Abstract Objectives It is unclear whether mandatory health examination is effective for employees who are already being treated for chronic diseases. We focused on patients being treated for hypertension and evaluated the association between employer‐based health examination attendance and diabetes treatment initiation. Methods Using a database that stores health insurance claims and health examination results of subscribers enrolled in society‐managed health insurance plans in Japan, we identified employees aged 40‐59 years who were being treated for hypertension when starting diabetes treatment from April 2012 to December 2016. A case‐crossover analysis was conducted using 90, 180, and 270 days prior to diabetes treatment initiation as reference points and 90 days after the mandatory health examination as the exposure period. We conducted a subgroup analysis by hemoglobin A1c (HbA1c) level and frequency of outpatient blood glucose testing before the mandatory health examination. Results We identified 1464 individuals starting treatment for diabetes while on antihypertensive drugs. The overall odds ratio for starting diabetes treatment within 90 days of the health examination was 1.89 (95% confidence interval: 1.70‐2.10). The subgroup analysis showed that this odds ratio increased as HbA1c level increased and as blood glucose testing frequency decreased. Conclusions Among employees starting treatment for diabetes while being treated for hypertension, employer‐based mandatory health examination attendance was associated with initiation of diabetes treatment. The health examinations may be functioning as a complement to screening in outpatient settings.

中文翻译：

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接受高血压治疗的员工参加强制健康检查与开始糖尿病治疗之间的关系


摘要 目的 目前尚不清楚强制健康检查对于已经接受慢性病治疗的员工是否有效。我们重点关注正在接受高血压治疗的患者，并评估了基于雇主的健康检查出席率与开始糖尿病治疗之间的关联。方法 使用存储日本社会管理健康保险计划订阅者健康保险索赔和健康检查结果的数据库，我们确定了 2012 年 4 月至 2016 年 12 月开始糖尿病治疗时正在接受高血压治疗的 40-59 岁员工使用糖尿病治疗开始前 90 天、180 天和 270 天作为参考点，以强制健康检查后 90 天作为暴露期进行病例交叉分析。我们根据糖化血红蛋白 (HbA1c) 水平和强制健康检查前门诊血糖检测频率进行了亚组分析。结果 我们确定了 1464 名在服用抗高血压药物的同时开始接受糖尿病治疗的个体。在健康检查后 90 天内开始糖尿病治疗的总体优势比为 1.89（95% 置信区间：1.70‐2.10）。亚组分析表明，随着 HbA1c 水平的增加和血糖检测频率的降低，这一优势比也随之增加。结论 在接受高血压治疗的同时开始糖尿病治疗的员工中，雇主强制健康检查的参加率与开始糖尿病治疗相关。健康检查可以作为门诊筛查的补充。