brancati_8_06课件.ppt

Prospective Cohort Studies Background Physical activity ? lower CVD risk DHHS recommends life-long pursuits Sports differ in sustainability CVD benefits of individual sports uncertain Hypothesis: Tennis ability in youth predicts lower CVD risk in middle age Design: Prospective cohort study Setting: Johns Hopkins Precursors Study Participants: 1019 male medical students Data Collection: Extensive interview and physical assessment at baseline (early 20s); annual mailed follow-up questionnaires Outcome: Incident CVD, including MI, CHD, CABG or PTCA, hypertensive heart disease, heart failure, cerebrovascular disease Analysis: Kaplan-Meier, Cox models Assessment of Sports Ability How would you rate your overall ability in tennis (golf, football, baseball, basketball) during and before medical school? No ability Poor or fair ability Good or excellent ability No data on frequency, intensity, or subsequent participation Conclusions / Implications Self-described tennis ability in young adulthood predicts lower CVD risk in middle age Association of tennis to lower risk is Graded (i.e. dose-response) Independent of many possible confounders Specific to tennis (as hypothesized) Suggests promotion of tennis as a means to reduce CVD risk Strengths Prospective design Long-term follow-up Multiavariate analysis Blinded assessment of CVD Weaknesses Observational studies can’t prove causality Residual confounding is likely Assessment of exposure was suboptimal Ability, not activity Single point, not repeated measures Self-assessed, not objective Sample limits generalizability Discussion Points What’s special about a cohort study? What are common obstacles? Can it be used for housestaff research? Can it ever be sufficient to change practice? How do cohort studies relate to outcomes research? Taxonomy of Designs Randomized Controlled Trial Prospective Cohort Study Case-Control Study Cross-Sectional Study Other Designs Quasi-Experimental Ecologic Case Report pro·spec·tive Pro