{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:22:28Z","timestamp":1791559348836,"version":"4.3.4"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Type 2 diabetes and hypertension are obesity-related, noncommunicable diseases becoming increasingly common worldwide. In 2008, Japan launched a nationwide universal health checkup program, Specific Health Checkup (SHC), for the primary prevention of obesity-related diseases, but its effectiveness has been understudied.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate the association of the SHC program with incident diabetes and hypertension, using a target trial emulation framework.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study used data from a longitudinal health care database involving both checkup history and medical encounter records in Japan. Individuals aged 40 to 74 years, without diabetes or hypertension, and without a prior checkup history, were eligible. Individuals were repeatedly assessed for eligibility from April 1, 2008, to March 31, 2020, to assemble sequential cohorts of 78\u202f620 SHC participants and 214\u202f554 nonparticipants. Statistical analysis was conducted from June 8 to December 30, 2023.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The composite risk of incident type 2 diabetes or hypertension over a period of up to 10 years, defined as the combination of a newly documented diagnosis and use of relevant medications. A propensity score\u2013weighted survival analysis was conducted to adjust for baseline variables. A series of sensitivity analyses and a negative outcome control analysis were conducted using depression as a benchmark.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Sequential cohorts consisted of 78\u202f620 SHC participants (median age, 46 years [IQR, 41-53 years]; 62.7% women) and 214\u202f554 nonparticipants (median age, 49 years [IQR, 44-55 years]; 82.0% women) from 153\u202f084 unique persons, each of whom entered the study cohort a mean (SD) of 1.9 (1.5) times. Within a median follow-up of 4.2 years (IQR, 2.7-6.3 years), the primary end point occurred among 11.2% of all individuals (10.6% of the SHC participants and 11.4% of the nonparticipants), with a lower hazard ratio (HR) among the SHC recipients (HR, 0.90; 95% CI, 0.89-0.92); the difference in cumulative incidence at 10 years was \u22121.6% (95% CI, \u22121.8% to \u22121.3%). The sensitivity analyses showed similar results. The negative control analysis suggested the potential for residual confounding (HR, 1.05; 95% CI, 1.02-1.07); the bias-calibrated HR was 0.86 (95% CI, 0.84-0.89) for the primary outcome.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, within a median of 4.2 years of follow-up, SHC recipients had a 9.8% lower risk of incident diabetes and hypertension (13.8% in the bias-calibrated analysis). The cost-effectiveness of the SHC and its transportability to other regions are unclear, requiring future investigations.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.51813","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T11:31:15Z","timestamp":1734694275000},"page":"e2451813","source":"Crossref","is-referenced-by-count":13,"title":["Universal Health Checkups and Risk of Incident Diabetes and Hypertension"],"prefix":"10.1001","volume":"7","author":[{"given":"Masato","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Department of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan"},{"name":"Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Shinozaki","sequence":"additional","affiliation":[{"name":"Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Katushika-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Kawakami","sequence":"additional","affiliation":[{"name":"Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"issue":"10","key":"zoi241442r1","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1016\/S2468-2667(18)30139-7","article-title":"Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study.","volume":"3","author":"Nyberg","year":"2018","journal-title":"Lancet Public Health"},{"issue":"4","key":"zoi241442r2","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S2213-8587(22)00033-X","article-title":"Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study.","volume":"10","author":"Kivim\u00e4ki","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"1","key":"zoi241442r3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12961-022-00899-y","article-title":"Improving WHO\u2019s understanding of WHO guideline uptake and use in member states: a scoping review.","volume":"20","author":"Saluja","year":"2022","journal-title":"Health Res Policy Syst"},{"issue":"5","key":"zoi241442r4","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.3390\/jcm12051876","article-title":"Type 2 diabetes prevention programs-from proof-of-concept trials to national intervention and beyond.","volume":"12","author":"Tuomilehto","year":"2023","journal-title":"J Clin Med"},{"key":"zoi241442r7","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.puhe.2021.01.022","article-title":"Income-based inequality in nationwide general health checkup participation in Japan.","volume":"195","author":"Shimoda","year":"2021","journal-title":"Public Health"},{"issue":"24","key":"zoi241442r8","doi-asserted-by":"publisher","first-page":"2446","DOI":"10.1001\/jama.2022.21383","article-title":"Target trial emulation: a framework for causal inference from observational data.","volume":"328","author":"Hern\u00e1n","year":"2022","journal-title":"JAMA"},{"issue":"16","key":"zoi241442r9","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1001\/jama.2023.4221","article-title":"Emulation of randomized clinical trials with nonrandomized database analyses: results of 32 clinical trials.","volume":"329","author":"Wang","year":"2023","journal-title":"JAMA"},{"issue":"7","key":"zoi241442r10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-070417","article-title":"Effectiveness of specific health check-ups in Japan for the primary prevention of obesity-related diseases: a protocol for a target trial emulation.","volume":"13","author":"Takeuchi","year":"2023","journal-title":"BMJ Open"},{"issue":"2","key":"zoi241442r11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.2188\/jea.JE20180192","article-title":"Utility of a specific health checkup database containing lifestyle behaviors and lifestyle diseases for employee health insurance in Japan.","volume":"30","author":"Fukasawa","year":"2020","journal-title":"J Epidemiol"},{"issue":"1","key":"zoi241442r12","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5680","article-title":"Inventory of real-world data sources in Japan: annual survey conducted by the Japanese Society for Pharmacoepidemiology Task Force.","volume":"33","author":"Kumamaru","year":"2024","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"8","key":"zoi241442r13","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1093\/aje\/kwv254","article-title":"Using big data to emulate a target trial when a randomized trial is not available.","volume":"183","author":"Hern\u00e1n","year":"2016","journal-title":"Am J Epidemiol"},{"issue":"3","key":"zoi241442r14","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1002\/pst.2086","article-title":"Adjusting win statistics for dependent censoring.","volume":"20","author":"Dong","year":"2021","journal-title":"Pharm Stat"},{"issue":"3","key":"zoi241442r15","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/EDE.0b013e3181d61eeb","article-title":"Negative controls: a tool for detecting confounding and bias in observational studies.","volume":"21","author":"Lipsitch","year":"2010","journal-title":"Epidemiology"},{"issue":"6","key":"zoi241442r16","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1002\/pds.5623","article-title":"Pragmatic considerations for negative control outcome studies to guide non-randomized comparative analyses: a narrative review.","volume":"32","author":"Levintow","year":"2023","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"20","key":"zoi241442r17","doi-asserted-by":"publisher","first-page":"2000","DOI":"10.1001\/jama.2023.19897","article-title":"Obesity management in adults: a review.","volume":"330","author":"Elmaleh-Sachs","year":"2023","journal-title":"JAMA"},{"issue":"24","key":"zoi241442r18","doi-asserted-by":"publisher","first-page":"2216","DOI":"10.1093\/eurheartj\/ehad273","article-title":"Sodium-glucose cotransporter 2 inhibitors vs sitagliptin in heart failure and type 2 diabetes: an observational cohort study.","volume":"44","author":"Fu","year":"2023","journal-title":"Eur Heart J"},{"issue":"4","key":"zoi241442r19","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value.","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"issue":"7497","key":"zoi241442r20","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1136\/bmj.330.7497.960","article-title":"Reader\u2019s guide to critical appraisal of cohort studies, 2: assessing potential for confounding.","volume":"330","author":"Mamdani","year":"2005","journal-title":"BMJ"},{"issue":"7","key":"zoi241442r21","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1136\/jech.2004.029496","article-title":"Estimating causal effects from epidemiological data.","volume":"60","author":"Hern\u00e1n","year":"2006","journal-title":"J Epidemiol Community Health"},{"issue":"4","key":"zoi241442r22","doi-asserted-by":"publisher","first-page":"537","DOI":"10.2486\/indhealth.2018-0112","article-title":"Associations of occupation, employment type and company size with actions related to health examinations among Japanese employees.","volume":"57","author":"Seko","year":"2019","journal-title":"Ind Health"},{"key":"zoi241442r23","doi-asserted-by":"publisher","first-page":"i1981","DOI":"10.1136\/bmj.i1981","article-title":"Sparse data bias: a problem hiding in plain sight.","volume":"352","author":"Greenland","year":"2016","journal-title":"BMJ"},{"issue":"2","key":"zoi241442r24","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/j.1524-4733.2009.00671.x","article-title":"Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals.","volume":"13","author":"Xu","year":"2010","journal-title":"Value Health"},{"issue":"12","key":"zoi241442r25","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1002\/sim.4780091214","article-title":"Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study.","volume":"9","author":"D\u2019Agostino","year":"1990","journal-title":"Stat Med"},{"issue":"8","key":"zoi241442r28","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1681\/ASN.0000000000000152","article-title":"Target trial emulation to improve causal inference from observational data: what, why, and how?","volume":"34","author":"Fu","year":"2023","journal-title":"J Am Soc Nephrol"},{"key":"zoi241442r29","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jclinepi.2023.10.008","article-title":"The target trial framework in clinical epidemiology: principles and applications.","volume":"164","author":"Matthews","year":"2023","journal-title":"J Clin Epidemiol"},{"key":"zoi241442r30","doi-asserted-by":"publisher","first-page":"g3617","DOI":"10.1136\/bmj.g3617","article-title":"Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial.","volume":"348","author":"J\u00f8rgensen","year":"2014","journal-title":"BMJ"},{"issue":"1","key":"zoi241442r31","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009009.pub3","article-title":"General health checks in adults for reducing morbidity and mortality from disease.","volume":"1","author":"Krogsb\u00f8ll","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"zoi241442r32","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1007\/s13679-020-00398-7","article-title":"Socioeconomics of obesity.","volume":"9","author":"Anekwe","year":"2020","journal-title":"Curr Obes Rep"},{"issue":"10431","key":"zoi241442r34","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/S0140-6736(23)02750-2","article-title":"Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults.","volume":"403","author":"NCD Risk Factor Collaboration (NCD-RisC)","year":"2024","journal-title":"Lancet"},{"issue":"4","key":"zoi241442r35","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1093\/aje\/kws412","article-title":"The table 2 fallacy: presenting and interpreting confounder and modifier coefficients.","volume":"177","author":"Westreich","year":"2013","journal-title":"Am J Epidemiol"},{"issue":"12","key":"zoi241442r36","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.1001\/jamainternmed.2020.4334","article-title":"Association of the national health guidance intervention for obesity and cardiovascular risks with health outcomes among Japanese men.","volume":"180","author":"Fukuma","year":"2020","journal-title":"JAMA Intern Med"},{"key":"zoi241442r6","volume-title":"OECD Reviews of Public Health: Japan","author":"Organisation For Economic Co-Operation And Development","year":"2019"},{"key":"zoi241442r5","unstructured":"Ministry of Health, Labour and Welfare, Japan. Specific health checkups and specific health guidance. Accessed January 25, 2024. https:\/\/www.mhlw.go.jp\/english\/wp\/wp-hw3\/dl\/2-007.pdf"},{"key":"zoi241442r26","doi-asserted-by":"crossref","unstructured":"Denz? R. adjustedCurves: confounder-adjusted survival curves and cumulative incidence functions. R package version 0.10.1; 2023. Accessed January 25, 2024 https:\/\/cran.r-project.org\/package=adjustedCurves.","DOI":"10.32614\/CRAN.package.adjustedCurves"},{"key":"zoi241442r27","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. 2015. Accessed January 25, 2024. https:\/\/cran.r-project.org\/"},{"key":"zoi241442r33","unstructured":"Ministry of Health, Labour and Welfare, Japan. Regarding the expenditure relevant to specific health examinations and health guidance. Accessed January 25, 2024. https:\/\/www.mhlw.go.jp\/jigyo_shiwake\/dl\/r04_jigyou01a_day1.pdf."}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2828308\/takeuchi_2024_oi_241442_1734015726.06583.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T11:31:18Z","timestamp":1734694278000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2828308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,20]]},"references-count":36,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.51813","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,20]]}}}