Current International Priorities
in Health Research
Opportunities for Epidemiology
Henry Völzke
The Risk Transition
WHO 2009
The Obesity Map, 2008
www.hsph.harvard.edu
Finucane et al.; Lancet 2011
WHO 2009
WHO 2009
Known Risk Factors for MI
Yusuf et al., Lancet 2007
Keller et al., Nat Comm 2012
Risk Factors for Peptic Ulcer
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wikipedia.org
Stress
Alcohol
Smoking
Diet
Family History
Society
Science
Epidemiology
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Disparities
Health care allocation
Preventive programs
Prognosis
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Risk factors
Predictors
Interactions
Subgroups
Quelle:
Nationalatlas
Bundesrepublik
Deutschland
Life Expectancy
RESEARCH NETWORK COMMUNITY MEDICINE
Epidemiology
Community Medicine
Radiology
Microbiology
Clinical Chemistry
Molecular
Medicine
SHIP
SNiP
Interventions
Psychiatry
Cardiology
Dentistry
Pneumology
Dermatology
Economics
Neurology
Gastroenterology
Endocrinology
Objectives
1. Prevalence and incidence of common
risk factors and diseases
2. Associations and interactions among
common risk factors, subclinical
disorders and diseases
Rügen
Stralsund
Nordvorpommern
Greifswald
Ostvorpommern Usedom
SchleswigHolstein
Hamburg
Niedersachsen
Mecklenburg
Vorpommern
Brandenburg
Berlin
SachsenAnhalt
N= 4308
20-79 years
SHIP-0
SHIP-1
SHIP-2
Baseline
5y Follow-up
10y Follow-up
n= 4308
(68.8%)
n= 3300
(84.5%)
n= 2333
(63.5%)
SHIP-TREND
Baseline
n= 4422
(50.3%)
1997-2001
2002-2006
2008-2012
Völzke et al.; Int J Epidemiol 2011
Hegenscheid et al.; Röfo 2009
Gloger et al.; Magn Resonance Tomography 2010
GWA Uric Acid
Metabolomics
Doering, et al. Nat Genetics 2008
10-year Trend BMI and Obesity
Missing Teeth and Mortality
Polzer et al., Int J Cardiol 2012
Publications
1-2 publications/ week, mean impact factor ~7
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Cardiovascular Disease (JAMA, Lancet, Nat Genetics, Circulation, JACC, Eur Heart J,
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Metabolic Syndrome (Nature, Science, Nat Genetics, Diabetes, Diab Care, JCEM)
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Gastroenterology (Nat Genetics, Gastroenterology, Gut, Hepatology, Am J Gastroenterol)
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Thyroidology (JAMA, Arch Intern Med, Am J Hum Genetics, JCEM, Thyroid)
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Psychiatry (JAMA, Nat Genetics, Am J Psychiatry, Biol Psychiatry, Mol Psychiatry)
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Dentistry (Diab Care, Dent Res, J Clin Periodontol, Thromb Haemost, J Hypertens)
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Haematology & Oncology (Nat Genetics, Blood, Am J Hum Genetics)
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Neurology (Lancet, Nat Genetics, Arch Intern Med, Stroke)
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Pneumology (Nat Genetics, Eur Respiratory J, Chest)
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Nephrology (Nat Genetics, J Am Soc Nephrol, Kidney Int)
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Epidemiology (Science, Am J Epidemiol, Int J Epidemiol, J Clin Epidemiol, Eur J Epidemiol)
ATVB, Hypertension, Nat Rev Cardiol)
Publications
1-2 publications/ week, mean impact factor 7
•
Cardiovascular Disease (JAMA, Lancet, Nat Genetics, Circulation, JACC, Eur Heart J,
•
Metabolic Syndrome (Nature, Science, Nat Genetics, Diabetes, Diab Care, JCEM)
•
Gastroenterology (JAMA, Nat Genetics, Gastroenterology, Gut, Hepatology, Am J
•
Thyroidology (JAMA, Arch Intern Med, Am J Hum Genetics, JCEM, Thyroid)
•
Psychiatry (JAMA, Nat Genetics, Am J Psychiatry, Biol Psychiatry, Mol Psychiatry)
•
Dentistry (Diab Care, Dent Res, J Clin Periodontol, Thromb Haemost, J Hypertens)
•
Haematology & Oncology (Nat Genetics, Am J Hum Genetics)
•
Neurology (Lancet, Arch Intern Med, Stroke)
•
Pneumology (Nat Genetics, Eur Respiratory J, Chest)
•
Nephrology (Nat Genetics, J Am Soc Nephrol, Kidney Int)
•
Epidemiology (Int J Epidemiol, Am J Epidemiol, J Clin Epidemiol, Eur J Epidemiol)
ATVB, Hypertension, Nat Rev Cardiol)
Gastroenterol)
Methods of Quality Management
• Standard Operating Procedures for each examination method
• Training of potential observers in hospitals and the SHIP
examination center
• Reader certification (2 x 25 images)
– Intra- and Inter-Reader-Variability
• Observer certification (2 x 12 volunteers before and 2 x 6
volunteers semiannually during the study)
– Intra- and Inter-Observer-Variability
• Calibration and re-certification
• Paper-free data documentation
• Semiannual quality reports to the Data Safety & Monitoring
Committee
Proband Management
Tasks
Training Certification
Data Collection
Communication Structures
Quality Monitoring
Data Clean-up
Data Transfer
Infrastructure (Devices, Computers, Facilities)
Data Dictionary
Web-based Certification System
Data Monitoring System
Recruitment of patient cohorts
(in accordance with methods and quality standards of SHIP)
Comparison to
SHIP cohorts
Cardiovascular
Heart failure
(systolic & diastolic)
BASELINE
Metabolism
Metabolic syndrome
& co-morbidities
Comprehensive,
standardized
phenotyping
Renal
Renal insufficiency
Subclinical and
overt parameters
Comparison to
SHIP cohorts
FOLLOW-UP
Subclinical
and overt
phenotypes
Morbidity
Biobanking
Cerebrovascular
Stroke / TIA
…
OMICs
Mortality
The Vision
International
To build up an international
consortium to collect multi-national
population data
Collaborative use of SHIP instruments
for standardization and quality
assurance
To achieve best possible comparability
of phenotypic data
Bassett & Winter-Nelson 2010
Bassett & Winter-Nelson 2010
Potential Bias in Global Epi Research
Measure
Methodological Differences
Obesity
Self-reported? Measured? With or without clothes?
Abdominal Obesity
Correct position? Horizontal measurement? Observer
certification?
Diabetes
Self-reported? Physician‘s diagnosis? Validated?
Glucose & Lipids
Fasting or not? Pre-analytic handling? Storage? Lab method?
Goiter
Ultrasound device and probe? Observer certification?
Brain atrophy
MR/CT device? Fasting or not? Reader certification?
Even high-quality epidemiological studies usually
take less care on external validity!
International
Santiago de Chile
Pomerode
voelzke@uni-greifswald.de