Don’t rely on a general check-up package to prevent disease; do the few evidence-based screens for your age and sex

People who regularly take general health checks have the same death rate as those who do not, including deaths from cardiovascular disease and cancer. The few evidence-based screens for your age and sex are enough. From age 35 you can have blood pressure measured free once a year; from age 65 there is one free check-up a year.

Cost

No money, and you save a few hundred to a few thousand yuan a year in package fees. What you owe in return is remembering which items to check and how often.

Benefit

The 2019 update of a Cochrane systematic review included 17 randomized controlled trials. For overall mortality it pooled 11 of them, 233298 participants, and 21535 deaths. The general-check group matched the control group: RR 1.00. RR is a risk ratio; 1 means the two sides match. 95% CI 0.97–1.03 is the credible range. For cardiovascular death it pooled 9 trials, 170227 people, and 6237 deaths: RR 1.05 (95% CI 0.94–1.16). For cancer death it pooled 8 trials, 139290 people, and 3663 deaths: RR 1.01 (95% CI 0.92–1.12). Neither showed a difference. The authors conclude that “general health checks are unlikely to be beneficial.” The national basic public-health service measures blood pressure free once a year for permanent residents aged 35 and above. It also gives people aged 65 and above one free health check a year. That free check covers physical exam, blood count, urine routine, fasting glucose, and ECG. Liver function: AST, ALT, total bilirubin. Kidney function: serum creatinine, blood urea. Lipids: total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol. Plus abdominal ultrasound of liver, gallbladder, pancreas, and spleen (nationwide).

Notes

What to reject is “using the yearly package as disease prevention,” not skipping every test. Also, free yearly blood pressure from 35 and the free yearly check from 65 are already in the national basic public-health program — you need not pay. Tests that have a reason should still be done. Blood pressure, glucose, hepatitis B: Section 1, Items 7, 8, 14. Breast, cervix, colorectal: Section 1, Items 17, 18, 19. Helicobacter pylori and low-dose CT: Section 1, Items 23, 24. Bone density for women 65 and above: Section 1, Item 39 (bone-density testing). High-risk behavior: go get checked — Section 1, Item 31. From what age and how often is written there. Employer-organized checks others pay for: go; what to stop is buying packages yourself and adding items yourself. People with chronic disease, people with symptoms, or tests a doctor ordered for the illness do not count here — that is care, not screening. The most common package items without evidence are tumour markers and whole-body imaging — see Item 7 in this section (whole-body PET-CT and tumour-marker panels). What to do when uric acid is high but never hurt, or gallstones never hurt: Items 19 and 20 in this section. Also, most trials Cochrane included were run in high-income countries where care is already easy to get; places short on medical resources should not copy the conclusion blindly.

Sources · 2

1. Krogsbøll LT, Jørgensen KJ, Gøtzsche PC (2019). General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database of Systematic Reviews, 1, CD009009. doi.org/10.1002/14651858.CD009009.pub3
2. 国家卫生计生委 (2017). 国家基本公共卫生服务规范（第三版）（老年人健康管理服务、高血压患者健康管理服务）. nhc.gov.cn/ewebeditor/uploadfile/2017/04/2017…