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LTU-KAU: Kaunas Contributor from the MPC: Stanislava Domarkiene

© National Institute for Health and Welfare and the MORGAM Project investigators Last updated: 4 May 2006 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

Cohort identification

• Country: Lithuania
• MPC: 45 - Kaunas
  • Administrative centre: Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania
  • Key personnel: Abdonas Tamosiunas (Principal Investigator), Stanislava Domarkiene (former Principal Investigator)
• RUs:
  • 01: Kaunas city located in central Lithuania, second largest city with one-fourth of industry, a scientific and business centre. Ethnically homogenous, average risk factor levels and cardiovascular disease mortality, high socio-economic status.
• RUAs:
  • LTU-KAUa
• Cohorts:
  • Cohort 01: Respondents of a representative sample of 35-64 years old men and women of the RU. The baseline survey was carried out in 1983-85.
  • Cohort 02: Respondents of a representative sample of 35-64 years old men and women of the RU. The baseline survey was carried out in 1986-87.
  • Cohort 03: Respondents of a representative sample of 35-64 years old men and women of the RU. The baseline survey was carried out in 1992-93.

Cohort recruitment and the baseline examination

The cohorts were formed by the respondents of representative sample surveys of the RUs. Card index of Kaunas inhabitants at the Address Bureau was used as sampling frame for the single stage sampling which was stratified by sex and 10-year age group. The baseline examinations were carried out as part of the WHO MONICA Project

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

DNA are not available for the 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: yes
• Thromboembolic events: no

End of follow-up period

• Fatal events: 31 December 1998
• Non-fatal events: 31 December 1998 with an upper age limit of 65 years for the follow-up of non-fatal stroke events.

Follow-up procedures

Sources of data

• Population Based Mortality Register: The MPC obtained the death certificates of all deaths of persons living in Kaunas at the time of death from the Death registration department in the Kaunas bureau of the Civil Registry Office.
• Coronary Event Register: The coronary event register is available from the year 1971 with ongoing registration. It covers fatal and non-fatal coronary events in Kaunas, and there is no upper age limit [1, 2].
• Stroke Event Register: The stroke event register is available from the year 1986 and event registration has been continued since then. It covers Kaunas. Non-fatal events have been recorded only for the age-group 35-64 [3, 4]. In 1998, stroke events were recorded without upper age limit.
• Kaunas Address Bureau

Procedures

For the follow-up of deaths, the MPC obtained the death certificates of all deaths in Kaunas which were linked manually with the cohorts. For the follow-up of coronary and stroke events, the cohort were linked to the event registers using name, date of birth and current address of residence. Notifications of loss-to-follow-up due to persons moving out of Kaunas were received from the Address Bureau, but only for Cohort 03. The follow-up of non-fatal strokes did not cover years 1983-1985.

Diagnostic procedures

At baseline:

• History of MI:
  • Documented: Those persons who reported history of MI were linked to the Coronary Event Registers (data since 1971) which operated in the city of Kaunas. Consultative committee verified history of MI using the data from the registers. Both definite and possible MI were considered as documented history of MI.
  • Self-reported: An affirmative answer to "Have you ever had myocardial infarction?" was considered as self-reported history of MI.
  • ECG: Persons with Minnesota code 1-1 or 1-2 in baseline ECG were considered having an ECG change indicating myocardial infarction.
  • 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: The person was considered having self-reported history of angina pectoris if he/she gave an affirmative answer to both questions "Have you ever had any pain or discomfort in your chest?" and "Has a doctor due to this pain or discomfort consulted you?" and an affirmative answer to the option "angina pectoris" under the question "If yes, what did he say?".
• History of coronary heart disease, type unspecified: not relevant because specific types were collected.
• History of stroke:
  • Documented: Those persons who reported history of stroke were linked to the stroke event register (data since 1986) which operated in the city of Kaunas. For previous events before the year 1986 the Consultative committee made classification using clinical diagnoses and available clinical documentation.
  • Self-reported: An affirmative answer to "Have you ever had stroke?" was considered as self-reported history of stroke.
• History of Diabetes: An affirmative answer to "Has a doctor ever told you that you have diabetes?" was considered as history of diabetes.

During follow-up:

• Deaths: Death certificate codes were used for the relevant items of MORGAM Form 25.
• CHD events: For fatal and non-fatal events found in the Coronary Event Register, MONICA diagnostic classification was used if the age of the person was 35-64. During years 1996-97, MONICA diagnostic classification was used without upper age limit.

  For fatal and non-fatal events which were not diagnosed using the MONICA criteria, the event registration was based on the clinical diagnosis made by certificated cardiologist or the underlying cause of death on the death certificate. The diagnostic classification was done using the ICD-codes:

  Clinical diagnosis code		MORGAM DGNCAT
  ICD-9	ICD-10
  410	I21, I22	3
  Other		7
  Underlying cause of death code
  410-414	I21-I25	3
  798	I46, R96, R98, R99	5
  Other		7

  Coronary events occurring within 28 days of each other were considered as one event. If several diagnoses were given during a 28-days period the most severe event was used for the classification.

  A non-fatal possible MI following a possible or definite MI was not recorded for MORGAM. The same concerns a non-fatal definite MI following a definite MI.

• Stroke events: For fatal and non-fatal events found in the Stroke Event Register, i.e. in age-group 35-64, MONICA diagnostic classification was used. In 1998, all stroke events were validated by MONICA procedure without upper age limit.

  For fatal events after the age of 65 years, death certificates were not verified and the diagnostic classification was done using the ICD-codes of the underlying cause of death on the death certificate:

  Underlying cause of death code		MORGAM DGNCAT
  ICD-9	ICD-10
  430, 431, 433, 434, 436, 437 or 438	I60, I61, I63, I64, I69	9
  Other		4

  Stroke events occurring within 28 days of each other were considered as one event.

References

1. Bluzas J, Rastenyte D, Rasteniene D, Grazuleviciene R, Cepatis Z. Ischemic Heart disease: mortality trends in Kaunas population aged 35-64 years from 1971 to 1989. In: Bluzas J, editor. Ischemic heart disease. Kaunas: Institute of Cardiology Publishers; 1993. p. 74-77.
2. Rasteniene D. Acute myocardial infarction morbidity trends in Kaunas population aged 35-64 years from 1971 to 1989. In: Bluzas J, editor. Ischemic heart disease. Kaunas: Institute of Cardiology Publishers; 1993. p. 78-81.
3. Rastenyte D, Cepaitis Z, Sarti C, Bluzas J, Tuomilehto J. Epidemiology of Stroke in Kaunas, Lithuania: first results from the Kaunas stroke register. Stroke. 1995; 26:240-244.
4. Rastenyte D, Tuomilehto J, Sarti C, Cepatis Z, Bluzas J. Trends in the incidence and mortality of stroke in Kaunas, Lithuania, 1986-1993. Cerebrovasc Dis. 1996; 6:13-20.

Updates to this document

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