Brookmeyer R
Department of Biostatistics, Johns Hopkins University, Baltimore, MD 21205.
Environ Health Perspect. 1990 Jul;87:43-9. doi: 10.1289/ehp.908743.
The development of effective disease prevention and treatment programs depends on an understanding of the natural history of disease. A conceptual framework is presented for disease natural history and consists of an asymptomatic period of disease followed by a period of symptomatic disease. The focus is on epidemiologic studies for identifying risk factors of the onset of asymptomatic disease, for identifying cofactors of progression to symptomatic disease, and for estimating the duration of the asymptomatic period. The strengths and limitations of various epidemiologic study designs and sources of epidemiologic data are considered for characterizing disease natural history. Issues in the interpretation and analysis of natural history parameters of disease estimated from cross-sectional, prevalent cohort, cohort, and matched case-control studies are considered. The issues and analytic methods are illustrated with studies of the acquired immunodeficiency syndrome (AIDS) and cervical cancer. Based on these analytic methods, an estimate of the incubation period distribution of AIDS is given.
有效的疾病预防和治疗方案的制定依赖于对疾病自然史的了解。本文提出了一个疾病自然史的概念框架，它包括疾病的无症状期，随后是症状期。重点在于流行病学研究，以确定无症状疾病发病的危险因素、确定进展为症状性疾病的辅助因素，以及估计无症状期的持续时间。为了描述疾病自然史，考虑了各种流行病学研究设计和流行病学数据来源的优势与局限性。还考虑了从横断面研究、现患队列研究、队列研究和匹配病例对照研究中估计的疾病自然史参数的解释和分析问题。通过获得性免疫缺陷综合征（艾滋病）和宫颈癌的研究来说明这些问题和分析方法。基于这些分析方法，给出了艾滋病潜伏期分布的估计。
