Tecumseh Community Health Study
Study Category: The Cohort Studies (1947-1972)
Years: 1959 - 1973
Location: Tecumseh, Michigan, USA
Principal Investigator: Epstein, Frederick
The Tecumseh Study is an epidemiological study of cardiovascular and other conditions in the community of Tecumseh, Michigan, performed on the entire population rather than a representative sample. The town was chosen for its proximity to the researchers’ institution, the University of Michigan, as well as its mixture of suburban and rural residents.  While cardiovascular disease was of central interest to the investigators, infectious and other types of chronic illness were studied in the cohort.
Approximately 90% of Tecumseh residents were interviewed in their homes in the initial examination phase beginning in 1959. Of the 9.500 Tecumseh residents, 8,641 agreed to participate (88% response rate). During the exam, a questionnaire with over 300 items was administered. The questions varied based on the age of the participant: persons over 16 years old, children between 6 and 15 years and children under 6 years.  Physicians completed the baseline exam at a local hospital, which included a blood test for hemoglobin, uric acid and rheumatoid factor, a urine test for sugar, albumin and bacteria count, measurement of blood pressure, skinfold thickness, height and weight, ECG, vital capacity and chest x-ray.  Deaths in the cohort were ascertained using the obituaries in the local newspaper and autopsy reports. 
Analysis of the baseline data revealed the prevalence of coronary heart disease was 12% and 6.1% for 50-59 year old men and women respectively, 18% and 16.3% for 60-69 year old men and women respectively and 17.8% and 10.9% for 70-79 year old men and women respectively. 
The Tecumseh cohort has since added the children of the baseline cohort. In a follow-up study, a positive relationship was found between entry hematocrit and risk of cardiovascular disease.  Young women in the cohort who smoke were also at a higher relative risk for developing CHD than young men who smoke.  Another much later study found that lean hypertensive individuals aged 40-79 were more likely to die of coronary heart disease than obese hypertensive counterparts. 
The investigators were able to quantify the role of a number of factors involved in the development of coronary heart disease. Strengths of the study include a large and complete population, high number of risk factors considered, lengthy follow-up period and the ability to address all-cause and single causes of death in an intact and stable community. Weaknesses include the lack of racial diversity in the population and the unfortunate loss of funding after 1973. 
Letter from James Watt to his good friend, Zdenek Fejfar, July 8, 1992
“There is one little anecdote you may find amusing. For some time I tried to get Dr.T. Francis, the Professor of Epidemiology, involved in a long term study of atherosclerosis. He demurred saying that he really was not qualified since all his life he had worked on infectious diseases. One day, I got a call from a very excited Dr. Francis, who said, ‘While shaving this morning I had an idea. I will simply call atherosclerosis “arterial pox,” and I will have no problem in knowing how to go about organizing a study.’
A short time later he applied for a grant to set a community study in the town of Tecumseh and it was approved by the council.” (HB)
 Montoye HJ, Epstein FH. Tecumseh community health study: an investigation of health and disease in an entire community. The Journal of Sports Medicine and Physical Fitness.
 Epstein FH, Francis Jr. T, Hayner NS, Johnson BC, Kjelsberg MO, Napier JA, Ostrander Jr. LD, Payne MW, Dodge HJ. Prevalence of chronic diseases and distribution of selected physiologic variables in a total community, Tecumseh, Michigan. American Journal of Epidemiology. 1965; 81(3): 307-322.
 Smith S. Julius S. Jamerson K. Amerena J. Schork N. Hematocrit levels and physiologic factors in relationship to cardiovascular risk in Tecumseh, Michigan. Journal of Hypertension. 1994; 12(4):455-62.
 Vriz O. Nesbitt S. Krause L. Majahalme S. Lu H. Julius S. Smoking is associated with higher cardiovascular risk in young women than in men: the Tecumseh Blood Pressure Study. Journal of Hypertension. 1997; 15(2):127-34.
 Carman WJ. Barrett-Connor E. Sowers M. Khaw KT. Higher risk of cardiovascular mortality among lean hypertensive individuals in Tecumseh, Michigan. Circulation. 1994; 89(2):703-11.
 Blackburn HB. Interview with Millicent Higgins. Ann Arbor, MI, October 17, 2003.
 From Z. Fejfar Archive. University of Minnesota Division of Epidemiology and Community Health.