what is life course approach in epidemiology

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels.

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What is life course epidemiology?

 · To counteract the increasing polarisation of biological programming in utero and adult lifestyle approaches to chronic disease aetiology, life course epidemiology was built on the premise that various biological and social factors throughout life independently, cumulatively and interactively influence health and disease in adult life. 9 A life course approach does not …

What is the a life course approach?

Abstract. A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing ...

What is the life course perspective in human biology?

Life course epidemiology J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech .57.10.778 ... C Power. Affiliation 1 Medical Research Council National Survey of Health and Development, Department of Epidemiology and Public Health, University College London and Royal Free Medical School, Gower Street Campus, 1-19 ...

What is the life course approach to the diagnosis of chronic disorders?

A life course approach to chronic disease epidemiology explicitly recognizes the importance of time and timing in understanding causal links between exposures and outcomes within an …

How does life course epidemiology work?

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

What is a life course approach to chronic disease epidemiology?

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels.

What is a life course perspective in epidemiology?

A life course perspective on chronic disease epidemiology relies on a multidisciplinary framework for understanding how early- and later-life biological, behavioral, social, and psychological exposures affect adult health ( 16 ). However, although general theorizing about these interconnected and multi-faceted processes is important ( 87 ), a life course approach to chronic disease epidemiology is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways ( 112 ), and by how these temporal processes are interconnected within the life course of one cohort. More ambitiously, a life course approach also attempts to understand how such temporal processes across the life course of one cohort occur in previous and subsequent birth cohorts and are manifested in disease trends that are observed over time at the population level.

How does life course epidemiology work?

Adopting a life course approach to chronic disease epidemiology presents multiple methodological and analytic challenges concerning study design, data collection, and interpretation. Fundamentally, investigating life course processes for chronic diseases requires measuring data at multiple time points from birth (or before) to middle and older ages ( 56, 182) and potentially across generations. Ideally, the timing of these data collections is informed by some knowledge of the relevant latency periods between particular life course exposures and outcomes. For some life course research questions, there are time lags of 50 or more years between exposures and outcomes of interest (e.g., H. Pylori infection and stomach cancer). That is why much of the current knowledge in the life course epidemiology of chronic diseases has been derived from reconstructed cohorts where information about early-life conditions and events was gathered from cohorts born in the late nineteenth and early twentieth centuries. One of the limitations of these data is that the life course processes studied in these cohorts are reflections of the past and may not in some cases be as applicable to current generations. Reconstructing early-life exposures from adult recall is limited because it introduces possibilities of bias and measurement error, so objective data collected at the relevant life course stage are most desirable. Innovative designs that combine individual and routinely collected register information for exposures, confounders, and outcomes will be important in this regard. Future life course studies that attempt to collect a diverse array of information about early- and later-life exposures will have high respondent burden, so recruitment and retention over long periods of time will be a major challenge.

What are some examples of life course thinking?

Life course thinking has been prominent in disciplines such as psychology, sociology, neurodevelopment, and anthropology ( 113 ), and there are important historical examples in epidemiology. For instance, in 1934, Kermack ( 107) showed cohort patterns in mortality declines in Britain between 1850 and the 1930s ( Figure 1 ), which suggests that each successive generation carried with it, from birth, the potential for a longer life ( 44 ). In a study of Maryland school children, Ciocco commented in 1941 that “disease in adulthood is often brought about by the cumulative effects over a long period of time of many pathological conditions, many incidents, some of which take place and are even perceived in infancy” ( 26, p. 2375). In the 1960s there were papers on the role of early-life influences on chronic diseases ( 96 ), and Dubos discussed the long-lasting effects of early environmental exposures under the intriguing title of biological Freudianism ( 54 ). Even in the 1970s, there was recognition by chronic disease epidemiologists of the importance of early-life influences on coronary heart disease (CHD) ( 104 ). Nevertheless, from the 1960s, chronic disease epidemiology came increasingly to focus on adult lifestyles, and interest in the childhood origins of disease understandably waned with the identification, among adults, of the major CHD risk factors of smoking, hypertension, and cholesterol. The revival of life course approaches to chronic diseases was stimulated by the work of Forsdahl beginning in the early 1970s ( 68 ). Forsdahl suspected that adverse environmental conditions in infancy and early childhood could increase the risk of CHD in adult life. He analyzed aggregate data from Norway and demonstrated that infant mortality rates early in the twentieth century correlated strongly with CHD mortality rates 70 years later ( 66 ). Forsdahl speculated that permanent damage may be caused by nutritional deficits in early life that rendered individuals less able to tolerate particular forms of fat in their adult diet, so early-life social disadvantage might interact with affluence in later life to increase CHD risk ( 67 ).

What is critical period model?

The critical period model emphasizes the timing of exposure, such that an exposure at a specific period in the life course has long-lasting effects on anatomical structure or physiological function that may eventually result in disease.

Why is it important to use multiple imputation techniques in long term life course studies?

Finally, long-term life course studies of chronic disease will make the problems of missing data even more acute than they are currently , and so advances in multiple imputation techniques are likely to be important ( 157 ). Additionally, innovative design through replenishment samples and analytic methods will need to be applied to avoid making inferences from overly selected study samples.

Why is triangulation important in epidemiology?

This process of triangulation is important in life course epidemiology because it attempts to integrate knowledge gained about life course processes at the individual, generational, and population levels. CLICK TO VIEW. TABLE 2. Types of epidemiological evidence of life course processes *.

When bone is growing during childhood and adolescence, what is the term for a fracture?

fracture across the epiphysis (growth plate) when bone is growing during childhood and adolescence;

What is life course epidemiology?

The definitions of life course epidemiology emphasize collaboration between the social and natural sciences. “The natural science process of aetiology supplies the disease outcomes, while the social science process of accumulation ensures the social patterning, by social class and such likes, of these diseases” [ 8 ].

What is the life course approach?

The life course approach, applying the accumulation model , has mostly focused on the association of chronic disorders with socioeconomic circumstances in different phases of life. Currently, increasing interest is being shown in age-related changes in functional capability, using tests of physical and cognitive performance, and sensory function [ 1 ]. The reverse epidemiology with respect to the conventional risk factors for a poor clinical outcome and premature mortality deserves further investigation from the life course perspective, as it may have a bearing on the management of people at advanced age.

What are the three strands of social and medical research?

According to Blane et al. [ 8 ], during the 1990s, three strands of social and medical research—biological programming, accumulation, and health inequalities —converged in life course epidemiology. The idea of biological programming holds that the development of organs and metabolism in utero and during early infancy determines the maximum functional capacity that an individual can attain and sets the limits of functional capacity for the entire life course [ 8, 9 ]. The accumulation model implies that childhood disadvantage tends to be followed by health-relevant disadvantage across adulthood and into early old age [ 10 ]. In the study of social inequalities in health, evidence is presented on the range of social factors that are found to be associated with different aspects of health in early life, childhood, adolescence, and adulthood [ 11 ]. Uncertainty, however, exists about the continuation of this inequality into older age [ 12 ]. It is clear that among the very old, the socioeconomic factors, at least with regard to mortality, have decreased their importance [ 13 ].

What is the critical period model?

According to Ben-Shlomo and Kuh [ 3 ], “the ‘critical period model’ is when an exposure acting during a specific period has lasting or lifelong effects on the structure or function of organs, tissues and body systems which are not modified in any dramatic way by later experience”.

What is life span psychology?

In the latter part of the twentieth century, a life span perspective in developmental psychology has emerged in which psychological development is seen as a lifelong process [ 6 ]. In this perspective, individual life courses are investigated in their biocultural and sociohistorical context. From the social science point of view, a life course approach concentrates on age-related transitions that are socially created, socially recognized, and shared [ 7 ]. Sociologists have investigated how the individual's life course is structured by institutions and culture, social and historical change, and changes in individual aging processes.

What is the biological programming model?

The biological programming model holds that organ development in utero and early infancy determines the maximum functional capacity that an individual can attain and influences the development of certain chronic diseases later in life.

How do cardiovascular risk factors relate to life?

The behavioral risk factors (tobacco smoking and recreational physical exercise) were associated primarily with adult socioeconomic circumstances, while the physiological risk factors (serum cholesterol, blood pressure, BMI, and lung function) were associated to varying extents with socioeconomic circumstances in both childhood and adulthood. These elaborations have led to the generalization that life course influences are strongest where they can be defined physiologically, i.e., in the form of health and disease, intermediate in relation to shaping preferences and taste, and are smallest in their effect on psychological reactions in everyday life [ 8 ]. There also is growing evidence suggesting that the various risk factors and their associations with socioeconomic circumstances as well as their interactions in the causation of chronic disorders and mortality are partly different in old age as compared to early old age [ 13]

What is life course epidemiology?

We defined life course epidemiology as ‘the study of long-term biological, behavioural and psychosocial processes that link adult health and disease risk to physical or social exposures acting during gestation, childhood, adolescence, earlier in adult life or across generations’. 1 Although our definition of life course epidemiology has stood the test of time, the field has evolved and there have been conceptual developments, methodological innovations which facilitate efforts to test these concepts, and an increasing corpus of empirical research demonstrating how factors from earlier life are associated with later life health and disease, as well as the pathways and biological mechanisms that may be involved. These developments have generated further ideas and challenges to life course models in an iterative process. As the theme of this special issue suggests, one important development has been the gradual shift of research focus from clinical disease endpoints to multi-faceted traits and longitudinal trajectories of functional phenotypes that can be assessed well before any clinical threshold is reached. This has naturally led on to the application of a life course epidemiological approach to ageing. The purpose of this overview is therefore to assess the development and current state of the field of life course epidemiology, including its recent application to the study of ageing as the focus of this special issue.

What is the scientific agenda of life course epidemiology?

This review has shown that the field of life course epidemiology has a healthy scientific agenda focused on understanding how different aspects of function change (at the individual, system and cellular levels) across life, and on discovering their lifetime risk factors, mediators, modifiers and consequences. Much of this agenda is shared with our colleagues in DOHaD, in ageing research (see commentary by Newman 106) and in geroscience (see commentary by Ferrucci 107,108) and we believe our complementary approaches add value and hence should be further integrated. This scientific agenda attracts researchers from many disciplines, and the demographic pressures of an ageing population on health and social care should ensure a parallel political agenda on the importance for these research streams.

Why is broadening study settings important?

The broadening of study settings is essential to help establish which life course associations are contextual and which are universal. A small but increasing number of papers involved multiple cohorts (see below) which sometimes crossed several of these settings.

Is epidemiology a life course?

Life course epidemiology is now recognized as a field of research in its own right and was added to the fifth edition of the Dictionary of Epidemiology. 2 The original life course book was to become the first in a series on a life course approach to adult health, 3–8 as well as a journal glossary 9 and chapters in a range of public health, epidemiology and other academic textbooks. 10–14 The original International Journal of Epidemiology editorial on life course epidemiology, published in 2002, 15 is the fifth most highly cited article in the journal’s history (search run on Web of Science core collection 19 February 2016).

Summary

ALINA RODRIGUEZ: My name's Alina Rodriguez.And I'm a professor in psychology. And I work in epidemiology.I'm with Imperial College London at the School of Public Health in the Department of Epidemiology and Biostatisticsas well as Queen Mary University of Londonat the Wolfson Institute of Preventive Medicine.

Abstract

Alina Rodriguez, Professor in Psychology at the Imperial College London, School of Public Health, discusses life course epidemiology, including characteristics of effective health interventions, the importance and impacts on brain development of health in early life.