ArticleHealth economics review2026
Nonlinear modeling of health checkup factors and future claims-based healthcare costs in Japan: a retrospective cohort study.
Article in Health economics review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPopulation health checkups support disease prevention and health management. Clarifying how routinely collected checkup factors relate to subsequent healthcare costs may inform population-level risk assessment and preventive planning. We aimed to characterize nonlinear and sex-specific associations between routine checkup factors and near-term claims-based healthcare costs in Japan and to explore whether composite metabolic indices provide additional information beyond routine measures.
methodsWe linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years. The outcome was annual claims-based healthcare costs in the third and fourth fiscal years after baseline, expressed as fee schedule points. We fitted generalized additive models with a Gamma distribution and log link in the overall sample and separately for men and women. Predictors included routine checkup measures (including glycated hemoglobin [HbA1c]) and lipid- and adiposity-related indices (atherogenic index of plasma, arteriosclerosis index, non-high-density lipoprotein cholesterol, fatty liver index, and visceral adiposity index). Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.
resultsThe dataset comprised 11,148 person-years from 6,757 residents. The models showed limited explanatory performance (mean R
conclusionsRoutine health checkup factors exhibited nonlinear, sex-specific associations with near-term claims-based healthcare costs in a Japanese community. These findings may inform population-level hypothesis generation and future indicator selection. However, routine checkup variables alone appear insufficient for precise individual-level prediction. External validation and integration of additional information on comorbidities, medications, healthcare utilization, and socioeconomic factors are warranted.
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