Why don't people attend a follow-up visit after being detected with dyslipidemia in health checkups? Findings from the University of Tsukuba

A research group led by Professor Nanako Tamiya and Professor Masao Iwagami of the Institute of Medicine at the University of Tsukuba has announced that they identified the characteristics of a group of people who did not seek medical attention even after they were found to have dyslipidemia in health checkups. The tracking data for National Health Insurance subscribers in Ibaraki Prefecture, who were found to have dyslipidemia in specific health checkups, were analyzed. Multiple characteristics were identified, including younger age, male sex and occasional alcohol consumption. The findings are expected to guide efforts for encouraging follow-up visits. The results were published in JMA Journal on October 15.

Dyslipidemia is a condition in which lipid concentration in the blood is abnormal. There are three types of the condition, depending on which lipid is abnormal: hyper-LDL cholesterolemia, in which the level of LDL cholesterol (the bad cholesterol) is too high; hypertriglyceridemia, in which the level of triglycerides is too high; and hypo-HDL cholesterolemia, in which the level of HDL cholesterol (good cholesterol) is too low. The estimated number of patients with dyslipidemia in Japan is 2.2 million. If left untreated, dyslipidemia increases the likelihood of developing diseases such as myocardial infarction, cerebral infarction and dementia. Patients with dyslipidemia should visit a medical institution to deal with the condition. Meanwhile, improving the attendance rate is a challenge.

In this study, the research group analyzed the characteristics of people who did not visit a medical institution after testing positive for dyslipidemia during health checkups, using data from specific health checkups and health insurance claims. Among the approximately 200,000 people aged 40-74 years who underwent specific health checkups in 2018, 33,503 met the recommended criteria for dyslipidemia (LDL cholesterol ≥140 mg/dL, triglycerides ≥300 mg/dL or HDL cholesterol ≤34 mg/dL). Only 18.1% of these individuals attended the follow-up visit within 6 months. Furthermore, among 31,084 participants with hyper-LDL cholesterolemia, the follow-up attendance proportions by severity level were 15.7%, 18.6% and 23.6% for mild, moderate and severe levels, respectively.

Factors associated with nonattendance were analyzed using a multivariate logistic regression analysis with the follow-up attendance as an outcome. The explanatory variables used were age, sex, frequency of alcohol consumption, current smoking status, place of health checkups (public facility or medical institution), presence of any subjective symptoms, BMI, presence of any abnormal health checkup results other than dyslipidemia, results of the health checkup in the previous fiscal year (dyslipidemia, no dyslipidemia or no health checkup), frequency of visits to medical institutions in the year before the health checkup, presence of any prior prescriptions within one year before the health checkup (blood pressure, blood sugar level, liver function, proteinuria and glucosuria), the type and severity of dyslipidemia and the number of medical institutions in the municipality of residence.

The results also revealed that lower attendance rates were associated with younger age, male sex, occasional alcohol consumption, health checkups at public facilities, having no subjective symptoms, having no abnormal health checkup results other than dyslipidemia and no medical institution visits or prescriptions within one year before the health checkup. Individuals who did not attend follow-up visits are likely to be characterized by low utilization of medical institutions. Thus, interventions to reduce nonattendance at follow-up visits may include providing a list of medical institutions in their neighborhood when sending the health checkup results.

Iwagami said, "Dyslipidemia is also known as 'silent killer' and is often left untreated because it has no symptoms. The longer it is left untreated, the more likely it leads to serious diseases such as myocardial infarction and dementia. In Japan, where people have probably the easiest access to health checkups in the world, I think that it would be a waste if dyslipidemia was luckily found but is left untreated. I hope that this study will lead to improved bridging between abnormal health checkup results to hospital visits in Japan."

Journal Information
Publication: JMA Journal
Title: Factors Associated with Non-attendance at a Follow-up Visit for Dyslipidemia Identified at Health Checkups: A Retrospective Cohort Study in a Japanese Prefecture
DOI: 10.31662/jmaj.2024-0065