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General health checks

This fact box will help you to weigh the benefits and harms of general health checks. The information and numbers are based on the best scientific evidence currently available.

This fact box was developed by the Harding Center for Risk Literacy.

What are general health checks?

General health checks are evaluations of an apparently healthyperson’s overall health status. The purpose of general health checks is to detect diseases and risk factors for diseases early in order to reduce the incidence of disease and death in the overall population. General health checks are for people who do not feel ill and who do not show symptoms of a disease [1]. 

In Germany, general health checks focus on the early detection of cardiovascular and kidney diseases as well as diabetes. These early detection tests include:

  • patient–doctor consultation to determine the patient’s medical history and current state of health (anamnesis),
  • a physical examination (e.g. listening to heart and lung sounds with a stethoscope),
  • testing of blood and urine samples,
  • and counseling [2].

Who might consider general health checks?

General health checks are offered once every three years to men and women aged 35 years and older as part of statutory health insurance coverage [2].

Fact box_general health checks_EN

What does the fact box show?

The fact box shows the benefits and harms of either participating or not participating in general health checks.

The table may be read as follows:

About 32 out of every 1,000 patients died of cardiovascular disease, irrespective of whether they participated in general checks over a time period of 4 to 22 years.

The numbers in this fact box are rounded. They are calculated from 15 studies that included a total of about 250,000 participants [1].

What other aspects should be considered?

During general health checks only small increasing blood pressure and cholesterol level will be measured, which might not have serious consequences and require a following therapy. This corresponds to an overdiagnosis and could lead to unnecessary follow-up treatments [3]. 

High blood pressure

Permanently elevated blood pressure puts strain on the vessels and increases the risk of secondary diseases (e.g. heart attack, kidney dysfunction and stroke), and premature death [4]. 

High cholesterol (LDL cholesterol)

An increased LDL cholesterol level (low-density lipoprotein) in the blood is considered a risk factor for cardiovascular disease, given that increased LDL levels can promote narrowing of the blood vessels (arteriosclerosis) [4]. 

One potential explanation for why general health checks do not show any effect could be that (primary care) physicians detect and treat risk factors and diseases they find in their patients during other visits [1].

Do the results provide proof (evidence) for the benefits and harms of general health checks?

Overall, the evidence is of moderate to high quality: Further research is likely to affect the findings on cardiovascular mortality (moderate quality of evidence), while the findings on cancer mortality and overall mortality are very unlikely to change over the course of further research (high quality of evidence).

Most of the included trials are quite old (from the 1960s to 1980s), and the results may be less applicable to today’s settings because new treatments have since become available (e.g. medication for cardiovascular diseases) and risk factors have changed [1].

Version history of the fact box

July 2019 (update of the literature research, no new evidence; update of the accompanying text)

November 2017 (update of the evidence)

July 2015 (development)

Sources

Information within the fact box was obtained from the following sources:

[1] Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, et al. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2019(10):CD009009.

[2] Bundesministerium für Gesundheit. Gesundheits-Check-up. 2018 [Available from: https://www.bundesgesundheitsministerium.de/checkup.html] 25.06.2019.

[3] Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy BMJ 2012; 344 :e3502.

[4] Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG).Bluthochdruck [Available from: https://www.gesundheitsinformation.de/bluthochdruck.2083.de.html] vom 24.05.2019.

Fact boxes

The idea of fact boxes was developed by Lisa Schwartz and Steven Woloshin. In several studies they demonstrated that fact boxes were effective tools for informing the general public about benefits and harms of medical interventions. Read more in the overview.

 

Terms of use: All fact boxes of the Harding Center for Risk Literacy and accompanying materials are licensed under a Creative Commons BY-NC-ND 4.0 license (attribution - non-commercial - no derivatives - 4.0 international).

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