Addressing Health Inequalities Through the NHS Health Check Programme in England

Abstract

Objectives: To explore equity in the invitation to and uptake of the NHS Health Check (NHSHC), and variation in cardiovascular disease (CVD) risk factor profiles and referrals to interventions across sociodemographic groups in England.

Design: A cross-sectional observational study

Setting: National primary care data extracted by NHS Digital from 90% of General Practices (GP) in England. Participants: 9,164,975 individuals aged 40-74 years invited to an NHSHC (2012-2017), defined using primary care Read codes.
Intervention: The NHSHC, a national risk assessment, awareness and management intervention which focusses on behavioural and metabolic risk factors for non-communicable disease and 10-year (CVD) risk.

Results: The NHSHC was offered to 58.5% of the eligible population, with older people and women more likely to accept the invitation. There was marked geographical variation in offers (9.2%-95.8%) with greater uptake by the White ethnic group living in least deprived areas, but also among Asian and Black ethnic groups living in more deprived areas. Uptake was lowest among those in the most deprived areas for all ethnicities but especially for White. Of those attending an NHSHC, CVD risk factors differed by ethnic group, with diabetes and obesity more prevalent among Asian, raised blood pressure in Black and alcohol use in White ethnic groups. Deprivation showed a clear positive association for smoking, obesity and alcohol dependence. Proportionally more interventions were offered to those from deprived areas and Asian and Black ethnic groups, even after adjusting for baseline risk, indicating active efforts to target inequalities.

Conclusion: The NHSHC offers important opportunities to address health inequality through proportionate universalism and targeting the needs of specific groups. The program is achieving this goal, but needs to be offered more equitably and widely across the country with greater efforts to engage those who remain ‘hard to reach’ to support the levelling up agenda

Note: Ethics: A Direction from the Secretary of State for Health and Social Care instructed NHS Digital with the legal requirement to carry out the NHSHC data extract. This study was subject to an internal review by the Research Support and Governance Office in PHE to ensure that it was fully compliant with the UK Policy Framework for Health and Social Care Research (2017) and with all other current regulatory requirements. Funding: RSP (FS/14/76/30933) and JD (BHF chair) were funded by the BHF. Data extraction and analysis were funded by PHE. JR is funded by Barts Charity and Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. Competing interests: All authors declare: no support from any organisation for the submitted work; RSP has received speaker fees and honoraria from Amgen, Sanofi and Bayer and research grant funding from Regeneron for CVD prevention and cholesterol management; no other relationships or activities that could appear to have influenced the submitted work. JD is Senior Advisor to Public Health England on cardiovascular disease prevention and has Chaired a review of the NHS Health Check programme for PHE. MK received honoraria from Bayer, AZ, and Novartis. JR is funded in part by Barts Charity, Health Data Research UK and NHS Clinical Commissioning Groups. MN receives honorarium from Bayer and Daiichi Sankyo and is a Director/Partner at Smart Health Solutions.

Keywords: Cardiovascular Disease Prevention, NHS Health Checks, Cardiovascular Risk, Public Health, Health Inequalities, Equity, Variation