Beyond 'normal' and 'abnormal': Health checkup values show nonlinear links to future health care costs
· Medical Xpressedited by Swati Mestri, reviewed by Andrew Zinin
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As populations age and health care expenditures continue to rise worldwide, there is growing interest in understanding how routinely collected health data may help characterize future health care needs and costs.
A multidisciplinary research team led by Kanazawa University investigated how routinely collected health checkup measurements are associated with health care costs several years later.
The 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.
The research is published in the journal Health Economics Review.
Using generalized additive models (GAMs), which can capture curved rather than strictly linear relationships, the team examined associations between health indicators measured at checkups and outpatient, inpatient and prescription drug costs incurred 3–4 years later.
Age and glycated hemoglobin (HbA1c) showed consistent associations with future health care costs in both men and women. In particular, HbA1c showed a J-shaped pattern, with the association becoming stronger above approximately 6.0%. Body mass index (BMI), waist circumference and fatty liver index (FLI) were also associated with future health care costs, but the patterns differed by sex.
In men, waist circumference and FLI showed relatively prominent associations with future health care costs. In women, stronger associations were observed at higher levels of BMI and waist circumference. These findings indicate that the relationship between health checkup values and later health care expenditures cannot always be adequately described by a simple straight line.
A key feature of the study is that it visualizes the ranges of health checkup values in which associations with future health care costs become stronger, rather than interpreting each measurement only as "normal" or "abnormal."
These findings characterize population-level associations between health checkup values and future health care costs, rather than providing precise predictions of individual health care costs.
The researchers plan to integrate additional information, including disease history, prescribed medications, health care use and lifestyle factors, to develop more comprehensive approaches to health risk assessment and preventive planning.
Researcher quote
"Many health checkup results are just numbers, and this can make it difficult for people to connect them with their own health, especially for lifestyle-related diseases that may progress without noticeable symptoms. Health care costs offer a different perspective by expressing the future health burden in economic terms.
"By showing how checkup values are associated with later medical spending, we hope to provide another way for people to reflect on their health. Although this study did not directly examine behavior change, such information may eventually help support preventive action and the design of community health programs," said Shigehiro Karashima, the corresponding author.
More information
Haruto Nakamura et al, Nonlinear modeling of health checkup factors and future claims-based healthcare costs in Japan: a retrospective cohort study, Health Economics Review (2026). DOI: 10.1186/s13561-026-00818-9
Key medical concepts
Waist CircumferenceBody Mass Index
Clinical categories
Preventive medicineCommon illnesses & PreventionHealthy agingHealthy living Provided by Kanazawa University Who's behind this story?
Swati Mestri
Swati Mestri holds a bachelor's degree in Electronics Engineering and has worked as a content editor since 2019. She has experience editing research documents across technology, health care, and materials science, and has a particular interest in technology and space. Full profile →
Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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