Tecumseh Community Health Study

Background/Question:

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. [1] While cardiovascular disease was of central interest to the investigators, infectious and other types of chronic illness were studied in the cohort.

Methods:

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. [1] 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. [1] Deaths in the cohort were ascertained using the obituaries in the local newspaper and autopsy reports. [1]

Results:

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. [2]

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. [3] Young women in the cohort who smoke were also at a higher relative risk for developing CHD than young men who smoke. [4] 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. [5]

Conclusion/Discussion:

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. [6]

Anecdote:

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.”[7] (HB)