Survival analysis of NHS health check programme: 15 years of follow up in an urban UK setting

Abstract Background The NHS Health Check programme was introduced in the UK in 2009 to prevent cardiovascular disease and related conditions. Despite its widespread implementation, concerns persist regarding its long-term clinical effectiveness, with existing studies often relying on surrogate outcomes, short follow-up periods, or non-representative populations. This study aims to determine whether participation in the NHS Health Check programme is associated with a long-term survival benefit. Methods This retrospective cohort study, adhering to STROBE guidelines, used anonymised primary care electronic health records from Lambeth (2009 to 2023). We identified 157,917 individuals eligible for an NHS Health Check, of whom 42,420 attended at least one Health Check and 115,497 did not. Follow-up began at eligibility and ended at death, study close, or administrative censoring. We employed a time-varying Cox proportional hazards model with propensity score weighting to adjust for confounding factors, including sociodemographic variables, behavioural risk factors, and family history. Results Among this ethnically diverse cohort (over 40% non-white), attending at least one NHS Health Check was associated with a significantly lower risk of all-cause mortality (adjusted hazard ratio [AHR] 0.68, 95% CI: 0.60 to 0.73). The absolute risk of death at 10 years was stratified by age, with the most notable reduction observed in individuals over 65 years, where risk decreased from 14.1% to 9.6%. Sensitivity analyses confirmed the robustness of these findings. Conclusions This is the first large-scale study to demonstrate a significant long-term survival benefit of the NHS Health Check programme using real-world, representative data. These findings support the continued investment in and optimisation of the programme to provide population health benefits. Further research should explore differential benefits across population subgroups to inform more equitable delivery. Key messages • NHS Health Checks are associated with a one third reduction in risk of death in diverse London population. • The biggest absolute risk reductions from NHS Health Checks were seen in people aged 65 years and over, highlighting their value in older age groups.