Loring G. Dales

Evaluating periodic multiphasic health checkups: a controlled trial.

Abstract In 1964 a controlled trial was initiated to evaluate the effectiveness of a program of urging subjects to take periodic multiphasic health checkups (MHCs) in preventing or postponing morbidity, disability, and mortality. A group of over 5000 Kaiser Foundation Health Plan members aged 35–54 at entry to the study has been urged to take MHCs annually. Along with a comparable group of members not so urged, these subjects have been followed for 11 years. Use of outpatient clinic services, other than those services forming part of the MHC was similar in the urged (study) group and in non-urged (control) group. Overall, hospital use was also similar in the two groups. There was no difference between the overall groups in self-reported disability. However, selfreported disability was significantly less common in the older study group men (aged 45–54 at entry), largely due to less disability from hypertension complications, ischemic heart disease, and back conditions. This provides a hypothesis as to a beneficial effect in a specific age-sex group that should be tested further. Mortality from a set of conditions hypothesized in advance to be most postponable or preventable through periodic MHCs was significantly lower in the study group as a whole, primarily due to fewer deaths from hypertension complications and colorectal cancer. On the other hand, suicides and lympho-hematopoietic cancer deaths were significantly more common in the study group, though reanalysis of the data revealed little relationship between these latter death rates and actual MHC exposure. Total mortality, from all causes combined, was slightly lower in the study group, but this difference was not statistically significant. Though the prevalence of a number of disability and mortality risk factors was somewhat higher in the control group at entry, adjustment for these differences did not eliminate the statistically significant control group excesses in disability (older men only) and potentially postponable cause mortality. With regard to processes by which increased study group MHC exposure may have caused the observed health outcome differences, there was more identification and treatment of hypertension, hyperlipidemia, cigarette smoking, obesity, and diabetes in the study group, though the differences were not large. There also was a trend toward earlier diagnoses of colorectal cancer in the study group, due mostly to MHC-related sigmoidoscopy. When the economic impact of all major health-related events was estimated for the older men in the 1965–1975 period, there was a net difference of over

Mortality in middle-aged smokers and nonsmokers.

2100 per man, favoring the study group. The health outcome rates for the women and the younger men indicated that there would be no savings for these other study group subjects, were similar cost analyses to be made.

3. Outpatient clinic utilization, hospitalization, and mortality experience after seven years☆

We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic.

Characteristics predictive of coronary heart disease in ex-smokers before they stopped smoking: Comparison with persistent smokers and nonsmokers

The Multiphasic Checkup Evaluation Study is a controlled clinical trial aimed at testing the efficacy of periodic Multiphasic Health Checkups in preventing or postponing illness, disability, and death. This paper reports on outpatient clinic utilization, hospitalization, and mortality experience of the study group subjects, who have been urged to undertake annual checkups, and of the control group subjects, who were not so urged, after the first seven years of the project effort. While there has been little difference in utilization of outpatient physician and laboratory services other than those directly connected with the Multiphasic Health Checkups, the study group subjects have had more diagnoses made. Among the men ages 45–54 at entry, hospital usage has been slightly lower in the study group, while the opposite has been the case among the women ages 45–54 at entry. The overall mortality rate has been slightly lower in the study group, while, for a group of causes of death defined as being potentially postponable or preventable, the study group mortality rate has been significantly lower (p < 0.05). There is no strong indication that chance fluctuation, underreporting, differentially selective loss to followup, or an initial study-control group health status disparity accounted for this last difference.

Cigarette smoking and serum chemistry tests

Abstract From the Kaiser-Permanente multiphasic checkup data for white and black men and women with three or more examinations, ex-smokers and continuing smokers have been compared for a large number of characteristics associated with risk of coronary heart disease (CHD) in our study population or others. Assessments of these characteristics were made at a time when all were smoking cigarettes and persons who remained nonsmokers provided an additional comparison group. Smokers who later quit showed statistically significant differences from smokers who continued smoking, in certain cardiovascular symptoms, social and personal characteristics, smoking intensity, and some other traits. Compared to persistent smokers, quitters in most or all race-sex subgroups had higher relative weight and lower alcohol consumption, but smoked fewer cigarettes for shorter duration, inhaled less, had higher vital capacity, lower leukocyte count, lower prevalence of abnormal electrocardiogram, less exertional chest pain. exertional dyspnea and exertional leg pain, higher educational level, and a tendency to answer a psychological questionnaire less like persons who later developed myocardial infarction. Although statistically significant, most of these differences were quantitatively small. Other CHD-related characteristics such as cholesterol and blood pressure showed small differences. Controlling for smoking quantity had little effect on differences between the persistent quitters and persistent smokers for certain characteristics which seemed likely to be smoking-related. For several characteristics, quitters were more similar at index examination to never smokers than to persistent smokers. Comparison of CHD outcomes among ex-smokers with those of persistent smokers should take into consideration smoking intensity and other baseline characteristics which may affect the degree to which quitting smoking might alter risk of CHD.

1. Methods and population

Abstract Eight serum chemistry levels were studied in over 65,000 cigarette smokers and non-smokers. On the average, creatinine and albumin levels were lower in the smokers of both sexes, while the opposite was true for 1-hr post-challenge serum glucose. Globulin levels were consistently lower in the women smokers only. Uric acid concentrations were lower in the men who smoked. Cholesterol levels were higher in the white men who smoked but not in the black male smokers. Calcium and SGOT levels of smokers were quite similar to those of nonsmokers. Alcohol consumption played a role in smoker-nonsmoker differences in serum glucose concentration. However, for other chemistries no additional factors were identified that could explain the relationships to cigarette smoking. Thus they may be either directly affected by smoking or related to undefined underlying differences between smokers and nonsmokers.

Cigarette Smoking Habits and Urine Characteristics

Abstract A controlled long-term study to evaluate the efficacy of the periodic health examination, utilizing automated multiphasic screening techniques, is being conducted. A representative sample of approximately 5000 persons aged 35–54 was selected in 1964 and has been urged to undergo annual examinations. The morbidity, mortality, and disability, as well as the utilization of medical care, in this group are being compared to a similar group of persons who have been allowed to seek medical care on their own initiative within the same medical care program. The study design, characteristics of the study population, and the experience in examining the population are described in this report. At the start of the study the population was relatively healthy and experienced very little disability. Approximately 65% of the study group is being examined each year, and 78% of the original group were still under surveillance after 7 years.

4. Preliminary cost benefit analysis for middle-aged men☆

Voided urines of 53,000 white and 9,300 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria m

2. Disability and chronic disease after seven years of multiphasic health checkups

Abstract A preliminary cost benefit analysis for a program of urging middle-aged men to take annual Multiphasic Health Checkups has suggested a net savings of more than

Racial Differences in Serum and Urine Glucose after Glucose Challenge

800 per man over a 7-year period among men urged to take the checkups as compared to men not so urged. This difference principally reflects the lower disability and mortality rates observed for the men who were urged to receive the checkups. Similar differences have not been demonstrated for women or younger men.