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Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis
  1. Kiara C-M Chang1,2,
  2. Eszter P Vamos1,2,
  3. Raffaele Palladino1,2,
  4. Azeem Majeed2,
  5. John Tayu Lee1,2,3,
  6. Christopher Millett1,2
  1. 1 Public Health Policy Evaluation Unit, Imperial College London, London, UK
  2. 2 Department of Primary Care and Public Health, Imperial College London, London, UK
  3. 3 Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Kiara C-M Chang, Public Health Policy Evaluation Unit, Imperial College London, London W6 8RP, UK; chu-mei.chang{at}


Background We assessed impacts of a large, nationwide cardiovascular disease (CVD) risk assessment and management programme on sociodemographic group inequalities in (1) early identification of hypertension, type 2 diabetes (T2D) and chronic kidney disease (CKD); and (2) management of global CVD risk among high-risk individuals.

Methods We obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138 788 patients aged 40–74 years without known CVD or diabetes, who were registered with 462 practices between 2009 and 2013. We estimated programme impact using a difference-in-differences matching analysis that compared changes in outcome over time between attendees and non-attendees.

Results National Health Service Health Check attendance was 21.4% (29 672/138 788). A significantly greater number of hypertension and T2D incident cases were identified in men than women (eg, an additional 4.02%, 95% CI 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% cases of hypertension in men and women, respectively). A significantly greater number of T2D incident cases were identified among attendees living in the most deprived areas, but no differences were found for hypertension and CKD across socioeconomic groups. No major differences in CVD risk management were observed between sociodemographic subgroups (eg, programme impact on 10-year CVD risk score was −1.13%, −1.48% to −0.78% in male and −1.53%, −2.36% to −0.71% in female attendees).

Conclusion During 2009–2013, the programme had low attendance and small overall impacts on early identification of disease and risk management. The age, sex and socioeconomic subgroups appeared to have derived similar level of benefits, leaving existing inequalities unchanged. These findings highlight the importance of population-wide interventions to address inequalities in CVD outcomes.

  • health inequalities
  • health services
  • prevention
  • screening
  • cardiovascular disease

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  • Contributors CM and AM set up the study concept. KC, EPV and CM designed the study. KC analysed the data. EPV, RP and JTL advised and reviewed statistical analysis. All authors discussed data analyses and interpreted the results. KC, EPV, CM and AM wrote the first draft of the manuscript. All authors critically revised and approved the final manuscript. KC has full access to all the data used in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KC is the guarantor.

  • Funding This study is an independent research commissioned and funded by the NIHR Policy Research Programme (National Evaluation of the NHS Health Check Program 009/0051). KC and CM are funded through an NIHR Research Professorship awarded to CM.

  • Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health, ‘arms’ length bodies or other government departments.

  • Competing interests AM is a GP Principal in a general practice that takes part in the NHS Health Check programme.

  • Patient consent Not required.

  • Ethics approval CPRD Independent Scientific Advisory Committee (protocol no. 12_039).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available. Patient-level data were obtained under license and remain the property of the Clinical Practice Research Datalink.