American Journal of Epidemiology Vol. 143, No. 10: 1025-1034
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Relations of Changes in Coronary Disease Rates and Changes in Risk Factor Levels: Methodological Issues and a Practical Example
1Centre for Clinical Epidemiology and Biostatistics, University of Newcastle Australia
2GSF Institute for Epidemiology Munich, Germany
3Department of Epidemiology and Health Promotion, National Public Health Institute Helsinki, Finland
4Department of Community Health, University of Auckland New Zealand
5Department of Public Health, University of Western Australia Perth, Australia
6Institute for Epidemiology and Social Medicine, University of Munster Germany
7Bremen Institute for Prevention Research and Social Medicine Bremen, Germany
Reprint requests to Prof. A. J. Dobson, Department of Statistics, University of Newcastle, New South Wales 2308, Australia.
One of the main hypotheses of the World Health Organization (WHO) MONICA Project is that trends in the major coronary disease risk factors are related to trends in rates of fatal and non-fatal coronary disease events. The units of study are populations rather than individuals. The WHO MONICA Project involves continuous monitoring of all coronary disease events in the populations over a 10-year period and periodic risk factor surveys in random samples of the same populations. Estimation of associations between average annual changes in mortality and risk factor levels is illustrated with the use of data from a subset of MONICA centers. Crude estimates of regression coefficients are compared with estimates obtained by weighting for standard errors in both the outcome and explanatory variables. The results show that the strength of association may be either underestimated or overestimated if these errors are not taken into account.
coronary disease; measurement error; mortality; proportional hazards models; risk factors
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