Addressing Health Inequalities Through the NHS Health Check Programme in England

Objectives: To explore equity in the invitation to and uptake of the NHS Health Check (NHSHC), and variation in cardiovascular disease (CVD) risk factor profiles and referrals to interventions across sociodemographic groups in England.Design: A cross-sectional observational studySetting: National primary care data extracted by NHS Digital from 90% of General Practices (GP) in England. Participants: 9,164,975 individuals aged 40-74 years invited to an NHSHC (2012-2017), defined using primary care Read codes.Intervention: The NHSHC, a national risk assessment, awareness and management intervention which focusses on behavioural and metabolic risk factors for non-communicable disease and 10-year (CVD) risk.Results: The NHSHC was offered to 58.5% of the eligible population, with older people and women more likely to accept the invitation. There was marked geographical variation in offers (9.2%-95.8%) with greater uptake by the White ethnic group living in least deprived areas, but also among Asian and Black ethnic groups living in more deprived areas. Uptake was lowest among those in the most deprived areas for all ethnicities but especially for White. Of those attending an NHSHC, CVD risk factors differed by ethnic group, with diabetes and obesity more prevalent among Asian, raised blood pressure in Black and alcohol use in White ethnic groups. Deprivation showed a clear positive association for smoking, obesity and alcohol dependence. Proportionally more interventions were offered to those from deprived areas and Asian and Black ethnic groups, even after adjusting for baseline risk, indicating active efforts to target inequalities. Conclusion: The NHSHC offers important opportunities to address health inequality through proportionate universalism and targeting the needs of specific groups. The program is achieving this goal, but needs to be offered more equitably and widely across the country with greater efforts to engage those who remain ‘hard to reach’ to support the levelling up agenda