Health checks have been long considered effective in the primary prevention of chronic diseases; a number of observational studies provided evidence that people with frequent health checks experienced a lower risk of mortality [[1], [2], [3], [4]]. Some researchers, however, pointed out that the observed association was probably due to the self-selection bias that people with a higher level of health consciousness were more likely to take health checks [5]. In support of this view, randomized controlled trials did not find that health checks could reduce the risk of cardiovascular disease (CVD), cancer, or mortality; a meta-analysis published in 2012 concluded that general health checks did not affect morbidity or mortality, although they increased the diagnosis [6]. However, that meta-analysis included trials being too old and having a small sample size. Current evidence is lacking in supporting an effective role of health checks in CVD prevention.

The objective of health checks is to screen individuals at high risk and provide an opportunity for treatment and control as well as prevention in an early stage. Delays in medical care seeking by clinic visits could therefore reduce the beneficial effect of health checks. Our community-based trial demonstrated that the standardized health counseling based on health-brief model, compared with usual counseling, increased more clinic visits after health checks and improved cardiovascular risk factors among high risk people [7].

That trail, however, has not shown a longer effect on reducing CVD hospitalization and mortality. We hypothesized that the delay in clinic visits is responsible for the reduced effect of health checks on the prevention of CVD and avoidable death. Hereby, we aimed to examine the association between the timing of clinic visits after the health checks and the risk of hospitalization for cardiovascular events or all-cause mortality among the high-risk population. In addition, we also compared days for sickness absence and payment for sickness allowance among groups according to timing of clinic visits.