Blane D, Netuveli G, Stone J
Department of Primary Care and Social Medicine, Imperial College, London W6 8RP, UK.
Rev Epidemiol Sante Publique. 2007 Feb;55(1):31-8. doi: 10.1016/j.respe.2006.12.004.
The present paper reviews the development of life course epidemiology since its origins during the 1990s from biological programming, birth cohort research and the study of health inequalities. Methods of studying the life course are examined, including birth cohort studies, linked register datasets and epidemiological archaeology. Three models of life course epidemiology are described: critical periods, accumulation, and pathways. Their conceptual and empirical differentiation can be difficult, but it is argued that accumulation is the underlying social process driving life course trajectories, while the critical period and pathway models are distinguished by their concern with specific types of aetiological process. Among the advantages of the accumulation model are predictive power, aetiological insights, contributions to health inequality debates and social policy implications. It is emphasised that the life course approach is not opposed to, or an alternative to, a concern with cross-sectional and current effects; major social disruption can have a large and immediate impact on health. Other limitations of the life course approach include a spectrum of impact (life course effects can be strong in relation to physiology, but often are weaker in relation to behaviour and psychological reactions to everyday life) and, more speculatively, the possibility that life course effects are diluted in the older age groups where morbidity and mortality are highest. Three issues for the future of life course epidemiology are identified. Many life course data are collected retrospectively. We need to know which items of information are recalled with what degree of accuracy over how many decades; and what methods of collecting these retrospective data maximise accuracy and duration. Second, the two partners in life course research need to take more seriously each other's disciplines. Social scientists need to be more critical of such measures as self-assessed health, which lacks an aetiology and hence biological plausibility. Natural scientists need to be more critical of such concepts as socio-economic status, which lacks social plausibility because it fails to distinguish between social location and social prestige. Finally, European comparative studies can play an important part in the future development of life course epidemiology if they build on the emerging infrastructure of European comparative research.
本文回顾了生命历程流行病学自20世纪90年代起源以来，从生物编程、出生队列研究和健康不平等研究方面的发展情况。研究生命历程的方法也得到了审视，包括出生队列研究、关联登记数据集和流行病学考古学。文中描述了生命历程流行病学的三种模型：关键期、累积和路径。它们在概念和实证上的区分可能较为困难，但有人认为，累积是驱动生命历程轨迹的潜在社会过程，而关键期和路径模型则因其对特定病因过程类型的关注而有所区别。累积模型的优点包括预测能力、病因学见解、对健康不平等辩论的贡献以及社会政策含义。需要强调的是，生命历程方法并非反对关注横断面和当前影响，也不是其替代方案；重大社会动荡可能会对健康产生巨大且直接的影响。生命历程方法的其他局限性包括影响范围（生命历程效应在生理方面可能很强，但在行为和对日常生活的心理反应方面往往较弱），更具推测性的是，在发病率和死亡率最高的老年人群体中，生命历程效应可能会被稀释。文中确定了生命历程流行病学未来的三个问题。许多生命历程数据是通过回顾性收集的。我们需要知道哪些信息项目在几十年间能被多准确地回忆起来；以及收集这些回顾性数据的哪些方法能最大限度地提高准确性和时长。其次，生命历程研究中的两个伙伴需要更认真地对待彼此的学科。社会科学家需要对诸如自我评估健康等缺乏病因学因而缺乏生物学合理性的测量方法更加挑剔。自然科学家需要对诸如社会经济地位等缺乏社会合理性的概念更加挑剔，因为它未能区分社会位置和社会声望。最后，如果欧洲比较研究能基于欧洲比较研究的新兴基础设施展开，那么它在生命历程流行病学的未来发展中可以发挥重要作用。
