Aging Clinical and Experimental Research

, Volume 19, Issue 3, pp 240–245 | Cite as

A mortality comparison of participants and non-participants in a comprehensive health examination among elderly people living in an urban Japanese community

  • Hajime Iwasa
  • Hideyo Yoshida
  • Hunkyung Kim
  • Yuko Yoshida
  • Jinhee Kwon
  • Miho Sugiura
  • Taketo Furuna
  • Takao Suzuki
Section on Longitudinal Studies


Background and aims: Recent studies have revealed that there are critical differences between participants and non-participants in health examinations. The aim of this study was to examine mortality differences between participants and non-participants in a comprehensive health examination for prevention of geriatric syndromes among community-dwelling elderly people, using a three-year prospective cohort study. Methods: The study population included 854 adults aged 70 to 84 at baseline. The following items were all studied: the status of participation in the comprehensive health examination as an independent variable, age, gender, number of years of education, living alone, presence of chronic diseases, experience of falls over one year, history of hospitalization over one year, self-rated health, body mass index, instrumental activities of daily living, and subjective well-being as covariates; and all-cause mortality during a three-year follow-up as a dependent variable. Results: In an adjusted Cox’s proportional hazard regression model, the mortality risk for participants in the comprehensive health examination was significantly lower than that of non-participants (Risk Ratio (for participants)=0.44, 95% confidence interval=0.24 to 0.78). Conclusions: The present study shows that there is a large mortality difference between participants and non-participants. Our findings suggest two possible interpretations: 1) There is a bias due to self-selection for participation in the trial, which was not eliminated by adjustment for the covariates in the statistical model; 2) There is an intervention effect associated with participation in the comprehensive health examination which reduces the mortality risk.


All-cause mortality comprehensive health examination for the elderly prevention of geriatric syndromes and long-term care dependence self-selection bias 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Deeg DJ, Haga H, Yasumura S, Suzuki T, Shichita K, Shibata H. Predictors of 10-year change in physical, cognitive and social function in Japanese elderly. Arch Gerontol Geriatr 1992; 15: 163–79.PubMedCrossRefGoogle Scholar
  2. 2.
    Ishizaki T, Watanabe S, Suzuki T, Shibata H, Haga H. Predictors for functional decline among nondisabled older Japanese living in a community during a 3-year follow-up. J Am Geriatr Soc 2000; 48: 1424–9.PubMedGoogle Scholar
  3. 3.
    Reuben DB. Geriatric syndromes. In: Beck AC, ed. Geriatric Review Syllabus, 2nd Ed. New York: American Geriatrics Society, 1991: 117–231.Google Scholar
  4. 4.
    Flacker JM. What is a geriatric syndrome anyway? J Am Geriatr Soc 2003; 51: 574–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Kubo H, Nakayama K, Ebihara S, Sasaki H. Medical treatments and care for geriatric syndrome: new strategies learned from frail elderly. Tohoku J Exp Med 2005; 205: 205–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Suzuki T, Kim H, Yoshida H, Ishizaki T. Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. J Bone Miner Metab 2004; 22: 602–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Suzuki T, Iwasa H, Yoshida H, et al. Comprehensive health examination (“Otasha-Kenshin”) for the prevention of geriatric syndromes and a bed-ridden state in the community elderly. 1. Differences in characteristics between participants and non-participants. Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2003; 50: 39–48.Google Scholar
  8. 8.
    Iwasa H, Suzuki T, Yoshida H, et al. Cognitive function as the factor determining higher-level competence in community-dwelling elderly: comprehensive health examination for the community elderly for the prevention of the geriatric syndrome and a bed-ridden state (“Otasha-kenshin”). Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2003; 50: 950–8.Google Scholar
  9. 9.
    Friedman GD, Collen MF, Fireman BH. Multiphasic health check-up evaluation: a 16-year follow-up. J Chronic Dis 1986; 39: 453–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Shinsho F, Fukuda H, Murakami S, Takatorige T, Nakanishi N, Tatara K. Analysis on the relationship between use of health check-ups and medical care by elderly patients. A study on urban cities with high health check-up rates. Nippon Koshu Eisei Zasshi (Japanese Journal of Public Health) 2001; 48: 314–23.Google Scholar
  11. 11.
    Nakahara T. Public health policies and strategies in Japan. In: Detels R, Holland WW, McEwen J, Omenn GS (Eds.), Oxford Textbook of Public Health, 3rd Edition. New York: Oxford University Press, 1997: 323–9.Google Scholar
  12. 12.
    Stone DH, Crisp AH. The effect of multiphasic screening on aspects of psychiatric status in middle age: results of a controlled trial in general practice. Int J Epidemiol 1978; 7: 331–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Norton MC, Breitner JC, Welsh KA, Wyse BW. Characteristics of nonresponders in a community survey of the elderly. J Am Geriatr Soc 1994; 42: 1252–6.PubMedGoogle Scholar
  14. 14.
    Reuben DB, Posey E, Hays RD, Lim ME. Predictors of patient refusal to participate in ambulatory-based comprehensive geriatric assessment. J Gerontol 1994; 49: M209–15.PubMedCrossRefGoogle Scholar
  15. 15.
    Hebert R, Bravo G, Korner-Bitensky N, Voyer L. Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol 1996; 49: 373–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Ives DG, Traven ND, Kuller LH, Schulz R. Selection bias and non-response to health promotion in older adults. Epidemiology 1994; 5: 456–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Launer LJ, Wind AW, Deeg DJ. Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. Am J Epidemiol 1994; 139: 803–12.PubMedGoogle Scholar
  18. 18.
    Osler M, Schroll M. Differences between participants and non-participants in a population study on nutrition and health in the elderly. Eur J Clin Nutr 1992; 46: 289–95.PubMedGoogle Scholar
  19. 19.
    Suzuki KJ, Nakaji S, Tokunaga S, Shimoyama T, Umeda T, Sugawara K. Confounding by dietary factors in case-control studies on the efficacy of cancer screening in Japan. Eur J Epidemiol 2005; 20: 73–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Otto SJ, Schroder FH, de Koning HJ. Low all-cause mortality in the volunteer-based Rotterdam section of the European randomised study of screening for prostate cancer: self-selection bias? J Med Screen 2004; 11: 89–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Minder CE, Muller T, Gillmann G, Beck JC, Stuck AE. Subgroups of refusers in a disability prevention trial in older adults: baseline and follow-up analysis. Am J Public Health 2002; 92: 445–50.PubMedCrossRefGoogle Scholar
  22. 22.
    Shimonaka Y, Nakazato K, Kawaai C, Sato S, Ishihara O, Gondo Y. The effect of life events on psychological well-being among Japanese middle-aged and elderly. In: Shibata H, Suzuki T, Shimonaka Y (Eds.), Facts research and intervention in geriatrics 1997. Longitudinal Interdisciplinary Study on Aging. Paris: Serdi Publisher, 1997: 137–46.Google Scholar
  23. 23.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.Google Scholar
  24. 24.
    Salthouse TA. What do adult age differences in the Digit Symbol Substitution Test reflect? J Gerontol 1992; 47: P121–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Epker MO, Lacritz LH, Munro Cullum C. Comparative analysis of qualitative verbal fluency performance in normal elderly and demented populations. J Clin Exp Neuropsychol 1999; 21: 425–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y. Measurement of competence: reliability and validity of the TMIG Index of Competence. Arch Gerontol Geriatr 1991; 13: 103–16.PubMedCrossRefGoogle Scholar
  27. 27.
    Lawton MP. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975; 30: 85–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric assessment in well-functioning, community-dwelling older people: secondary analysis of a randomized trial. J Am Geriatr Soc 1999; 47: 389–95.PubMedGoogle Scholar
  29. 29.
    Saltvedt I, Saltnes T, Mo ES, Fayers P, Kaasa S, Sletvold O. Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study. Aging Clin Exp Res 2004; 16: 300–6.Google Scholar
  30. 30.
    Vass M, Avlund K, Hendriksen C, Andersen CK, Keiding N. Preventive home visits to older people in Denmark: methodology of a randomized controlled study. Aging Clin Exp Res 2002; 14: 509–15.PubMedGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2007

Authors and Affiliations

  • Hajime Iwasa
    • 1
  • Hideyo Yoshida
    • 1
  • Hunkyung Kim
    • 1
  • Yuko Yoshida
    • 1
  • Jinhee Kwon
    • 1
  • Miho Sugiura
    • 1
  • Taketo Furuna
    • 2
  • Takao Suzuki
    • 1
  1. 1.Tokyo Metropolitan Institute of GerontologyTokyoJapan
  2. 2.School of Health SciencesSapporo Medical UniversitySapporoJapan

Personalised recommendations