title: Utilizing harmonization and common surveillance methods to consolidate 4 cohorts: the Western Alaska Tribal Collaborative for Health (WATCH) study.
abstract: BACKGROUND
  According to health status reports, chronic disease prevalence appears to be rising in western Alaska Native (AN) people, and accurate population-based data are needed. Four cohort studies of western AN people were conducted in the Norton Sound and Yukon-Kuskokwim regions, but none have been large enough to allow reliable estimates of rates of chronic diseases and evaluate their risk factors.
  
  
  OBJECTIVE
  In this article, the methods used to combine 4 major cohort studies of rural western AN people are described and the benefits and challenges encountered in combining data and standardizing surveillance methods for these studies are discussed.
  
  
  METHODS
  Tribal permission was obtained for each cohort study and the consolidated study. Data from baseline exams were directly combined or harmonized into new variables. Common surveillance methods were developed and implemented to identify incidence and risk factors for cardiovascular disease (CVD) events and type 2 diabetes.
  
  
  RESULTS
  A cohort of 4,569 western AN participants (2,116 men and 2,453 women), aged 18-95 years, was established to study CVD and diabetes prevalence. Prospective surveillance data over an average 6.7-year follow-up can now be used to study CVD and diabetes incidence and associated risk factors in a subset of 2,754 western AN participants (1,218 men and 1,536 women) who consented to initial surveillance.
  
  
  CONCLUSIONS
  The combined cohort provides statistical power to examine incidence rates and risk factors for CVD and diabetes and allows for analyses by geographic region. The data can be used to develop intervention programmes in these populations and others.
authors.affiliation: Division of Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Koller
authors.forename: Abbie W
authors.initials: AW
authors.lastname: Wolfe
authors.forename: Jesse S
authors.initials: JS
authors.lastname: Metzger
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Austin
authors.forename: Scarlett E
authors.initials: SE
authors.lastname: Hopkins
authors.forename: Cristiane
authors.initials: C
authors.lastname: Kaufmann
authors.forename: Stacey E
authors.initials: SE
authors.lastname: Jolly
authors.forename: Sven O E
authors.initials: SO
authors.lastname: Ebbesson
authors.forename: Jason G
authors.initials: JG
authors.lastname: Umans
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.forename: Bert B
authors.initials: BB
authors.lastname: Boyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D001110:Arctic Regions / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology*; D002908:Chronic Disease; D015331:Cohort Studies; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D004930:Inuit; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D018571:Sentinel Surveillance; D055815:Young Adult
keywords: Alaska Native; cardiovascular disease; cohort study; risk factors; statistical power; type 2 diabetes