Epidemiology is the application of the scientific method to the study of disease in populations for the purpose of prevention or control. It is a key basic science of public health and preventive medicine with its scope of training in study design and statistical methods crucial for accurate scientific research across all medical disciplines. Dr. Sue-Min Lai is the program leader in epidemiology and prevention for the department with her expertise in chronic disease. She has been with KUMC since the fall of 1993 and under her leadership a program studying the epidemiology of various chronic diseases has flourished.
The Kansas Cancer Registry, established in 1994, has successfully competed for grant funds from the Centers for Disease Control and Prevention (CDC) as well as the Kansas Department of Health and Environment (KDHE) in order to study cancer surveillance and cancer epidemiology. Cancer surveillance has been a collective effort which involves hospitals, pathology laboratories, surgery and radiation treatment centers, physicians, other health care providers and even the Kansas Legislature. Since 1994 KCR has collected data on more than 200,000 newly diagnosed cancers of all types in Kansans and has been awarded the gold standard by NAACCR for case completeness, timeliness, and data quality and is considered a top performer among all State cancer registries. In addition to the routine cancer surveillance effort, the registry data has been made available to the public and researchers online at http://www2.kumc.edu/kcr. Registry data is used for many purposes such as prioritizing cancer types for the effort on Kansas Comprehensive Cancer Control and Prevention http://www.cancerkansas.org/cancer_plan.htm, characterizing cancer burden in the nation http://apps.nccd.cdc.gov/uscs, cancer care market share analysis, and support for research activities including monographs on colorectal and HPV-related cancers.
Another important function of the Kansas Cancer Registry is to provide timely response to concerns of a cancer cluster within a group of people, in a geographic area, or over a period of time. The KCR team has responded to numerous suspected cancer cluster investigations both in-state and out-of-state. A recent investigation of a possible excess of brain cancer in Lawrence led by Dr. Neuberger used the KCR database extensively as a research tool for the investigation.
Cardiovascular disease (CVD), including coronary heart disease and stroke, remains the leading cause of death in the United States for both men and women. Kansas is no exception with CVD accounting for 37% of all deaths. Unfortunately, current state-level data on cardiovascular health is inadequate to guide critical strategic planning and development to improve the cardiovascular health of our citizens. The Kansas Cardiovascular Health Examination and Survey used grant funds from the CDC to design a NHANE-type project to assess cardiovascular health in Kansas. Only three projects in the nation were funded by CDC to implement such a survey at the state level to provide state-specific data for cardiovascular health strategic planning. This project will produce data to examine the interplay between CVD events and traditional CVD risk factors, their control status as well as non-traditional CVD risk factors (e.g., sleep pattern and periodontal disease). This project is progressing favorably and has recruited 1,500 subjects and will ultimately recruit over 1,700 subjects from 20 different counties in Kansas. The study subjects participate in three phases, with a telephone interview, a mail-in questionnaire, and physical examination with serum collection for biochemical assays. This project is a testimony to the power of collaboration in which faculty from KUMC worked alongside key personnel from the state agency (KDHE), participating county health departments, clinics and a commercial laboratory.
Stroke epidemiology and rehabilitation is another focus of this program (Lai). In collaboration with neurologists and rehabilitation medicine specialists in the Kansas City metro area hospitals, over 1,000 stroke patients were recruited for the two studies funded by the American Heart Association, Veterans Administration, and the National Institutes of Health. More than 30 original research manuscripts in stroke epidemiology, recovery, and rehabilitation, as well as depressive symptoms management after stroke have been published in major peer-reviewed journals including Lancet, Stroke, and Neurology. The richness of stroke databases resulting from these two studies provides the investigative team excellent sources of invaluable information for continued stroke research. A major result from these stroke studies has produced an outcome measurement tool, the Stroke Impact Scale, which is being used in research, clinical practice, and therapeutic drug trials (http://www2.kumc.edu/coa/SIS/Stroke-Impact-Scale.htm). This scale has been translated into more than 15 languages worldwide.
The activities in environmental health epidemiology in our program focused on radon and lung cancer, residential exposure to radon and multiple sclerosis (Neuberger). A recent investigation on the causes of brain cancer included 765 individuals who had offices in Wescoe Hall during the last eleven years. This study included a detailed Industrial Hygiene survey of the building and completion of a questionnaire on environmental exposures including home and occupational exposures. All brain tumors were confirmed by medical records and pathology reports. A complete list of names was linked to the Kansas Cancer Registry to determine the number of cancer cases. The report on this study has been released to the public.
The focus of infectious disease epidemiology in our program is through education to students, public health practitioners locally and internationally on surveillance and control, immunotherapy of chronic viral hepatitis and hepatocellular carcinoma, influenza and emerging infectious diseases (Chin).
Low birth weight remains a serious problem in Kansas and in the US as a whole. Among many consequences of low birth weight are poor brain size development and lower educational attainment. Strategies for eliminating low birth weight including provision of nutrition, education, and prenatal care. Researchers in our program (Guillory and Lai) work closely with the KDHE to quantify the effect of prenatal care, maternal comorbidities, socioeconomic status, and the Medicaid program on low birth weight.
Causes of scoliosis and many other spine deformities remain largely unknown. While researchers continue to search for causes, spinal instrumentation remains the treatment of choice for many patients. To better our understanding of various choices of spinal instrumentation, orthopedic surgeons at KUMC (Drs. Asher, Burton, and Glattes) and Dr. Lai systematically evaluated the effectiveness of various spinal instrumentations in patients with scoliosis and other spine deformities and also assessed patients' health related quality of life after spinal instrumentations. An outcome measure (SRS-22r) has been developed and refined to characterize patient's outcomes. This measure is used worldwide.
The faculty and researchers in our program strive to further our understanding of the biologic spectrum of selected diseases and improve the accuracy of their diagnosis, treatment strategy, and prognosis using independent research and collaboration with clinicians and other researchers.