11/29/2006 linhtinh2004@ Handbook of Epidemiology Wolfgang Ahrens Iris Pigeot Editors 123 Handbook of Epidemiology With 165 Figures and 180 Tables Editors Prof. Dr. rer. nat. Wolfgang Ahrens Prof. Dr. rer. nat. Iris Pigeot Division of Epidemiological Methods and Ethiologic Research and Division of Biometrie and Data Management Bremen Institute for Prevention Research and Social Medicine (BIPS) Linzer Str. 8−10 28359 Bremen Germany Library of Congress Control Number: 2004106521 ISBN 3-540-00566-8 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science+Business Media springeronline.com © Springer-Verlag Berlin Heidelberg 2005 Printed in Germany The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt fromthe relevant protective laws and regulations and therefore free for general use. Typesetting and Production: LE-T E X Jelonek, Schmidt & Vöckler GbR, Leipzig Cover design and production: deblik, Berlin Printed on acid-free paper 40/3142/YL 5 4 3 2 1 0 F orew ord WhenIwas learning epidemiologynearly50 yearsago,therewasbarelyonesuitable textbook and a handful of specialized monographs to guide me. Information and ideas in journals were pretty sparse too. That all began to changeabout 25 years ago and soon we had a plethora of books to consider when deciding on something to recommend to students at every level from beginners to advanced postgraduate s. This one is different from all the others. There has never been a single source of detailed descriptive accounts and informed discussions of all the essential aspects of practical epidemiology, written by experts and intended as a desk reference for mature epidemiologists who are in practice, probably already specializing in a particularfield, but in need of currentinformationand ideas about every aspect of the state of the art and science. W ithout a work likethis, it is difficul t to stayabreast of the times. A comprehensive current ov erview like this where each chapter is written by acknowledged experts chosen from a rich int ernational pool of talent and expertise makes the task considerably easier. It had been a rare privilege to receive and read the chapters as they have been written and sent to me through cyberspace. Each added to my enthusiasm for the project. I know and have a high regard for the authors of many of the chapters, and reading the chapters by those I did not know has given me a high regard for them too. The book has a logical framework and structure, pr oceeding from sections on concepts and methods and statistical methods to applications and fields of current resear ch. I have learned a great deal from all of it, and furthermore I have enjoyed reading these accounts. I am confident that many others will do so too. John M. Last Emeritus professor of epidemiology University of Ottawa, Canada Preface The objective of this book is to provide a comprehensive overview of the field of epidemiology, bridging the gap between standard textbooks of epidemiology and publications for s pecialists with a narrow focus on specific areas. It reviews the key issues, methodological approaches and statistical concepts pertinent to the field for which the reader seeks a detailed overview. It thus serves both as a first orientation for the interested reader and a starting point for an in-depth study of a specific area, as well as a quick reference and a summarizing overview for the expert. The handbook is intended as a reference source for professionals involved in health research, health reporting, health promotion, and health system adminis- tration and related experts. It covers the major aspects of epidemiology andmay be consulted as athorough guide for specific topics. It is therefore of interest for public health re searchers, physicians, biosta tisticians, epidemiologists, and executives in health services. The broad scope of the book is reflected by four major parts that facilitate an integration of epidemiological concepts and methods, statistical tools, applica- tions, and epidemiological practice. The various facets are presented in 39 chapters and a general introduction to epidemiology. The latter pr ovides the framework in which all other chapters are embedded and gives an overall picture of the whole handbook. It also highlights specific aspects and reveals the interwoven nature of the various research fields and disciplines related to epidemiology. The book covers topics that are usually missing from standard textbooks and that are o nly marginally represented in the specific literature, such as ethical aspects, practical fieldwork, health services research, epidemiology in developing countries, quality control, and good epidemiological practice. It also covers innov ativ e areas, e.g., molecular and genetic epidemiology, modern study designs, and recent method- ological developments. Each chapter of the handbook serves as an introduction that allows one to enter a new field by addressing basic concepts, but without being too elementary. It also conveys more advanced knowledge and may thus be used as a reference source VIII Preface for the reader who is familiar with the given topic by reflecting the state of the art and future prospects. Of course, some basic understanding of the concepts of probability, sampling distribution, estimation, and hypothesis testing will help the reader to profit from the statistical conc epts primarily presented in Part II and from the c omprehensive discussion of empirical methods in the other parts. Each chapter is intended to stand on its own, giving an overview of the topic and the most important problems and app roaches, which are supported by examples, practical applications, and illustrations. The basic concepts and knowledge, stan- dard procedures and methods are presented, as well as recent advances and new perspectives. The handbook provides refer ences both to introductory texts and to publica tions for the advanced reader. The editors dedicate this handbook to Professor Eberhard Greiser, one of the pioneers of epidemiology in Germany. Heis thefounder of the Bremen Institute for Prevention Research and Social Medicine (BIPS), which is devot ed to research into the causes and the prevention of disease. This institute, which started as a small enterprise dedicated to cardiovascular prevention, has grown to become one of the most highly regarded research institutes for epidemiology and public health in Germany. For almost 25 years Eberhard Greiser has been a leader in the field of epidemiology, committing his professional career to a critical appraisal of health practices for the benefit of us all. His major interests have been in pharmaceutical care and social medicine. In recognition of his contributions as a resear cher and as a policy advisor to the advancement of the evolving field of epidemiology and public health in Germany we take his 65th birthday in November 2003 as an opportunity to acknowledge his efforts by editing this handbook. The editors are indebted to knowledgeable experts for their valuable contribu- tions and their enthusiastic support in producing this handbook. We thank all the colleagues who critically reviewed the chapters: Klaus Giersiepen, Cornelia Heit- mann, Katrin Janhsen, Jürgen Kübler, Hermann Pohlabeln, Walter Schill, Jürgen Timm, and especially Klaus Krickeberg for his never-ending efforts. We also thank Heidi Asendorf, Thomas Behren s, Claudia Brünings-Kup pe, Andrea Eberle, Ronja Fo raita, Andrea Gottlieb, Frauke G ünther, Carola Lehmann, Anette Lübke, I nes Pelz, Jenny Peplies, Ursel Prote, Achim Reineke, Anke Suderburg, Nina Wawro, and Astrid Zierer for their technical support. Without the continuous and outstanding engagement of Regine Albrecht – her patience with us and the contributors and her remarkable autonomy – this volume would not have been possible. She has devo ted many hours to our handbook over and above her other responsibilities as administrative assistant of the BIPS. Last but not least we are deeply grat eful to Clemens Heine of Springer for his initiative, support, and advice in realizing this pro ject and for his confidence in us. Bremen June 2004 Wolfgang Ah rens Iris Pigeot Table of Contents An Introduction to Epidemiology Wolfgang Ahrens, Klaus Krickeberg, Iris Pigeo t 1 I. Concepts and Methodological Approaches in Epidemiology I.1 Basic Concepts K enneth J. Rothman, Sander Greenland 43 I.2 Rates, Risks, Measures of Association and Impact Jacques Benichou, Mari Palta 89 I.3 Descriptive Studies D. Maxwell Parkin, Freddie Bray 157 I.4 Use of Disease Registers Måns Rosén, T imo Hakulinen 231 I.5 Cohort Studies Anthony B. Miller, David C. Goff Jr., Karin Bammann, Pascal Wild 253 I.6 Case-Control Studies No rman E. Breslow 287 I.7 Modern Epidemiologic Study Designs Philip H. Kass, Ellen B. Gold 321 I.8 Intervention Trials Silvia Franceschi, Martyn Plummer 345 I.9 Confounding and Interaction Neil Pearce, Sander Greenland 371 I.10 Epidemiological Field Work in Population-Based Studies Arlène Fink 399 I.11 Exposure Assessment Sylvaine Cordier, Patricia A. Stewart 437 I.12 Design and Planning of Epidemiological Studies Pascal W ild 463 I.13 Quality Control and Good Epidemiological Practice Preetha Rajaraman, Jonathan M. Samet 503 X Table of Contents II. Statistical Methods in Epidemiology II.1 Sample Size Determination in Epidemiologic Studies Ja net D . Elashoff, Stanley Lemesho w 559 II.2 General Principles of Data Analysis: Continuous Covariables in Epidemiological Studies Heiko Becher 595 II.3 Regression Methods for Epidemiologic Analysis Sander Greenland 625 II.4 Survival Analysis Peter D. Sasieni 693 II.5 Measurement Error J e ffrey S. Buzas, Leonard A. Stefanski, Tor D. Tosteson 729 II.6 Missing Data Geert Molenberghs, Caroline Beunckens, Ivy Jansen, Herbert Thijs, Geert Verbeke, Michael G. Kenwar d 767 II.7 Meta-Analysis in Epidemiology Maria Blettner , Peter Schlattmann 829 II.8 Geographical Epidemiology John F. Bithell 859 III. Applications of Epidemiology III.1 Social Epidemiology Tarani Chandola, Michael Marmot 893 III.2 Occupational Epidemiology Franco Merletti, Dario Mirabelli, Lorenzo Richiardi 917 III.3 Environmental Epidemiology Lothar Kreienbrock 951 III.4 Nutritional Epidemiology Dorothy Mackerras, Barrie M. Margetts 999 III.5 Reproductive Epidemiology Jør n Olsen, Olga Basso 1043 III.6 Molecular Epidemiology Pa olo Vineis, Giuseppe Matullo, Marianne Berwick 1111 III.7 Genetic Epidemiology Heike Bickeböller 1139 III.8 Clinical Epidemiology HolgerJ.Schünemann,GordonH.Guyatt 1169 III.9 Pharmacoepidemiology Edeltraut Garbe, Samy Suissa 1225 Table of Contents XI III.10 Screening Anthony B. Miller 1267 III.11 Community-Based Health Promotion John W. Farquhar, Stephen P. Fortmann 1305 IV. Research Areas in Epidemiology IV.1 Infectious Disease Epidemiology Susanne Straif-Bourgeo is, Raoult Ratard 1327 IV.2 Cardiovascular Diseases Darwin R. Labarthe 1363 IV.3 Cancer Epidemiology P aolo Boffetta 1405 IV.4 Musculoskeletal Disorders Hilkka Riihimäki 1443 IV.5 Health Services Research Thomas Schäfer, Christian A. Gericke, Reinhard Busse 1473 IV.6 Epidemiology in Developing Countries Klaus Krickeberg, A nita Kar, Asit Kumar Chakraborty 1545 IV.7 Ethical Aspects of Epidemiological Research Hu bert G. Leufkens, Johannes J.M. van Delden 1591 List of Contributors 1613 [...]... radiology, and pharmacology, and third from public health sciences with epidemiology as their core Definition and Purpose of Epidemiology One of the most frequently used definitions of epidemiology was given by MacMahon and Pugh (1970): Epidemiology is the study of the distribution and determinants of disease frequency in man The three components of this definition, i.e frequency, distribution, and determinants... These techniques augment the standard tools of epidemiology in the investigation of low-level risks, risks imposed by complex exposures, and the modification of risks by genetic factors The use of such biomarkers of exposure and effect has led to a boom of the so-called molecular epidemiology (Schulte and Perera 1998; Toniolo et al 1997; Chap III.6 of this handbook) , a methodological approach with early... representation of the geographic distribution of diseases has recently taken an upsurge with the advent of geographical information systems (Chap II.8) Forerunners of the use of inferential statistics in various parts of epidemiology are also mentioned in Sect 2.1 Thus, in the area of clinical trials, the efficacy of citrus fruit to cure scurvy was established by purely statistical reasoning In the realm of causal... investigation of an association at the individual level is considered to be less vulnerable to be mixed up with the effect of a third common factor For a detailed discussion of this issue we refer to Sect 4.2.5 of Chap I.3 of this handbook Studies that are primarily designed to describe the distribution of existing variables that can be used for the generation of broad hypotheses are often classified... action of several factors as described by the concepts of interaction and confounding play a prominent role (Chap I.9) The use of modern statistical ideas and tools has thus allowed a conceptual and practical unification of the many parts of epidemiology The same statistical models and methods of analysis (Chaps II.1 to II.8) are being used in all of them Let us conclude with a final example of this... typically applied in epidemiological studies (Part II) to the majority of important applications (Part III) and to special fields of research (Part IV) Within these four parts, its structure is to a large extent determined by various natural subdivisions of the domain of epidemiology These correspond mostly to the elements of the definition of epidemiology as given by Last and quoted above, namely study, distribution,... trials of preventive interventions, another part of experimental epidemiology The idea of the purpose of a study gives rise to another, less clearly defined, subdivision, i.e explanatory vs descriptive epidemiology The objective of an explanatory study is to contribute to the search of causes for health-related events, in particular by isolating the effects of specific factors This causal element is lacking... the focus, we speak of “outcome-oriented” studies, in which risk factors for the specific disease are searched for Finally, some subfields of epidemiology are defined by a particular type of application such as prevention, screening, and clinical epidemiology Let us now have a short look at the chapters of the handbook Part I contains general concepts and methodological approaches in epidemiology: After... and genetic (III.7) Clinical epidemiology An Introduction to Epidemiology 9 (III.8) and pharmacoepidemiology (III.9) are large areas where knowledge about the interplay between many types of exposures, e.g therapies, and many types of outcomes, usually diseases, is being exploited A similar remark applies to the classical domains of screening in view of early detection of chronic diseases (Chap III.10)... population of Framingham, a small community in Massachusetts The study was initiated in 1949 to yield insights into causes of cardiovascular diseases (CVD) (see Chap IV.2 of this handbook) For this purpose, 5127 participants free from coronary heart disease (CHD), 30 to 59 years of age, were examined and then followed for nearly 50 years to determine the rate of occurrence of new cases among persons free of . 11/29/2006 linhtinh2004@ Handbook of Epidemiology Wolfgang Ahrens Iris Pigeot Editors 123 Handbook of Epidemiology With 165 Figures and 180 Tables Editors Prof. Dr. rer. nat. Wolfgang Ahrens Prof. Dr. rer too. John M. Last Emeritus professor of epidemiology University of Ottawa, Canada Preface The objective of this book is to provide a comprehensive overview of the field of epidemiology, bridging the. sciences with epidemiology as their core. Definition and Purpose of Epidemiology 1.1 One of the most frequently used definitions of epidemiology was given by MacMa- hon and Pugh (1970): Epidemiology