Nordic Population based cohorts from a GP perspective ?

Nordic Population based cohorts from a GP perspective?

Carsten Obel

Things that characterise a GP’s work

• Evaluates health in a life long perspective• Follows people over a long period of time• Deals with factors relevant for health that

goes beyond disease

Things that characterize a GP’s work

• Evaluates health in a life long perspective• Follow people over a long period of time• Deals with factors relevant for health that

goes beyond disease

• Same that characterise a population based cohort

The cohort idea and life perspective

The Framingham study

• In 1948 about 5000, aged 30-62 from the town of Framingham, Massachusetts

• Third generation enrolled 2005• The basis of our counceling in preventing CVD– Cholesterol, blodpressure, smoking

Nordic cohorts established in adulthood

• The Glostrup cohort (1964-)• Umeå, Stockholm, Tromsø, Oslo, Bergen,

Copenhagen, Aarhus and probably more

• The Danish Diet, cancer, health prolect– 57,000 participants– Focus on diet

The Northern Finland Birthcohort

• Established 1966 by professor Rantakillio• About 12,000 pregnant women enrolled week 24 of

pregnancy• Offspring follow until the age of 31• Similar cohort of children born 1985-6

Examples of Nordic birth cohorts

• The Northern Finnish birthcohorts (born 1966 & 1985-86)

• The Aarhus Birth cohort (born 1990-2009)• The national birth cohorts– Norway (born 1999-2008)– Denmark (born 1996-2003)

Aarhus Birth cohort 1990-2007%

Danish National Birth Cohort

• Established in collaboration with GP’s

• More than 100,000 children

• Telephone interviews• Biobank (3 full blood

samples)• Follow up to 7 years• 11 y follow up next

Example from DNBC

• Does infertility treatment cause offspring with problems?

• Zhu et al.– Malformations– Intrauterine growth retardation– Psychomotor development– Cerebral palsy, behavioural problems

• Subfecundity more than treatment matters

The Nordic Perspective

• Can we combine cohorts to gain further scientific value?

• Yes, if data are comparable– Retesting hypotheses– Study rare endpoints– Develop clinical tools

Example- A clinical tool to identify children in risk of overweight

• Overweight is a major public health problem• The preschool age is the most promising point of

attack• We need a tool to identify children at risk for

overweight

• The algoritm for risk assesment of CVD is extensively used in gereral practice

• Aim: To develop an algoritm to predict overweight in pre-school age

Framingham for kids?

• Cohorts– Aarhus Birth Cohort (90-92)– Northern Finnish Birth Cohort (85-86)

• Some of the potential predictive variables– Both parents BMI– Maternal smoking– Breastfeeding– Childs growth

Growth-pattern of Finnish children

Data from Northern Finnish Birth Cohorts. Marjo Riita Järvellin et al.

Conclusion

• We have large and well established cohorts in the Nordic countries

• In combination with the national registers the Nordic cohorts are unique

• Results from cohort studies could often be relevant for the GP’s work

• There is an added value of Nordic collaboration • Science would gain from more GP’s taking active

part in cohort studies