第四章队列研究带备注.

DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity队列研究CohortStudy哈尔滨医科大学流行病学教研室Departmentofepidemiology，HarbinMedicalUniversityDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity队列研究CohortstudyIncidencestudiesLongitudinalstudiesFollow-upstudiesProspectivestudies发病率研究纵向研究随访研究前瞻性研究DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityOutlineExampleDesignandimplementMeasuresofRiskDatasortandanalysisBiasandControlAdvantage，disadvantage概述实例研究设计与实施资料的整理与分析偏倚及控制优缺点队列研究CohortstudyDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity队列研究简史定义与目的原理与类型HistoryofcohortstudyDefinitionandPurposePrincipleandTypesDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity历史History起源OriginsGraunt(17thcentury)usedcross-sectionalmortalitydatatoreconstructlifehistoryusinglife-tablemethodsGraunt(17世纪)用横断面死亡资料，用寿命表方法构建生命史Farr(19thcentury)advancedtheuseoflife-tablemethodsaanindicatorofpopulationhealthFarr（19世纪）将寿命表方法发展为人群健康的指标Insuranceindustrystudy1870–1899保险业研究1870–1899DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityTuberculosis(20thcentury)结核（20世纪）WHFrostperformedthefirstretrospectivecohortstudyinacohortof132homeswithtuberculosisWHFrost在有结核的132个家庭的队列开展第一个回顾性队列研究Usedperson-yearstoestimateattackrates用人年来估计罹患率历史HistoryDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityWHFrostinitiatedprospectivecohortstudyoftuberculosisinWilliamsoncounty,TennesseeWHFrost在德州启动有关结核的前瞻性队列研究历史HistoryDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityFraminghamstudyofcardiovasculardisease,1948Japaneseatomicbombsurvivors,1946Britishphysicianstudy,1950sColoradoPlateauuraniumminers,1950sAniline-dyeoccupationalcohort,1954Asbestosexposureandlungcancermortality1965RetrospectivecohortstudiesProspectivecohortstudiesDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityNursesHealthstudy,1976topresentBritishphysicianstudyMulti-centerAIDSCohortStudyMACS,1984–1999CurrentStudiesDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityAnepidemiologicdesigninwhichtheincidenceofadisease(orcondition)iscomparedamongexposedandunexposedindividuals是比较暴露与非暴力人群发病率的一种流行病学设计定义What’thecohortstudyDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityCohortStudyBeginwithdisease-freepatientsClassifypatientsasexposed/unexposedRecordoutcomesinbothgroupsCompareoutcomesusingrelativerisk从没有疾病人群开始将研究对象分为暴露与非暴露组记录两组结局用相对危险度比较结果DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityCohortStudyKeyPoint:Presenceorabsenceofriskfactorisdeterminedbeforeoutcomeoccurs.DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityWhatisacohort?队列Cohort-Latinwordforoneofthe10divisionsofaRomanlegionAgroupofindividualssharingsameexperiencefollowedupforaspecifiedperiodoftimeExamplesbirthcohortoccupationalcohortchemicalplantworkers队列拉丁语原意是指古罗马军团中的一个分队一组人群有共同经历随访一特定时间例如出生队列职业队列DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity暴露指接触过某种物质、具备某种特征或处于某种状态。危险因素泛指能引起某特定不良结局,或使其发生的概率增加的因子，包括个人行为、生活方式、环境和遗传等多方面的因素。ExposurecontactsomematerialofbeinginsomestatusRiskfactorisavariableassociatedwithanincreasedriskofdiseaseorinfection.Includingbehavior,lifestyle,environmentalandgeneticfactorandsoon.DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity目的PurposeDescribeincidenceofoutcomesovertime,naturalhistoryofdiseaseDeterminecausalrelationshipsbetweenthoseoutcomesandexposures(riskorprognostic)factors.描述随着时间变化结果的发生率，疾病自然史确定结果与暴露（危险或预后）因素间的因果关系DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity目的PurposeDetermineaprognosisEvaluatenewtherapiesanddiagnosticsEvaluatescreeningprocedures确定预后评价新的治疗与诊断方法评价筛检过程DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityFraminghamstudyofcardiovasculardiseaseIndividuals30–62yearsoldincommunityatriskfordiseaseFramingham,MA,1948topresentExamplesofcohortstudyDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityGoaltoelucidatethenaturalhistoryofHIV/AIDS5000gaymen,volunteers5citiesinUS1984–ExtensiveevaluationsQuestionnairePhysicalexaminationLaboratorytestingMulti-CenteredAIDSCohortStudyDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversitySource:partiallyadaptedfromWHO,1993R1R0A1A0IncidencerateamongexposedIR1=A1(no.exposedcases)/R1(totalperson-timeexposed)IncidencerateamongunexposedIR0=A0(no.unexposedcases)/R0(totalperson-timeunexposed)Incidencerateratio(exposedvs.unexposed)=IR1/IR0=(A1/A0)/(R1/R0)PrincipleofaCohortStudyDepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversityCharacteristics特点ObservationalCategorybyexposureNeedcontrolProspective观察性研究根据暴露分组需要对照前瞻性DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity类型TypesBasedonrecruittimeofstudysubjectProspectivestudyv.s.RetrospectiveStudyBasedonthetypeofcohortFixedcohortv.s.Dynamiccohort依据研究对象召集的时间前瞻性研究VS回顾性依据队列的类型固定队列VS动态队列DepartmentofEpidemiologyPublicHealthCollegeHarbinMedicalUniversity类型