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Korean Journal of Preventive Medicine 1999;32(4): 452-458.
A Cohort Study on Risk Factors for Chronic Liver Disease: Analytic Strategies Excluding Potentially Incident Subjects.
Moo Song Lee, Dae Sung Kim, Dong Hyun Kim, Jong Myun Bae, Myung Hee Shin, Yoon Ok Ahn
1Department of Preventive Medicine, University of Ulsan College of Medicine, Korea.
2Preventive Medicine, Gachon Medical School, Korea.
3Department of Social Medicine, Hallym University College of Medicine, Korea.
4Department of Preventive Medicine, Cheju National University College of Medicine, Korea.
5Department of Preventive Medicine, Sungkyunkwan University College of Medicine, Korea.
6Department of Preventive Medicine, Seoul National University, College of Medicine, Korea.
OBJECTIVES: The authors conducted the study to evaluate bias when potentially diseased subjects were included in cohort members while analyzing risk factors of chronic liver diseases. METHODS: Total of 14,529 subjects were followed up for the incidence of liver diseases from January 1993 to June 1997. We have used databases of insurance company with medical records, cancer registry, and death certificate data to identify 102 incident cases. The cohort members were classified into potentially diseased group(n=2,217) when they were HBsAg positive, serum GPT levels higher than 40 units, or had or has liver diseases in baseline surveys. Cox' model were used for potentially diseased group, other members, and total subjects, respectively. RESULTS: The risk factors profiles were similar for total and potentially diseased subjects: HBsAg positivity, history of acute liver disease, and recent quittance of smoking or drinking increased the risk, while intake of pork and coffee decreased it. For the potentially diseased, obesity showed marginally significant protective effect. Analysis of subjects excluding the potentially diseased showed distinct profiles: obesity increased the risk, while quitting smoking or drinking had no association. For these intake of raw liver or processed fish or soybean paste stew increased risk; HBsAg positivity, higher levels of liver enzymes and history of acute liver diseases increased the risk. CONCLUSIONS: The results suggested the potential bias in risk ratio estimates when potentially diseased subjects were included in cohort study on chronic liver diseases, especially for lifestyles possibly modified after disease onset. The analytic strategy excluding potentially diseased subjects was considered appropriate for identifying risk factors for chronic liver diseases.
Key words: Cohort studies; Liver diseases; Epidemiology; Cox regression; Bias
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