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Beyond 'normal' and 'abnormal': Health checkup values show nonlinear links to future health care costs (opens in a new tab)

medicalxpress.com · 2026-09-28

Short answerEvidenceSource

Short answer

Mixed

Mixed.

The claims we could check match the study, but some claims were not covered by the evidence reviewed.

  • 4 supported
  • 4 not covered

Checked against the study summary. The full text wasn't available, so some details couldn't be settled either way.

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Follow the evidence trail
1
2

NewsLink checks it

Mixed

Every claim we could check holds up. Four of eight claims match the study. This overall rating is based only on the claims we could check. Four claims the study doesn't address.

  • 4 supported
  • 4 not covered
Open claim evidence
3
Then inspect each claim

Evidence layer

Claim by claim

Each claim gets a verdict. Expand it to see the evidence directly below.

8 claims in this story

Showing all 8 claimsChoose a verdict to focus the list.

Claim 1 of 8Not coveredA multidisciplinary research team led by Kanazawa University investigated how routinely collected health checkup measurements are associated with health care costs several years later.View evidenceHide evidence

Why this verdict

The abstract-level profile supports that the paper investigated associations between routine Specific Health Checkup measures and later claims-based healthcare costs. However, the supplied paper profile does not verify the story’s institutional/author-team framing that the work was led by Kanazawa University or was multidisciplinary.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
Claim 2 of 8Not coveredThe researchers linked Specific Health Checkup data with claims data from Japan's National Health Insurance Database (KDB) and analyzed 6,757 adults ages 60–74, corresponding to 11,148 person-years of observation.View evidenceHide evidence

As stated6,757 adults; 11,148 person-years

Why this verdict

The sample size, age range, person-years, and linkage of Specific Health Checkup records to administrative insurance claims are supported. The specific identification of the claims source as Japan’s National Health Insurance Database/KDB is not verified in the abstract-level profile, which describes administrative insurance claims in Hakui City.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
Claim 3 of 8Not coveredUsing generalized additive models, the team examined associations between health indicators measured at checkups and outpatient, inpatient and prescription drug costs incurred 3–4 years later.View evidenceHide evidence

As stated3–4 years later

Why this verdict

Use of generalized additive models and the 3rd–4th fiscal-year outcome window are supported. The abstract-level profile describes annual claims-based healthcare costs overall, but does not verify the story’s more specific breakdown into outpatient, inpatient, and prescription drug costs.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
2

Study evidence

Internal validation used 50 repeated individual-level 80/20 random splits to assess model fit and the stability of observed nonlinear association patterns.

“Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.”
Claim 4 of 8Not coveredIn men, waist circumference and FLI showed relatively prominent associations with future health care costs, while in women stronger associations were observed at higher levels of BMI and waist circumference.View evidenceHide evidence

Why this verdict

The abstract-level profile supports a notable fatty liver index association in men and sex-specific patterns generally. It does not verify the fuller sex-specific detail that waist circumference was relatively prominent in men or that stronger associations in women occurred specifically at higher BMI and waist circumference levels.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
2

Study evidence

The atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index provided limited additional information beyond routine health checkup measures for explaining near-term claims-based healthcare costs.

“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).”
Claim 5 of 8SupportedAge and glycated hemoglobin (HbA1c) showed consistent associations with future health care costs in both men and women.View evidenceHide evidence

Why this verdict

The paper profile states that age and HbA1c showed consistent associations across groups, including overall and sex-stratified models.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
2

Study evidence

Internal validation used 50 repeated individual-level 80/20 random splits to assess model fit and the stability of observed nonlinear association patterns.

“Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.”
Claim 6 of 8SupportedHbA1c showed a J-shaped pattern, with the association becoming stronger above approximately 6.0%.View evidenceHide evidence

As statedapproximately 6.0%

Why this verdict

The profile directly reports that HbA1c showed a J-shaped association with costs, with steeper increases above approximately 6.0%.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
Claim 7 of 8SupportedBody mass index (BMI), waist circumference and fatty liver index (FLI) were also associated with future health care costs, but the patterns differed by sex.View evidenceHide evidence

Why this verdict

The profile reports that BMI, waist circumference, and fatty liver index showed moderate association patterns and that the study emphasized nonlinear, sex-specific associations. Fatty liver index is also specifically discussed as a derived adiposity-related index.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
2

Study evidence

The atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index provided limited additional information beyond routine health checkup measures for explaining near-term claims-based healthcare costs.

“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).”
Claim 8 of 8SupportedThe study is presented as showing population-level associations between health checkup values and later health care expenditures, rather than precise predictions of individual health care costs.View evidenceHide evidence

Why this verdict

The paper profile reports low explanatory performance, mean R2=0.06, and states that routine checkup variables alone are insufficient for precise individual-level cost prediction. The story’s population-level framing is consistent with this limitation.

1

Study evidence

Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06

“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
2

Study evidence

Internal validation used 50 repeated individual-level 80/20 random splits to assess model fit and the stability of observed nonlinear association patterns.

“Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.”
Then look for missing context

Context layer

What the story left out

Important study details the story did not include.

  • The cohort was from Hakui City, Japan, which limits geographic generalizability.

    The story frames the data as Japanese and references national claims data, but does not reflect the profile’s single-city Hakui City setting or the associated generalizability limitation.

    From Retrospective cohort using linked health checkup and administrative claims data

  • Several other composite indices, including atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index, provided limited additional information beyond routine measures.

    The story discusses FLI but does not reflect the paper’s secondary contribution that several other composite lipid/adiposity indices added limited information beyond routine measures.

    From Secondary-data observational cohort; generalized additive modeling of routine and derived indices

  • Model fit and stability were assessed using 50 repeated 80/20 individual-level split validations.

    The story does not mention the internal validation procedure or the repeated split-sample design.

    From Repeated split-sample internal validation (50 × 80/20 individual-level splits)

9 things the story did carry across
  • The study was a retrospective observational cohort analysis linking Japan Specific Health Checkups to subsequent administrative insurance claims for adults aged 60–74.
  • The analytic dataset contained 6,757 residents and 11,148 person-years.
  • The outcome was annual claims-based healthcare costs in the 3rd and 4th fiscal years after baseline.
  • The paper used generalized additive models with a Gamma distribution and log link, fitted overall and separately for men and women, to characterize nonlinear associations.
  • Age and HbA1c showed consistent associations across groups; HbA1c showed a J-shaped pattern with steeper cost increases above about 6.0%.
  • BMI, waist circumference, and fatty liver index showed moderate association patterns, with fatty liver index notable in men.
  • Routine checkup variables alone explained only a small proportion of variation in later costs, with mean R2=0.06, limiting individual-level prediction.
  • The study is observational and does not establish causal effects of checkup values on future healthcare costs.
  • The authors recommended external validation and incorporation of additional data such as comorbidities, medications, healthcare utilization, and socioeconomic factors.
Then read the study layer

Study layer

Study at a glance

Scan the study first. Expand only the parts you want to inspect.

Pieces of work

3

Evidence read

study summary

Lead result

secondary data

1Lead resultsecondary dataCharacterize nonlinear and sex-specific associations between routine Specific Health Checkup factors and near-term future claims-based healthcare costs in older adults in Hakui City, Japan, using linked checkup + claims data.Retrospective cohort using linked health checkup and administrative claims dataExpand

In plain English

Retrospective cohort analysis of linked Japan Specific Health Checkups (FY2012–FY2022) and subsequent administrative insurance claims in Hakui City examined nonlinear, sex-specific associations between baseline routine checkup factors (including age and HbA1c, plus lipid- and adiposity-related composite indices) and annual claims-based healthcare costs measured in the 3rd and 4th fiscal years after baseline. Generalized additive models with a Gamma distribution and log link were fit in the overall sample and stratified by sex; model fit was assessed with 50 repeated 80/20 split validations. Routine checkup variables explained only a small proportion of variation in near-term claims-based costs (mean R2=0.06). Age and HbA1c showed consistent associations across groups, with HbA1c exhibiting a J-shaped relationship (steeper cost increases above ≈6.0%). Body mass index, waist circumference, and fatty liver index showed moderate associations; composite indices such as the atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index provided limited additional information beyond routine measures, though fatty liver index showed a notable pattern in men. The authors conclude that routine checkup factors reveal nonlinear, sex-specific associations useful for hypothesis generation and indicator selection, but are insufficient alone for precise individual-level cost prediction; they call for external validation and incorporation of comorbidity, medication, utilization, and socioeconomic data.

Key findings

  • Routine health checkup variables explained only a small proportion of variation in near-term claims-based healthcare costs.mean R2 = 0.06
  • HbA1c demonstrated a J-shaped association with future healthcare costs, with steeper increases in costs above approximately 6.0% HbA1c.J-shaped; steeper increase above ≈6.0% (as reported)
“We linked Japan's Specific Health Checkups (FY2012-FY2022) to subsequent administrative insurance claims in Hakui City and analyzed adults aged 60-74 years.”
What this piece can’t prove
  • Models had limited explanatory performance (mean R2=0.06) indicating routine checkup variables alone explain only a small portion of variation in near-term claims-based costs.
  • Abstract does not provide numerical effect estimates, uncertainty intervals, or full model specification details; inference is limited to reported summary statements.
  • Observational design and administrative claims outcome preclude causal inference from these associations.
  • Authors note the need for external validation and incorporation of comorbidity, medication, utilization, and socioeconomic data to improve prediction.

1 further detail could not be confirmed from the summary.

2secondary dataEvaluate whether composite lipid-/adiposity-related indices (e.g., fatty liver index, visceral adiposity index, atherogenic index of plasma) add information beyond routine checkup measures for explaining future healthcare costs.Secondary-data observational cohort; generalized additive modeling of routine and derived indicesExpand

In plain English

Within a retrospective cohort of Japanese adults aged 60–74, the authors evaluated whether composite lipid- and adiposity-related indices (atherogenic index of plasma, arteriosclerosis index, non-HDL cholesterol, fatty liver index, visceral adiposity index) added explanatory information beyond routine health checkup measures for near-term claims-based healthcare costs using GAMs. Overall, routine checkup variables explained little variance in subsequent costs (mean R2=0.06). Several composite indices (atherogenic index of plasma, arteriosclerosis index, visceral adiposity index) provided limited additional information beyond routine measures, while the fatty liver index showed a more notable association pattern in men. Analyses were sex-stratified and used repeated 80/20 split validation to assess stability.

Key findings

  • The atherogenic index of plasma, arteriosclerosis index, and visceral adiposity index provided limited additional information beyond routine health checkup measures for explaining near-term claims-based healthcare costs.
  • The fatty liver index showed a notable association pattern with future healthcare costs in men, suggesting some sex-specific incremental information for this index.
“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).”
What this piece can’t prove
  • Cohort restricted to Hakui City residents aged 60–74; generalizability to other populations or age groups is uncertain.
  • Outcome is claims-based healthcare costs in fiscal years 3–4 after baseline; other outcomes or longer horizons not assessed here.

3 further details could not be confirmed from the summary.

3secondary dataAssess model fit and stability/robustness of observed association patterns using repeated split-sample validation.Repeated split-sample internal validation (50 × 80/20 individual-level splits)Expand

In plain English

The study performed internal validation of generalized additive models (Gamma distribution, log link) for predicting near-term claims-based healthcare costs using routine health checkup variables. Validation used 50 repeated individual-level 80/20 random splits to assess model fit (reported as mean R2) and the stability of nonlinear association patterns. Mean explanatory performance was low (mean R2 = 0.06), and the authors report that some predictors (age, HbA1c) showed consistent associations across groups while routine variables overall explained only a small proportion of cost variation.

Key findings

  • Internal validation used 50 repeated individual-level 80/20 random splits to assess model fit and the stability of observed nonlinear association patterns.
  • Model explanatory performance was limited: routine health checkup variables alone explained only a small proportion of variation in subsequent claims-based healthcare costs.mean R2 = 0.06
“Model fit and the stability of the observed association patterns were assessed using 50 repeated 80/20 individual-level split validations.”
What this piece can’t prove
  • Abstract provides mean R2 but does not report variability across the 50 repeats or other performance metrics (e.g., calibration, prediction error distributions).
  • Study population restricted to residents aged 60–74 in a single Japanese city (Hakui), which may limit generalizability beyond the sample.

3 further details could not be confirmed from the summary.

Finally, the search trail

Method layer

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Papers considered

The selected paper, plus nearby candidates.

PubMed, Europe PMC, Crossref · 35 candidate papers

Candidate

Extension of marginal conditional stochastic dominance to prospect and Markowitz stochastic dominance rules

The Quarterly Review of Economics and Finance · 2026 · Crossref

Source (opens in a new tab)

And 29 more candidates considered.