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GER-AUG: Augsburg Contributors from the MPC: Angela Döring and Christa Meisinger

© National Institute for Health and Welfare and the MORGAM Project investigators Last updated: 19 May 2010 For more information, please contact Kari Kuulasmaa (firstname.lastname@thl.fi)

Contents

• Cohort identification
• Cohort recruitment and the baseline examination
• End-points followed up
• End of follow-up period
• Follow-up procedures
• Diagnostic procedures
  • at baseline
  • during follow-up
• References
• Updates
• Appendix 1: The conversion for the MORGAM item ECG in GER-AUG

Cohort identification

• Country: Germany
• MPC: 26 - Augsburg
  • Administrative centre: Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
  • Key personnel: A. Peters (Principal Investigator), A. Döring (former Principal Investigator), J. Baumert, U. Kuhn, C. Meisinger, A. Hörmann, A. Schneider , B. Thorand
• RUs:
  • 03 - Augsburg. City of Augsburg and the less urban Landkreis Augsburg and Landkreis Aichach-Friedberg in Bavaria, South Germany.
• RUAs:
  • GER-AUGa
• Cohorts:
  • Cohort 01 - Respondents of a representative sample of 25-64 years old men and women of the RU. The baseline survey was carried out in 1984-85.
  • Cohort 02 - Respondents of a representative sample of 25-74 years old men and women of the RU. The baseline survey was carried out in 1989-90.
  • Cohort 03 - Respondents of a representative sample of 25-74 years old men and women of the RU. The baseline survey was carried out in 1994-95.

Cohort recruitment and the baseline examination

The cohorts were formed by the respondents of representative sample surveys of the RUs. List of municipalities and population registers were used as sampling frames for the first and the second stage of two-stage sampling, respectively. The second stage of the sampling was stratified by sex and 10-year age group. The baseline examinations were carried out as part of the WHO MONICA Project, where they were recognized by codes GER-AURa (RU 02) and GER-AUUa (RU 01). RU 03 of MORGAM combines RUs 01 and 02 of MONICA. Follow-up studies were conducted in the frame of the Cooperative Research in the Study region of Augsburg (KORA).

The size of the MORGAM cohorts and the response rates of the population surveys from which the cohorts were derived are:

DNA are available for about 80% of the participants of all three cohorts.

End-points followed up:

• Deaths: yes
• Non-fatal acute MI: yes
• Unstable angina pectoris: no
• Silent MI: no
• Cardiac revascularization: no
• Stable angina pectoris: no
• Non-fatal stroke events: no
• Thrombo-embolic events: no

End of follow-up period:

• Fatal events: 2 November - 31 December 2002, depending on when the person returned the follow-up questionnaire or when population registries gave information on vital status and address.
• Non-fatal events: 2 November - 31 December 2002, depending on when the person returned the follow-up questionnaire or when population registries gave information on vital status and address. There was an upper age limit of 74 years for the follow-up of non-fatal events.

Follow-up procedures

Sources of data

• Population Registers: The population registries are kept by the administration of the cities and villages. The procedure is regulated by law. Among other things, the register includes information on removals from the population register due to death, migration or other reasons.
• Regional Health Departments: These are the sources for death certificates, maintained by Bavarian Ministry of Health (Landkreise) and the City of Augsburg.
• Coronary Event Register: The coronary event register started as a population based register taking part in the WHO MONICA Project. The MONICA register was followed by the KORA register. At the mid-eighties, the data sources for hospitalized patients included 13 hospitals within the study region and 13 hospitals in the adjacent areas. By year 2002, due to centralization of hospitals, the numbers had reduced to eight hospitals inside the study area and two in the adjacent areas. Fatal events were selected for registration on the basis of the information on death certificate or on the questionnaire sent to the last attending physician and/or coroner. The coronary event register covered the study area since 1984. Its upper age limit was 74 years [1, 2].
• Person himself

Procedures

Within the framework of the KORA Study, a follow-up questionnaire was sent to each former participant in 1997-1998 and in 2002-2003 to obtain information on the occurrence of chronic diseases and risk factors.

Mortality follow-up: If a person did not return the follow-up questionnaire, the person's vital status was ascertained through the Population Registers inside and outside the study area. Record linkage was based on name, sex, date of birth and address. If the person has died the information on when and where is provided by the Population Registers and a copy of death certificate is obtained from the Regional Health Department. If the person has moved out of the study area the time of move and usually the information on the new address is available. The vital status could not be assessed for those who had moved to a foreign country or to an unknown location in the country.

Follow-up of CHD events: Each time a non-fatal event was entered to the Coronary Event Register, it was linked to the Cohorts using name and date of birth. All deaths in the Cohorts were linked to the Coronary Event Register using the dates of birth and death. If a person has moved out of the study area, information from the follow-up questionnaire was used and General Practitioner's notes and hospital discharge letters were gathered. If such a person did not return the questionnaire, the date of moving outside the study area is known through the Population Registers and the date of loss to follow-up for non-fatal events was the date of moving. Non-fatal events were not followed up for those who had a self-reported MI at baseline.

Diagnostic procedures

At baseline:

• History of MI:
  • Documented: data not available
  • Self-reported: An affirmative answer to both questions "Have you ever been told by a doctor, that you had a myocardial infarction (heart attack)?" and "If yes, was it treated in a hospital?".
  • ECG: data not available
  • Rose questionnaire: As specified in item HISMI4 of MORGAM Form 21.
• History of cardiac revascularisation:
  • Documented: data not available
  • Self-reported: data not available
• History of angina pectoris:
  • Documented: data not available
  • Rose questionnaire: As specified in item HISAP2 of MORGAM Form 21.
  • Self-reported: An affirmative answer to the question "Have you ever been told by a doctor that you have had angina pectoris?"
• History of coronary heart disease, type unspecified: data not available
• History of stroke:
  • Documented: data not available
  • Self-reported: An affirmative answer to the question "Have you ever had a stroke?".
• History of Diabetes: An affirmative answer to the question "Have you ever been told by a doctor that you have diabetes mellitus?" or if the answer was negative but the person was currently taking medication for diabetes.

During follow-up:

• Deaths: Since the underlying cause of death is not given on the death certificate, the underlying cause of death is coded to ICD-9 by the MPC using the information on the death certificate and the rules of the International Classification of Diseases (ICD) of the WHO.
• CHD events: For events found in the Coronary Event Register, the MONICA diagnostic classification was used up to 1994. Since1995, ECG recordings were not coded for the Minnesota codes, instead ECG recordings were coded for clinical ECG signs (Q-wave, ST-elevation, ST-depression, T-inversion, etc.). Clinical ECG signs of consecutive ECGs were then used for the derivation of the MONICA categories of ECG findings and then, the MONICA diagnostic algorithm was used for the event validation. See Appendix 1 for details of the ECG conversion rules.
  For fatal events which were found in the Population Registers but not in the Coronary Event Register, the diagnostic classification was done using information from the General Practitioner's notes and hospital discharge letter, or the ICD-code of the underlying cause of death:

  Underlying cause of death code	MORGAM DGNCAT
  ICD-9
  410-414	3
  798	5
  other	7

  For non-fatal events which occurred outside the study area and were not in the Coronary Event Register, the diagnostic classification was done using the General Practitioner's notes, hospital discharge letter or clinical diagnoses:

  Clinical diagnosis code	MORGAM DGNCAT
  ICD-9
  410	3
  other	7

• Stroke deaths: The diagnostic classification was done using the ICD-codes of the underlying cause of death:

  Underlying cause of death code accepted as stroke (ICD-9)	MORGAM DGNCAT
  430, 431, 433, 434, 436, 437 or 438	9
  other	4

References

1. Löwel H, Lewis M, Hörmann A, Keil U. Case finding, data quality aspects and comparability of myocardial infarction registers: Results of a south German register study. J Clin Epidemiol. 1991;44(3):249-260.
2. Keil U, Liese AD, Hense HW, Filipiak B, Doring A, Stieber J, Lowel H. Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases. Eur Heart J. 1998;19(8):1197-207.

Updates to this document

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