Studies with Secondary Data in Taiwan

Application in Life Course Epidemiology

Chung-Yi Li, Ph.D.

Professor

Department and Graduate Institute of Public Health

College of Medicine, National Cheng Kung University

Outlines

• Background: Life-course perspectives• Some Examples • Perspectives on life course

epidemiological studies in Taiwan

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Background: Life-course perspectives

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(a): biological pathway(b): social pathway(c): socio-biological(d): bio-social

Life Course Approach to Health

• Emphasizes a temporal and social perspective– looking back across an

individual’s or a cohort’s life experiences or across generations for clues to current patterns of health and disease

– recognizing that both past and present experiences are shaped by the wider social, economic and cultural context. 5

Life Course Approach (I)• The “fetal origins hypothesis” (programming)

which links conditions in the intrauterine environment to the later development of adult chronic disease (Barker, 1998).– Critical periods of growth and development– Sensitive developmental stages when social and

cognitive skills, habits, coping strategies, attitudes and values are more easily acquired than at later ages.

– Biological and social experiences may act interactively, to attenuate or exacerbate long term risks to health

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Life Course Approach (II)

• Cumulative effects on later health may occur not only across an individual’s life but also across generations (Lumey 1998; Davey Smith 2000).

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Three Models (hypotheses) • Critical period

– Barker’s “Fetal Programming Theory”– Sensitivity period

• Accumulation of risk– Exposures or insults gradually accumulate to

increase the risk of chronic disease and mortality

• Social mobility– Downward or upward inter-generational or

intra-generational mobility9

Key Concepts

• Health and risk of premature death are determined by socioeconomic factors acting throughout life

• Socioeconomic influences on particular causes of death may have different critical times

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Model Paper

Disentangle “accumulation”, “critical point”, “social mobility”

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Trajectory of Exposure

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Trajectory in Detail

Effect of “risk accumulation”

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Effect of “critical period”

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Effect of “social mobility”

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NSHD• It began with interviews of more than

13,000 mothers who had given birth in the United Kingdom during one week of March 1946.NCDS

• Attempts to trace 17,000 members of the 1958 birth cohort to get information concerning their physical, educational and social development.

• During the period 2002-2004, genetic information on participants was also obtained to examine the genetic effects on common traits and diseases.

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BCS70• Monitoring the development of

17,000 babies born in the UK in one particular week in April 1970

MCS• Following the lives of 19,000 babies

born in the year 2000–2001. • Collecting information on child

development, social stratification and family life in order to identify possible advantages and disadvantages that the children are facing.

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Some Examples

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Two Articleson

Assessment of Risk Accumulation

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LBW

Lower learning achievement

Lower family SES

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Study Design: A Cohort Study

• Between September 1, 1985 and August 31, 1989, a total of 1 623 038 live births were registered in the Taiwan Birth Registry (TBR).– TLBW: >=37 GW and BW <2500 g;

N=37,925– PNBW: <37 GW and BW >=2500 g;

N=22,080 – PLBW: <37 GW and BW <2500 g; N=

30,594– Reference group: A random sample of

TNBW births; N= 90,599

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Outcome Measures

• Four study groups were linked to the first-time BCT test scores of 3 different disciplines.

• The rate of successful linkage was– TLBW: – PNBW: – PLBW: 84.5% (lowest)– Reference group: 92.5% (highest)

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LBW

Lower learning achievement

No apparent risk accumulation risk was found for two risk factors for lower learning achievement of Taiwanese adolescents

Lower family SES

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Study design• Study cohort

– 312,335 live singletons registered in the Taiwan Birth Registry between Sep. 1st 1989 and Aug. 31st 1990. 42.9% are first births

• Linkage to 2005 BCT score dataset– Successful linkage rate was the highest

(92.3%) and lowest (88.3%) for the second and the >=fifth births, respectively

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Higher birth order

Lower learning achievement

A risk compromise was found for the two risk factors for lower learning achievement of Taiwanese adolescents

Lower family SES

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Two Paperson

Assessment of Critical Periods

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LBW at birth for mothers

Deliver a LBW infant

Consequences of mal-adaptation to pregnancy

cigarette smoking and hypertension

Barker’s fetal origins hypothesis

The LBW-Cardiovascular Disease Model

CVD

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Deliver a LBW infant

CVD

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The LBW-Cardiovascular Disease Model

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Study Design• Retrospective cohort study (nearly 30

years)• Study cohorts

– 1,400,383 singletons from primigravida were registered in TBR, 1978-1987

– 85,285 mothers delivered LBW infants – 1,315,098 gave birth to NBW infants

• Study cohorts were linked to mortality registry (up to 2007)

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Deliver a LBW infant

Consequences of mal-adaptation to pregnancy ???

cigarette smoking and hypertension ???

CVD

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Study Cohort & Nested Case-control Design

All 5,654,833 live births registered in Taiwan

between 1978 and 1993, followed to the end of

2008

3,984 suicides

aged 15-30 during

1993–2008

A total of 119,520 controls

For each case, 30 controls with the

same sex and birth year, who

were alive at the date of suicide were selected

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Incomplete Consideration of Potential Confounders

• Psychological comorbidity prior to suicide• Major illnesses• Familial clustering of psychological illness• Behaviors disorders

Live Birth Registry

•Perinatal risk factors

NHI Data

• Psychological disease

• Major illnesses

Death Registry

• Causes of death

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Some Other Examples

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Perspectives on life course epidemiological studies in Taiwan

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Birth registry

Vaccination registry

Inf. Dis. registry

National Health

Insurance claims data

Cancer registry

Cause of death

Catatrophic illnesses registry

Population-based Health Data in Taiwan

Birth registry

Cause of death

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(Live) Birth Registry

Household Registration

National Nutritional /

Health Surveys

National Health

Insurance

Cancer Registry

Death Registry

Life Course Approach Since 1978/1994

Since 1996 Since 1982Since 1979

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台灣「全民健康保險學術研究資料庫」大型追蹤 --證明抗病毒藥物可有效降低 B 型肝炎相關肝癌復發率及死亡率刊登世界頂尖的「美國醫學會雜誌(JAMA) 」成果深具臨床意義

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Hypothesis

Parental mental

illnesses

1. Adverse birth outcome

2. Inadequate care & attention

1. Natural causes of death in childhood

2. Unnatural causes of death

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5-Year Follow-up, Up to 2008

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