Higher mortality in women living in high-participation areas of a population-based health check and lifestyle intervention study
The aim was to study whether the effects of a population-based health check and lifestyle intervention differed according to study participation rate.
All persons living in 73 areas of Copenhagen County, Denmark, were included in the Inter99 randomized trial in 1999 (intervention group n = 11,483; control group n = 47,122). All persons in the intervention group were invited for health checks and were offered lifestyle counseling if they were at high risk of ischemic heart disease. Areas were divided into low 35–49%, middle 50–54% and high ≥ 55% health check participation. All persons were followed in registers for 10-year cause-specific mortality.
In high-participation areas, there was a significantly higher risk of lifestyle-(HR 1.37 [1.04, 1.79]) and cancer-related deaths (HR 1.47 [1.08, 2.02]) among women in the intervention group than control group. Regarding smoking-related cancer deaths, differences were even more pronounced. Among men, no significant difference in mortality was seen between control and intervention groups.
The results of this paper suggest that among women, the health check and lifestyle intervention may increase the risk of lifestyle and cancer-related deaths.
KeywordsCancer Health check Lifestyle intervention Mortality Participation rate Randomized controlled trial
TJ conceived and designed the experiments. CP performed the experiments. AMB, TJ, CP analyzed the data. AMB wrote the paper. All authors approved the final version of the manuscript and the submission to Clinical Epidemiology.
The Inter99 study was funded by the Danish Health Foundation (Grant No. 2010 B 131).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Written informed consent was obtained from all the participants. In Denmark, researchers are entitled to use registers for research purposes (regarding the control group and non-participants of the intervention group) without persons’ informed consent as long as the researchers comply with predefined research regulations.
The study was approved by the Regional Scientific Ethics Committee (KA 98 155) and the Danish Data Protection Agency. The study is registered at ClinicalTrials.Gov (NCT00289237).
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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