Current International Priorities in Health Research

Opportunities for Epidemiology

Henry Völzke

The Risk Transition

WHO 2009

www.hsph.harvard.edu

The Obesity Map, 2008

Finucane et al.; Lancet 2011

WHO 2009

WHO 2009

Yusuf et al., Lancet 2007

Known Risk Factors for MI

Keller et al., Nat Comm 2012

Risk Factors for Peptic Ulcer

- Stress- Alcohol- Smoking- Diet- Family History

wikipedia.org

Society Science

Epidemiology

• Disparities • Health care allocation• Preventive programs• Prognosis

• Risk factors• Predictors• Interactions• Subgroups

Life Expectancy

Quelle: Nationalatlas Bundesrepublik Deutschland

SHIP SNiP

Interventions

Epidemiology Clinical Chemistry

Dermatology

PsychiatryMicrobiology

NeurologyGastroenterolog

y

Endocrinology

RESEARCH NETWORK COMMUNITY MEDICINE

Cardiology

Pneumology

Radiology Molecular Medicine

Dentistry

Community Medicine

Economics

Objectives

1. Prevalence and incidence of common risk factors and diseases

2. Associations and interactions among common risk factors, subclinical disorders and diseases

N= 430820-79 years

Rügen

Use-dom

Stralsund

Greifswald

Nordvorpommern

OstvorpommernSchleswig-

Holstein

Hamburg

BerlinNiedersachsen

Sachsen-Anhalt

Mecklenburg-Vorpommern

Brandenburg

1997-2001

SHIP-0

Baseline

SHIP-1

5y Follow-up

SHIP-2

10y Follow-up

SHIP-TREND

Baseline

2002-2006 2008-2012

n= 2333(63.5%)

n= 4422(50.3%)

n= 4308 (68.8%)

n= 3300 (84.5%)

Völzke et al.; Int J Epidemiol 2011

Hegenscheid et al.; Röfo 2009

Gloger et al.; Magn Resonance Tomography 2010

GWA Uric Acid

Doering, et al. Nat Genetics 2008

Metabolomics

10-year Trend BMI and Obesity

Polzer et al., Int J Cardiol 2012

Missing Teeth and Mortality

Publications1-2 publications/ week, mean impact factor ~7

• Cardiovascular Disease (JAMA, Lancet, Nat Genetics, Circulation, JACC, Eur Heart J, ATVB, Hypertension, Nat Rev Cardiol)

• Metabolic Syndrome (Nature, Science, Nat Genetics, Diabetes, Diab Care, JCEM)

• Gastroenterology (Nat Genetics, Gastroenterology, Gut, Hepatology, Am J Gastroenterol)

• 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, Blood, Am J Hum Genetics)

• Neurology (Lancet, Nat Genetics, Arch Intern Med, Stroke)

• Pneumology (Nat Genetics, Eur Respiratory J, Chest)

• Nephrology (Nat Genetics, J Am Soc Nephrol, Kidney Int)

• Epidemiology (Science, Am J Epidemiol, Int J Epidemiol, J Clin Epidemiol, Eur J Epidemiol)

Publications1-2 publications/ week, mean impact factor 7

• Cardiovascular Disease (JAMA, Lancet, Nat Genetics, Circulation, JACC, Eur Heart J, ATVB, Hypertension, Nat Rev Cardiol)

• Metabolic Syndrome (Nature, Science, Nat Genetics, Diabetes, Diab Care, JCEM)

• Gastroenterology (JAMA, Nat Genetics, Gastroenterology, Gut, Hepatology, Am J Gastroenterol)

• 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)

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

Data Collection

Data Dictionary

Training Certification

Quality Monitoring

Data Clean-up

Data Transfer Infr

ast

ruct

ure

(D

evi

ces,

Co

mp

ute

rs, F

aci

litie

s)

Communication Structures

Web-based Certification System

Data Monitoring System

BASELINE

Comprehensive,standardized phenotyping

Subclinical and overt parameters

Biobanking

OMICs

FOLLOW-UP

Subclinical and overt

phenotypes

Morbidity

Mortality

CardiovascularHeart failure(systolic & diastolic)

RenalRenal insufficiency

CerebrovascularStroke / TIA

MetabolismMetabolic syndrome & co-morbidities

Comparison to SHIP cohorts

Comparison to SHIP cohorts

…

Recruitment of patient cohorts(in accordance with methods and quality standards of SHIP)

InternationalThe Vision

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