Lifelines Wiki

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====== General Cohort & Factsheets ======

The general population cohort of [[Start|Lifelines]] consists of 167.729 participants, identified with a Lifelines-ID.\\ 

===== Recruitment =====

Lifelines participants were initially recruited through general practitioners in the three provinces in the [[location|northern part of the Netherlands]]: Groningen, Friesland and Drenthe((Scholtens, S., Smidt, N., Swertz, M.A., Bakker, S.J.L., Dotinga, A., Vonk, J.M., van Dijk, F., van Zon, S.K.R., Wijmenga, C., Wolffenbuttel, B.H.R., et al. (2015). Cohort Profile: LifeLines, a three-generation cohort study and biobank. Int. J. Epidemiol. 44, 1172–1180)).\\ 
General practitioners (GP's) invited all their patients between 25 and 50 years old (on Terschelling 18+), resulting in ~81.500 participants at [[1A|baseline]].\\ 
These individuals were then asked to invite their family members (parents, partner, children, parents-in-law), resulting in an additional ~64.500 participants at [[1A|baseline]].\\ 
~21.500 interested individuals registered directly for [[1A|baseline]] participation via the Lifelines website.

===== Selection criteria =====

There were no specific inclusion criteria for Lifelines.\\
GP's were asked to decide which of their patients should be excluded from Lifelines, based on the following list of exclusion criteria provided by Lifelines:
  * terminal illness (life expectancy < 5 years)
  * severe mental illness (i.e. not fully capable to make rational decisions)
  * not being able to visit the GP
  * not being able to fill in the questionnaires
  * not being able to understand the Dutch language

===== Age groups =====

Lifelines has participants of all ages.\\
[[Children]] follow a special child protocol until they turn 18. [[Elderly]] participants follow the adult protocol plus some additional questions (in assessments [[1A]], [[1B]] and [[1C]]) and additional measurements ([[Mini Mental State Examination|MMSE]]).\\
Since baseline, the original distribution of the three age groups (children, adults and elderly) has shifted as follows:

^ Age group            ^ Baseline          ^ 2012  ^ 2016  ^ 2020  ^
| [[Children]] (0-17)  | 9% (n=~15.000)    | 9%    | 7%    | 6%    |
| Adults (18-64)       | 84% (n=~140.000)  | 82%   | 80%   | 78%   |
| [[Elderly]] (65+)    | 7% (n=~12.000)    | 9%    | 13%   | 16%   |

===== Gender =====

Lifelines has ~97,000 female participants (58%) and ~71,000 male participants (42%).\\
Most questionnaires and measurements are performed in both sexes.\\ 
Notable exceptions:
  * [[ROAQ]], an [[additional assessments|additional assessment]] in women
  * [[VESP]], an [[additional assessments|additional assessment]] in men
  * [[NEXT]], our birth cohort with an emphasis on pregnant women (but fathers are also included)
Thus far, the *binary* gender of participants was assessed via self-report and via [[https://www.government.nl/topics/personal-data/personal-records-database-brp|BRP]] linkage.\\ 
More recently, attention is given to *non-binary* [[sex & gender|gender]] within the cohort.

===== Nationality and Ethnicity =====

The vast majority of Lifelines participants is born in the Netherlands (97%) and has a Caucasian ethnicity (98%). See also the subsection on [[Nationality & ethnicity]].

===== Mortality =====

Click [[mortality|here]] to learn more about the Lifelines death rate and causes of death.   

===== Family connections =====

Lifelines includes many participants with a family connection to one another, including 355 twins and 5 triplets. Current and past family connections between participants are identified using:
  * The [[https://www.government.nl/documents/leaflets/2017/01/19/brochure-brp-engelstalig|Dutch citizen registration]]
  * Self-reported information
  * Genotyping (see [[GWAS]] and [[UGLI]])

Based on BRP and self-report, the following Lifelines [[https://en.wikipedia.org/wiki/Nuclear_family|nuclear families]] can be identified:

| Number of families       |        ^ Child(ren) = LL Participant(s)                             |||||
^ Parent = LL participant  | Total  | 1                               | 2      | 3     | 4    | 5    |
| Only the mother          | ~2200  | ~1500                           | ~600   | ~80   | <10  | <10  |
| Only the father          | ~350   | ~250                            | ~80    | ~10   | <10  | <10  |
| Mother and father        | ~5000  | ~2600                           | ~2000  | ~350  | ~40  | <10  |

Other family connections (e.g. grandparent-grandchild, siblings) are present in the cohort as well.


===== Cohort Facts & Representativity =====

At baseline, the adult Lifelines cohort was generally representative of the adult population of the north of the Netherlands((Klijs, B. et al. (2015). Representativeness of the LifeLines Cohort Study. PloS One 10, e0137203)).
An updated report on the representativity of the current cohort is currently in preparation.

Comprehensive factsheets were developed on a number of health-related topics covered by Lifelines: 

  * {{ :factsheet_asthma-copd_def.pdf |Asthma & COPD}}
  * {{ :factsheet_frequency_of_cancer.pdf |Cancer}}
  * {{ :factsheet_diabetes_def.pdf |Diabetes}}
  * {{ :factsheet_cardiologie.pdf |Cardiovascular diseases}}
  * {{ :factsheet_mental_health.pdf |Mental health}}
  * {{ :factsheet_frequency_of_disease.pdf|Frequency of disease}}
  * {{ :factsheet_genetic_data.pdf |Omics data}}
  * {{ :factsheet_geo_health.pdf |Geolocation linkage}}

In addition, some informative cohort statistics can be found here:
  * [[Cancer statistics]] (prevalence, incidence, relation to smoking)
  * [[Diabetes statistics]]

===== Subcohorts =====

Subsets of participants have been selected for [[additional assessments]] according to assessment-specific criteria. This results in subcohorts that are defined by the availability of certain additional variables.\\
Some notable examples are:
  * [[GWAS]] subcohort (15,000 genotyped participants)
  * [[UGLI]] subcohort (38,000 genotyped participants)
  * [[DEEP]] subcohort (1,500 participants with extensive metabolomics/microbiomics)
  * [[DAG3]] subcohort (9,500 participants with extensive metabolomics/microbiomics)

===== Data Linkage =====

  * **Basic information** (address, date of birth, sex, birth of children, marriage/divorce, date of death) about our participants is provided by the [[https://www.government.nl/documents/leaflets/2017/01/19/brochure-brp-engelstalig|Dutch citizen registration]]
  * Information about **living environment** (or [[https://en.wikipedia.org/wiki/Exposome|exposome]]), such as [[Environmental exposure (linkage)|air pollution]] or [[https://www.lisa.nl|LISA-data]], can be linked to individual participants via [[Environmental exposure (linkage)|postal codes or x-y coordinates]] (see also: [[http://www.gecco.nl]])
  * Individual data from **governmental registries** (i.e. causes of death, socio-economic data) can  be linked to Lifelines health-related data via [[http://www.cbs.nl/microdata|Statistics Netherlands]]
  * Individual results from **pathological tests** (i.e. biopsies) can be linked to Lifelines health-related data (including self-reported [[cancer]]) via [[https://www.palga.nl|PALGA]] and [[https://www.zorgttp.nl|ZorgTTP]]
  * Individual longitudinal **prescription medication** data from Dutch pharmacies can be linked to Lifelines health-related data (including self-reported [[medication]]) via [[http://www.iadb.nl|IADB]] (the {{ ::pharmlines_procedures_20210415.pdf|Pharmlines}} initiative)
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