NHS Health Checks are associated with improved survival in an ethnically diverse cohort.

Background Cardiovascular disease (CVD) prevention is a policy priority due to widening inequalities and increasing preventable deaths. The NHS Health Checks (NHS-HC) programme aims to promote early detection and prevention of CVD but has wider reaching impacts due to targeting multiple risk factors. While programme evaluations demonstrate improvements in detection and surrogate markers, mortality outcomes remain limited, particularly in representative, real-world data. Aim To evaluate effectiveness of NHS-HC in reducing all-cause mortality. Design And Setting Longitudinal cohort study in an inner-city London borough. Method Data from electronic primary care records were analysed for 158,645 eligible participants (2009-2023). Survival was modelled using a Cox proportional hazards model with time-varying exposure. All-cause mortality risk was compared between those attending at least one NHS-HC (n=42,589) and those who did not (n=116,056). Sociodemographic, geographic, and behavioural factors were adjusted using propensity score weighting. Results 63,347 participants (39.9%) were non-white and 100,825 (63.5%) lived in the two most deprived quintiles in England. Attendance at ≥1 NHS Health Check was associated with lower mortality (adjusted HR 0.68, 95% CI 0.63-0.74), indicating a 32% reduction in risk. Ten-year absolute mortality risk reduction increased with age, with the largest difference among those >70 years (18.1% vs 12.9%). Sensitivity analyses supported these findings. Conclusion This study suggests significant long-term survival benefit associated with the NHS-HC, supporting continued investment in and optimisation of the programme to provide population health benefits. Findings were robust to missing data assumptions and COVID-19, though residual confounding cannot be ruled out.