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Cohort profile: the Doetinchem Cohort Study.

How did the study come about? The origin of the Doetinchem Cohort Study lies within the Monitoring Project on Cardiovascular Disease Risk Factors (MP-CVDRF), which was aimed at providing prevalence estimates of cardiovascular disease risk factors, such as smoking, blood pressure and serum cholesterol levels. During 1987–91 each year an age-and sex-stratified random sample of men and women aged 20–59 years, was invited to participate. The MP-CVDRF was carried out in three towns in The Netherlands (Amsterdam in the west, Doetinchem in the east and Maastricht in the south), and from each of the three towns, about 12 000 men and women were examined. In the subsequent Monitoring Project on Chronic Disease Risk Factors (MORGEN-project), carried out from 1993–97, in Doetinchem only respondents from the MP-CVDRF were invited to participate, while in Amsterdam and Maastricht again random samples from the general population were examined. The protocol was extended, because the focus broadened from cardiovascular to other chronic diseases such as cancer, diabetes, musculoskeletal disorders and COPD. Due to extension of the protocol, with similar budget, not all 12 405 participants in the MP-CVDRF could be re-invited. Instead, a random sample of in total 7769 of the respondents at baseline was invited for re-examination. This random sample is considered the basis of the cohort (Figure 1). The aim of the Doetinchem Cohort Study is to study the impact of (changes in) lifestyle factors and biological risk factors on aspects of health, such as the incidence of chronic diseases, physical and cognitive functioning and quality of life. During the course of the study, the scope has continuously broadened. At baseline, the focus was on determinants of cardiovascular diseases. Starting from the second examination of the cohort, the scope has extended to a broad spectrum of chronic diseases that have a substantial public health impact, such as diabetes, cancer, musculoskeletal disorders, asthma and COPD. During the fourth round the social aspects were assessed and in the fifth round that will start in 2008 the focus will be more on healthy ageing and the measures will also include bone density, osteoarthri-tis, osteoporosis and fractures, other chronic diseases than the big five (such as diseases of bowel, liver, thyroid gland), incontinence, muscle strength and tests for physical functioning. The study is thus aimed at a broad spectrum of hypotheses, with respect to both exposure and outcomes (Table 1). A biobank, with blood samples from each …