Zusammenfassung
Kohortenstudien, das heißt Langzeitbeobachtungen an ausgewählten Bevölkerungsgruppen, bieten unter den beobachtenden Studiendesigns die höchstmögliche Evidenz für den Nachweis kausaler Zusammenhänge zwischen bestimmten Risikofaktoren (Exposition) und dem Auftreten von Erkrankungen auf Bevölkerungsebene. Neben der Tatsache, dass sich viele Expositionen nicht in experimentellen Designs untersuchen lassen, haben Kohortenstudien gegenüber randomisierten klinischen Studien den Vorteil, dass sie unter Alltagsbedingungen stattfinden und nicht in einem restringierten Setting. Im vorliegenden Beitrag beschreiben wir die Ziele und Charakteristika von internationalen Kohorten, die aufgrund ihrer Bedeutung, ihrer Größe oder ihrer Endpunkte ausgewählt wurden. Wir stellen dabei nicht nur die Studiendesigns und die eingesetzten Instrumente vor, sondern berichten auch einige zentrale Ergebnisse. Die meisten dieser Prospektivstudien untersuchen häufige chronische Krankheiten von älteren Menschen wie Krebs, Diabetes, kardiovaskuläre oder neurodegenerative Erkrankungen, Osteoporose und Augenerkrankungen. Neuere Kohorten beziehungsweise spätere Nachuntersuchungen existierender Kohorten beinhalten praktisch alle die Sammlung und Asservierung biologischer Proben. In jüngerer Zeit kommen aufgrund der technischen Entwicklung zunehmend auch anspruchsvolle Messverfahren bis hin zu bildgebenden Verfahren zur Phänotypisierung zum Einsatz. Abschließend diskutieren wir zum einen die Übertragbarkeit dieser Studiendesigns auf die deutsche Situation und zum anderen, inwiefern sich Ergebnisse aus ausländischen Kohorten auf die deutsche Bevölkerung übertragen lassen, um daraus Anforderungen an zukünftige Kohortenstudien abzuleiten.
Abstract
Among observational studies, cohort studies, i.e. longitudinal observations of selected population groups, provide the highest possible evidence of a causal association between specific risk factors (exposure) and the occurrence of disease in populations. Besides the fact that many exposures cannot be investigated in experimental designs, cohort studies have the advantage over randomized clinical trials that they are conducted in free living populations and not in restrictive, clinical settings. In this paper we describe the aims and features of international cohorts that have been selected because of their impact, their size or their endpoints. We do not only present the study designs and survey instruments used but we also highlight some of the most important results gained by these studies. Most of these prospective studies investigated common chronic diseases in the elderly, such as cancer, diabetes, cardiovascular or neurodegenerative diseases, osteoporosis and ophthalmologic disorders. Newer cohorts and recent reassessments of existing cohorts almost always include the collection and storage of biological samples. In recent years technological developments allowed the implementation of cutting edge measurement procedures, such as imaging techniques for phenotyping. Finally, we discuss on the one hand whether these designs can be transferred to the German situation and on the other hand to what degree the results obtained from foreign cohorts can be generalized for the German population. We conclude with recommendations for future cohort studies.
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Ahrens, W., Pigeot, I. Internationale Kohortenstudien. Bundesgesundheitsbl. 55, 756–766 (2012). https://doi.org/10.1007/s00103-012-1495-2
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DOI: https://doi.org/10.1007/s00103-012-1495-2