Journal Article

Mortality and cancer incidence in the EPIC-NL cohort: impact of the healthy volunteer effect

Ellen A. Struijk, Anne M. May, Joline W.J. Beulens, Carla H. van Gils, Evelyn M. Monninkhof, Yvonne T. van der Schouw, Monique W.M. Verschuren, Jolanda M.A. Boer, Bas H. Bueno-de-Mesquita and Petra H.M. Peeters

in European Journal of Public Health

Published on behalf of European Journal of Public Health

Volume 25, issue 1, pages 144-149
Published in print February 2015 | ISSN: 1101-1262
Published online April 2014 | e-ISSN: 1464-360X | DOI: https://dx.doi.org/10.1093/eurpub/cku045
Mortality and cancer incidence in the EPIC-NL cohort: impact of the healthy volunteer effect

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  • Public Health and Epidemiology
  • Economics of Health
  • Health, Illness, and Medicine

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Background: Prospective cohort studies recruit relatively healthy population samples, resulting in lower morbidity and mortality rates than in the source population. This is known as the healthy volunteer effect. The aim of this study was to define the magnitude and the development over time of the healthy volunteer effect in the EPIC-NL cohort. Methods: We studied mortality rates in the EPIC-NL cohort, which comprises 37 551 men and women aged 20–70 years at recruitment in 1993–97. The date and cause of death of deceased participants until 2010 were obtained through linkage with the municipal registry and Statistics Netherlands. Standardized mortality ratios (SMRs) were computed by dividing the observed number of deaths by the number of deaths expected from the general Dutch population. Additionally, standardized incidence ratios were calculated to compare cancer incidence. Results: After an average follow-up of 14.9 years, 3029 deaths were documented. Overall mortality in men [SMR 73.5%, 95% confidence interval (CI): 68.1–79.3] and women (SMR 65.9%, 95% CI: 63.2–68.6) was lower compared with the general population for the whole follow-up period. The SMRs clearly increased over the follow-up period. Among women, the SMR was lower for death due to cardiovascular diseases than death due to cancer. Cancer incidence was also lower in EPIC-NL than in the general population (SMR 78.3 and 82.7% for men and women, respectively). Conclusion: The results show a healthy volunteer effect in the EPIC-NL cohort, which tapers off with longer follow-up. Therefore, in the first years of follow-up, power might not be sufficient to detect small associations.

Journal Article.  4247 words. 

Subjects: Public Health and Epidemiology ; Economics of Health ; Health, Illness, and Medicine

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