Representativeness of the LifeLines Cohort Study.
BACKGROUND
LifeLines is a large prospective population-based three generation cohort study in the north of the Netherlands. Different recruitment strategies were adopted: recruitment of an index population via general practitioners, subsequent inclusion of their family members, and online self-registration. Our aim was to investigate the representativeness of the adult study population at baseline and to evaluate differences in the study population according to recruitment strategy.


METHODS
Demographic characteristics of the LifeLines study population, recruited between 2006-2013, were compared with the total adult population in the north of the Netherlands as registered in the Dutch population register. Socioeconomic characteristics, lifestyle, chronic diseases, and general health were further compared with participants of the Permanent Survey of Living Conditions within the region (2005-2011, N = 6,093). Differences according to recruitment strategy were assessed.


RESULTS
Compared with the population of the north of the Netherlands, LifeLines participants were more often female, middle aged, married, living in a semi-urban place and Dutch native. Adjusted for differences in demographic composition, in LifeLines a smaller proportion had a low educational attainment (5% versus 14%) or had ever smoked (54% versus 66%). Differences in the prevalence of various chronic diseases and low general health scores were mostly smaller than 3%. The age profiles of the three recruitment groups differed due to age related inclusion criteria of the recruitment groups. Other differences according to recruitment strategy were small.


CONCLUSIONS
Our results suggest that, adjusted for differences in demographic composition, the LifeLines adult study population is broadly representative for the adult population of the north of the Netherlands. The recruitment strategy had a minor effect on the level of representativeness. These findings indicate that the risk of selection bias is low and that risk estimates in LifeLines can be generalized to the general population.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Bart
B
Klijs
LifeLines Cohort Study and Biobank, Groningen, the Netherlands.
Salome
S
Scholtens
Sociology of Consumption and Households, Wageningen University, Wageningen, the Netherlands.
Jornt J
JJ
Mandemakers
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Harold
H
Snieder
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; LifeLines Cohort Study and Biobank, Groningen, the Netherlands.
Ronald P
RP
Stolk
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Nynke
N
Smidt
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003710:Demography; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011159:Population Surveillance; D011446:Prospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult