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1、DesignofcohortstudiesforairpollutionhealtheffectsBertBrunekreef,PhDProfessorofEnvironmentalHealthInstituteforRiskAssessmentSciences(IRAS)UniversityofUtrechtPOBox801763508TDUtrechtNetherlandsPhone31302535400FAX31302535077EMAILB.Brunekreef@vet.uu.nl1.What’sacohortstudy?““Inepid
2、emiology,thewordcohortisoftenusedtodesignateagroupofpeoplewhoshareacommonexperienceorcondition(…).Often,therearetwocohortsinthestudy,oneofthemisdescribedastheexposedcohort,theotheristhoughtofastheunexposed,orreference,cohort;iftherearemorethantwocohorts,eachmaybecharacterized
3、byadifferentlevelortypeofexposure.””(1).Inthesewords,cohortstudiesarebeingintroducedinoneofthemostauthoritativetextbooks,‘ModernEpidemiology’byRothmanandGreenland.Inacohortstudy,theincidenceofdiseaseand/ordeathisstudiedintherespectivecohortsoveraperiodoftime.Theycanbeeitherre
4、trospective(lookingbackintime)orprospective(followingcohortsoveracertainperiodoftime).Retrospectivecohortstudiesoftenusestudypopulationsthatweredefinedinthepastin,forexample,atwinregistryorinemploymentrecords,andthatcanstillbetracedtoday.Prospectivecohortstudieshavetheadvanta
5、geofoptimalcontroloverthedesigntoanswertheprincipalstudyhypothesis.Prospectivecohortstudiesareinprincipleattractivetostudyhealtheffectsofairpollutionbecausepitfallsofotherdesignscantosomeextentbeavoided.Pitfallsof‘ecologic’studiesrelatingairpollutiontopublichealthindicatordat
6、a(suchasmortalitystatistics)includeabsenceofinformationattheindividuallevelaboutpotentialconfounderssuchassmoking,dietaryhabitsandoccupationalexposures.Pitfallsofcross-sectionalandcase-controlpopulationstudiesincludeabsenceofhistoricexposuredataandhence,limitedpossibilitiesto
7、establishthetemporalorderofcauseandeffect.Prospectivecohortstudiesinwhichasuitablylargenumberofsubjectsarebeingfollowedovertime,however,areexpensive;also,longperiodsoffollow-upareusuallyneededtocometofirmconclusions.Inthiscontribution,somedesignissuesrelatedtocohortstudiesofa
8、irpollutionandhealthwillbediscussed.2.Examplesofrecentcohortstudieso
