Elsevier

Annals of Epidemiology

Volume 12, Issue 7, October 2002, Pages 445-451
Annals of Epidemiology

Original report
The Logic for a Conception-to-Death Cohort Study

https://doi.org/10.1016/S1047-2797(01)00314-3Get rights and content

Abstract

This article proposes that the nation undertake a study of a cohort which will be followed from pregnancy to death– a research project that will require more than 100 years. The project would take advantage of the recent completion of the human genome study, the accelerating development of new non-invasive measurement technologies, as well as new information about the complexity and long duration of the causal period for diseases. This complexity involves increasing awareness of long developmental processes which do not fit the typical picture of disease and that do not always have an obvious demarcation of disease onset. Appreciation for the complexity of the web of causation has expanded as the human genome project has unfolded, because it has become increasingly apparent how intimately the action of genetic material depends on contingencies of the individual interacting with the environment; and that the chances of discovering the action of genes, singly or in clusters, will be greatly enhanced by the ability to characterize the environment during distinct developmental periods. Likewise, the ability to understand environmental influences will depend on knowledge of genes. Additionally, there is new evidence for here-to-fore unsuspected comorbidities, the understanding of which would be greatly benefitted by a conception-to-death cohort study with a broad range of health outcomes. In many cases these developmental processes, contingencies, and comorbidities involve long causal periods, approaching that of the entire human lifespan. A conception-to-death cohort study would provide information on disease, human development, environmental risk and protective factors, and public health that will not be achievable by any other research design.

Section snippets

Selected Abbreviations and Acronyms

AIDS = Acquired Immune Deficiency Syndrome

DNA = deoxyribonucleic acid

ECA = economic catchment area

HIV = Human Immunodeficiency Virus

NIH = National Institutes of Health

RNA = ribonucleic acid

Conclusion

When do diseases begin? How do genes and environment interact over the life course to influence the occurrence of diseases? How do diseases, and the etiologic processes underlying them, affect one another? How do we study these questions when the causal period is approaching that of the human life span itself? Reviewing these questions, it seems curious or even paradoxical that we have not already begun such a study. We have studied thousands of generations of fruit flies, for example; and

Acknowledgements

The paper was prepared for the Rema Lapouse Award Lecture, American Public Health Association, Boston, Massachusetts, November 2000. Preparation was greatly aided by discussion with the following persons, who have no responsibility for the contents: James Anthony, Harout Armenian, Leon Gordis, Janet Hardy, Larry Mayer, Alvaro Muñoz, Gerald Nestadt, Peter Scheidt, and Peter Zandi. Salary support for this work came from NIMH grants MH47447 and MH53188.

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