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Health checks in the general population: No influence on morbidity or mortality on a population level!

Editorial by Torben Jørgensen, EACPR Prevention, Epidemiology and Population Science Section

Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial
Jørgensen T, Jacobsen RK, Toft U, Aadahl M, Glümer C, Pisinger C
BMJ 2014;348:g3617, published 09 June 2014


The aim of this study was to investigate the effect of a systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling during five years on the 10 year development of ischaemic heart disease at a population level.

Screening and lifestyle counselling has been done for decades with disappointing results. Former studies have been criticised for not analysing the effect on a population level, not avoiding a spill over effect to the control group, not using absolute risk measures and not using modern behaviouristic methods in life counselling.

In 1999 the Inter99 study was initiated taking into account this criticism. A random sample of 11,629 was compared with the control group of 47,987. The persons were 30-60 years old and all persons in the intervention group were invited for health screening and lifestyle counselling. All had individualised lifestyle counselling and those at high risk for developing ischaemic heart disease were furthermore offered group based counselling over a six months period. This was repeated after 1 and 3 years and after 5 years all participants were assessed and a plan for maintenance was made. The persons in the control group were not invited and were not aware of the intervention going on. All 59,616 persons were followed in central registries over 10 years.

In spite of an effect on changes in lifestyle factors after five years in the intervention group compared to a random sample of the control group (questionnaire survey), there was no effect as regards ten year incidence of ischaemic heart disease hazard ratio (HR) 1.03 (0.94-1.13), stroke, combined events or total mortality.

The study confirms that health checks in the general population do not influence morbidity or mortality on a population level. The reasons are several, but two main reasons should be observed:

1) Those who either do not attend or are non-compliant to the intervention are mostly recruited from the lower social classes, and they are the one who are in most need for intervention.
2) It seems that those who do change lifestyle cannot stick to the changes obtained in the ten year period.

The study confirms that health checks in the general population are a waste of time and money. This is an important message to countries who have already initiated or plan to introduce health check in the general population. It is important with more detailed analyses to explain why this does not work.

In the meantime the right way forward to prevent cardiovascular diseases on a population level are structural changes in society.

Read also:
Population-level changes to promote cardiovascular health
T. Jørgensen et al.
on behalf of the EACPR Prevention, Epidemiology & Population Science Section
European Journal of Preventive Cardiology, 18 April 2012
DOI: 10.1177/2047487312441726