethnic groups. Attendees were more likely to be prescribed statins, 26/1000, than non-attendees 8/1000; and anti-hypertensive medicines, 25/1000 vs 13/1000 non-attendees. However, of the 117,963 people with 10% or greater CVD risk eligible for statins only 9,785 (8.3%) were prescribed them. CONCLUSIONS: NHS Health Checks uptake remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension and CKD and receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, fewer than 10% were treated.

Implications and Impact

The study will:
• Show how many people are attending NHS Health Checks and highlight groups that may be missing out.
• Calculate if there are any differences in the proportion of people with and without severe mental illness attending health checks.
• Help to find the best way to identify those patients most at risk of diabetes so that support and advice can be offered to those who most need it.

Funding Source

Department of Health Policy Research Programme

Public Benefit Statement

Research Team

University of Oxford:

  • Julia Hippisley-Cox.
  • Cesar Carriga

University of Nottingham

  • Carol Coupland.

Queen Mary University of London:

  • John Robson.

Publications

Access Type

Trusted Research Environment (TRE)

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