Effectiveness of workers’ general health examination in Korea by health examination period and compliance: retrospective cohort study using nationwide data

ObjectivesThis study aimed to investigate the relationship between cardiovascular mortality in elderly Asians and decline in renal function.DesignA retrospective cohort study.SettingCommunity-based health examination database from Taipei city.ParticipantsAt the beginning, the database included 315 045 health check-up visits of 97 803 elderly persons aged ≥65 years old from 2005 to 2012. After excluding missing values and outliers, there were 64 732 elderly persons with at least two visits retained for further analyses.Primary outcome measuresKidney function indicators include estimated glomerular filtration rate (eGFR) and urine protein, and rapid decline in eGFR was defined as slope ≤ −5 mL/min/1.73 m2 per year. The endpoint outcome was defined as the cardiovascular deaths registered in the death registry encoded by the International Classification of Diseases. We applied a Cox proportional hazards model to analyse the association between renal function and cardiovascular mortality.ResultsIn this study, we found 1264 elderly persons died from cardiovascular diseases, for whom the data included 4055 previous health check-up visits. We observed significant and independent associations of eGFR <60 mL/min/1.73 m2 (HR (95% CI) of 60>eGFR≥45 and eGFR<45 in males: 2.85 (1.33 to 6.09) and 3.98 (1.84 to 8.61); in females: 3.66 (1.32 to 10.15) and 6.77 (2.41 to 18.99)), positive proteinuria (HR (95% CI) of +/−, +,++ and +++, ++++ in males: 1.51 (1.29 to 1.78) and 2.31 (1.51 to 3.53); in females: 1.93 (1.54 to 2.42) and 4.23 (2.34 to 7.65)) and rapid decline in eGFR (HR (95% CI) in males: 3.24 (2.73 to 3.85); in females: 2.83 (2.20 to 3.64) with higher risk of cardiovascular mortality. The joint effect of increased concentration of urine protein and reduced eGFR was associated with a higher risk of cardiovascular mortality.ConclusionsRenal function and rapid decline in renal function are independent risk factors for cardiovascular mortality in the elderly.

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Personal status of general health checkups and medical expenditure: A large-scale community-based retrospective cohort study

Journal of Epidemiology ◽

10.1016/j.je.2016.06.001 ◽

2017 ◽

Vol 27 (5) ◽

pp. 209-214 ◽

Cited By ~ 2

Author(s):

Yasuo Haruyama ◽

Takako Yamazaki ◽

Motoki Endo ◽

Rika Kato ◽

Masanori Nagao ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

General Health ◽

Retrospective Cohort ◽

Large Scale ◽

Medical Expenditure ◽

Community Based ◽

Personal Status

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Incremental yield of ECG screening repeated annually over 4 years in an adult Japanese population without prior atrial fibrillation: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2019-035650 ◽

2020 ◽

Vol 10 (7) ◽

pp. e035650

Author(s):

Yoshiki Nagata ◽

Takashi Yamagami ◽

Don Nutbeam ◽

Ben Freedman ◽

Nicole Lowres

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cohort Study ◽

Health Service ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stroke Risk ◽

Current Data ◽

Health Examination ◽

Annual Screening

ObjectivesInternational guidelines recommend opportunistic screening for atrial fibrillation (AF); however, there is no current data to inform how often to repeat screening. We aimed to investigate the incremental annual yield and stroke risk of new AF cases in individuals screened annually over 4 years.DesignA retrospective cohort study.SettingHokuriku Health Service Association, Toyama prefecture, Japan.ParticipantsEmployees and their families receiving annual health examinations from Hokuriku Health Service Association.InterventionEach subject received an annual health examination (including 12-lead ECG) from 2014 to 2017. Only subjects with baseline ECGs in 2012 and/or 2013 were included.Main outcome measuresRates (cases/100 person-years) of new AF identified each year for 4 consecutive years of screening (stratified according to gender and age groups). Calculated stroke risk of new AF cases using modified CHA2DS2-VASc scores (without heart failure data) (CHA2DS2VASc = C: congestive heart failure [1 point]; H: hypertension [1 point]; A2: age 65-74 years [1 point] or age ≥75 years [2 points]; D: diabetes mellitus [1 point]; S: prior stroke or transient ischemic attack [2 points]; VA: vascular disease [1 point]; and Sc: sex category [female] [1 point])ResultsIn 2014, 88 218 subjects had an ECG (46.8±12.5 years; 64% men): identifying 346 (0.39%) known AF and 69 (0.08%) new AF. The incidence rate of new AF increased with age from 0.01% (<50 years) to 0.98% (≥75 years) and was higher in men (0.1%) than women (0.05%). Repeated annual screening over 4 years identified a consistent new AF yield 0.06%–0.10% per year (0.33%–0.55% ≥65 years). Forty-two per cent of all new AF cases, and 76% of cases aged ≥65 years, had a class-1 oral anticoagulation (OAC) recommendation (modified CHA2DS2-VASc score ≥2 men, ≥3 women).ConclusionsRepeated annual ECG screening of the same population provides a consistent yield of new AF each year. The majority of new AF (≥65 years) are eligible for anticoagulation for stroke prevention. Although AF prevalence and incidence are lower in Japan than Western countries, 2318 new cases would be identified in Toyama prefecture each year with annual screening, of whom ~927 would have a high stroke risk with a recommendation for OAC therapy.

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