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China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up
Open accessAbstract
BACKGROUND: Large blood-based prospective studies can provide reliable assessment of the complex interplay of lifestyle, environmental and genetic factors as determinants of chronic disease. METHODS: The baseline survey of the China Kadoorie Biobank took place during 2004-08 in 10 geographically defined regions, with collection of questionnaire data, physical measurements and blood samples. Subsequently, a re-survey of 25,000 randomly selected participants was done (80% responded) using the same methods as in the baseline. All participants are being followed for cause-specific mortality and morbidity, and for any hospital admission through linkages with registries and health insurance (HI) databases. RESULTS: Overall, 512,891 adults aged 30-79 years were recruited, including 41% men, 56% from rural areas and mean age was 52 years. The prevalence of ever-regular smoking was 74% in men and 3% in women. The mean blood pressure was 132/79 mmHg in men and 130/77 mmHg in women. The mean body mass index (BMI) was 23.4 kg/m(2) in men and 23.8 kg/m(2) in women, with only 4% being obese (>30 kg/m(2)), and 3.2% being diabetic. Blood collection was successful in 99.98% and the mean delay from sample collection to processing was 10.6 h. For each of the main baseline variables, there is good reproducibility but large heterogeneity by age, sex and study area. By 1 January 2011, over 10,000 deaths had been recorded, with 91% of surviving participants already linked to HI databases. CONCLUSION: This established large biobank will be a rich and powerful resource for investigating genetic and non-genetic causes of many common chronic diseases in the Chinese population.
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“GWAS using siblings (within-sibship GWAS) (Fig. 2) have been previously limited by available data, but are now feasible by combining well-established family studies with recent large biobanks that incidentally or by design contain thousands of sibships35–39.”
From Within-sibship genome-wide association analyses decrease bias in estimates of direct genetic effects (2022) · cites this paper as [38]
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“Similar initiatives have been conducted in other countries, such as the China Kadoorie Biobank 86 and Biobank Japan 87 .”
From Multimodal biomedical AI (2022) · cites this paper as [86]
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“These biobank efforts, pioneered in studies such as the Framingham Cohort70 and the efforts of DeCODE in Iceland71,72, now encompass a growing inventory of national cohorts in North America, Europe, Asia and beyond73–76.”
From A brief history of human disease genetics (2020) · cites this paper as [76]
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Liu, T., Song, Y., Chen, R., Zheng, R., Wang, S., & Li, L. (2020) · Environmental Research · doi:10.1016/j.envres.2020.109578 · Cited by 38
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“23 The classification and distribution of hepatobiliary diseases are shown in online supplementary table 2.”
Self-citationYang, S., & Zhou, X. (2022) · Briefings in Bioinformatics · doi:10.1093/bib/bbac039 · Cited by 39
“Commonly available biobank data include UK Biobank (UKB; [20]), Biobank of Japan (BBJ; [21]), China Kadoorie Biobank (CKB; [22]), FINNGEN [23] and All of Us [24], to name a few.”
Machine Learning to Advance Human Genome-Wide Association Studies
Sigala, R. E., Lagou, V., Shmeliov, A., Atito, S., Kouchaki, S., Awais, M., Prokopenko, I., Mahdi, A., & Demirkan, A. (2023) · Genes · doi:10.3390/genes15010034 · Cited by 41
“The best-known longitudinal population-based biobanks include the UK Biobank [98], the China Kadoorie Biobank [99], the Estonian Biobank [100], and the Lifelines Biobank [101].”
BackgroundCardiovascular risk factors and Parkinson's disease in 500,000 Chinese adults
Kizza, J., Lewington, S., Mappin‐Kasirer, B., Turnbull, I. J., Yu, C., Bian, Z., Chen, Y., Yang, L., Chen, Z., Clarke, R., et al. (2019) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.732 · Cited by 37
“At enrollment, data were collected on demographic, medical history, and lifestyle characteristics using an interviewer-administered electronic questionnaire.(31) Demographic and behavioral characteristics included details on age, sex, region, income, occupation, education status, alcohol consumption, cigarette smoking…”
MethodSelf-citationNing, X., Lv, J., Guo, Y., Bian, Z., Tan, Y., Pei, P., Chen, J., Yan, S., Li, H., Fu, Z., et al. (2019) · Obesity · doi:10.1002/oby.22713 · Cited by 38
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“(Chen et al., 2011, 2005) Briefly, in 2004–2008, ~512,000 adults aged 30–79 years were recruited from five rural and five urban areas across China (Figure A1).”
BackgroundSelf-citationYang, S., Han, Y., Yu, C., Guo, Y., Pang, Y., Sun, D., Pei, P., Yang, L., Chen, Y., Du, H., et al. (2022) · Neurology · doi:10.1212/wnl.0000000000200139 · Cited by 36
“Incident events were identified by using linkages with local disease and death registries and the national health insurance system and supplemented by active follow-up.(17) The loss to follow-up was <1% prior to censoring on December 31, 2017.”
Self-citationBennett, D., Parish, S., Millwood, I. Y., Guo, Y., Chen, Y., Turnbull, I. J., Yang, L., Lv, J., Yu, C., Smith, G. D., et al. (2023) · International Journal of Epidemiology · doi:10.1093/ije/dyad147 · Cited by 36
“Details of the design, survey methods, procedures and participant characteristics of the China Kadoorie Biobank (CKB) study have been previously reported [18,19].”
Self-citationXia, X., Meng, X., Liu, C., Guo, Y. Z., Li, X., Niu, Y., Lam, H. K. B., Wright, N., Kartsonaki, C., Chen, Y., et al. (2024) · The Lancet Public Health · doi:10.1016/s2468-2667(24)00264-0 · Cited by 36
Self-citationSi, J., Yu, C., Guo, Y., Bian, Z., Meng, R., Yang, L., Chen, Y., Jin, J., Liu, J., Guo, Z., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027696 · Cited by 36
Self-citationFan, J., Yu, C., Pang, Y., Guo, Y., Pei, P., Sun, Z., Yang, L., Chen, Y., Du, H., Sun, D., et al. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab213 · Cited by 41
“We used data from the China Kadoorie Biobank (CKB), a large prospective cohort study of 500,000 participants aged 30-79 years, that were enrolled in 2004-08 and followed-up until the present time (17).”
MethodSelf-citationEpigenome-wide analysis of DNA methylation and coronary heart disease: a nested case-control study
Si, J., Yang, S., Sun, D., Yu, C., Guo, Y., Lin, Y., Millwood, I. Y., Walters, R. G., Yang, L., Chen, Y., et al. (2021) · eLife · doi:10.7554/elife.68671 · Cited by 35
Self-citationLevy, M., Chen, Y., Clarke, R., Bennett, D., Tan, Y., Guo, Y., Bian, Z., Lv, J., Yu, C., Li, L., et al. (2020) · The Lancet Global Health · doi:10.1016/s2214-109x(20)30078-4 · Cited by 35
Self-citationCausal effects of gallstone disease on risk of gastrointestinal cancer in Chinese
Pang, Y., Lv, J., Kartsonaki, C., Guo, Y., Yu, C., Chen, Y., Yang, L., Bian, Z., Millwood, I. Y., Walters, R. G., et al. (2021) · British Journal of Cancer · doi:10.1038/s41416-021-01325-w · Cited by 35
Self-citationAssociation of Red Meat Consumption, Metabolic Markers, and Risk of Cardiovascular Diseases
Pan, L., Chen, L., Lv, J., Pang, Y., Guo, Y., Pei, P., Du, H., Yang, L., Millwood, I., Walters, R., et al. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.833271 · Cited by 33
Self-citationZou, S., Wang, Z., Bhura, M., Zhang, G., & Tang, K. (2020) · Journal of Public Health · doi:10.1093/pubmed/fdaa204 · Cited by 35
Chen, R., Ma, S., Guan, C., Song, G., Ma, Q., Xie, S., Wang, M., Shao, D., Li, X., & Wei, W. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027360 · Cited by 35
The Diabetes Pearl: Diabetes biobanking in The Netherlands
Riet, E. V. ‘., Schram, M. T., Abbink, E. J., Admiraal, W. M., Dijk-Schaap, M. W., Holleman, F., Nijpels, G., Özcan, B., Pijl, H., Schaper, N. C., et al. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-949 · Cited by 34
“Database (GPRD) in the UK, the Swedish National Diabetes Register and the China Kandoori Biobank, have been valuable in various research topics concerning diabetes [12-15].”
BackgroundIm, P. K., Millwood, I. Y., Kartsonaki, C., Chen, Y., Guo, Y., Du, H., Bian, Z., Lan, J., Feng, S., Yu, C., et al. (2021) · International Journal of Cancer · doi:10.1002/ijc.33538 · Cited by 33
“Details of the CKB study design and methods have been previously reported.(19) Briefly, 512 715 adults aged 30 to 79 years were recruited from 10 areas across China during 2004 to 2008.”
MethodSelf-citationChan, K. H., Yan, M., Bennett, D., Guo, Y., Chen, Y., Yang, L., Lv, J., Yu, C., Pei, P., Lu, Y., et al. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003716 · Cited by 34
“outside of clinical settings, standardised verbal autopsy was conducted to ascertain the most probable cause of death [11].”
BackgroundSelf-citationAdvances and Applications of Polygenic Scores for Coronary Artery Disease
Patel, A. P., & Khera, A. V. (2022) · Annual Review of Medicine · doi:10.1146/annurev-med-042921-112629 · Cited by 35
Metabolic diseases in the East Asian populations
Sun, Z., & Zheng, Y. (2025) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-025-01058-8 · Cited by 40
“In a study including 512,891 Chinese participants from the CKB, individuals with T2DM had a 68% increased risk of ischaemic stroke and a 24% increased risk of intracerebral haemorrhage compared with those without T2DM 167 .”
InfluentialWu, H., Wang, H., Hu, R., Zhong, J.-M., Qian, Y., Wang, C., Xie, K., Chen, L., Gong, W., Yu, C., et al. (2016) · Acta Diabetologica · doi:10.1007/s00592-016-0918-1 · Cited by 32
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Self-citationWang, L., Jin, G., Yu, C., Lv, J., Guo, Y., Bian, Z., Yang, L., Chen, Y., Hu, Z., Chen, F., et al. (2019) · International Journal of Cancer · doi:10.1002/ijc.32394 · Cited by 34
“Linkage to the HI database was renewed annually.(10,13) Suspicious diagnoses were further confirmed via active follow-up by visiting local committees or directly contacting the participants.”
BackgroundMethodSelf-citationConstitutional multicenter bank linked to Sasang constitutional phenotypic data
Jin, H., Baek, Y., Kim, H., Ryu, J.-H., & Lee, S. (2015) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-015-0553-3 · Cited by 33
“The China Kadoorie biobank (CKB) is set up to investigate the main genetic and environmental causes of common chronic diseases in the Chinese population [4,5].”
BackgroundPang, Y., Holmes, M. V., Kartsonaki, C., Yu, C., Yang, L., Bian, Z., Chen, Y., Bragg, F., Iona, A., Millwood, I. Y., et al. (2017) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2017-208895 · Cited by 33
Self-citationMeng, R., Liu, N., Yu, C., Pan, X., Lv, J., Guo, Y., Bian, Z., Yang, L., Chen, Y., Chen, Z., et al. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.052 · Cited by 34
“The estimated population response rate was about 30% (26–38% in the five rural areas and 16–50% in the five urban areas) (Chen et al., 2011).”
BackgroundMethodInfluentialSelf-citationImportance of Genetic Studies of Cardiometabolic Disease in Diverse Populations
Fernández‐Rhodes, L., Young, K. L., Lilly, A. G., Raffield, L. M., Highland, H. M., Wojcik, G. L., Agler, C. S., Love, S.-A. M., Okello, S., Petty, L. E., et al. (2020) · Circulation Research · doi:10.1161/circresaha.120.315893 · Cited by 33
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Self-citationYang, J., Du, H., Yu, C., Bian, Z., Yu, C., Chen, Y., Yang, L., Liu, J., Han, X., Chen, J., et al. (2022) · Journal of Nutrition · doi:10.1093/jn/nxac041 · Cited by 32
“Study population Details of the CKB study design, methods, and participants have been reported previously (19, 20).”
Self-citationO’Loughlin, J., Casanova, F., Fairhurst-Hunter, Z., Hughes, A., Bowden, J., Watkins, E. R., Freathy, R. M., Millwood, I. Y., Lin, K., Chen, Z., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-02735-8 · Cited by 33
Self-citationLung cancer risk score for ever and never smokers in China
Ma, Z., Lv, J., Zhu, M., Yu, C., Ma, H., Jin, G., Guo, Y., Bian, Z., Yang, L., Chen, Y., et al. (2023) · 癌症：英文版 · doi:10.1002/cac2.12463 · Cited by 31
Self-citationA global analysis of dairy consumption and incident cardiovascular disease
Zhuang, P., Liu, X., Yin, L., Ao, Y., Wu, Y., Ye, H., Wan, X., Zhang, L., Meng, D., Tian, Y., et al. (2025) · Nature Communications · doi:10.1038/s41467-024-55585-0 · Cited by 34
“…linkages with disease registries, national health insurance claim databases, and the local disease surveillance points system death registries by reviewing residential records and/or by visits to local communities for those uninsured participants inCKB to minimize any underreporting cases 70 .”
Governing International Biobank Collaboration: A Case Study of China Kadoorie Biobank
Chen, H. (2013) · Science Technology and Society · doi:10.1177/0971721813498497 · Cited by 31
“The follow-up study is electronically linked with the new national health insurance claim databases that are now established in all ten study regions (Z. Chen et al., 2005; Z. Chen et al., 2011).”
MethodWang, M., Hu, R., Wang, H., Gong, W., Wang, C., Xie, K., Chen, Z., Yu, C., Yu, M., & Li, L. (2017) · Journal of Diabetes Investigation · doi:10.1111/jdi.12775 · Cited by 30
Self-citation
Metadata
- Authors
- Chen, Z., Chen, J., Collins, R., Guo, Y., Peto, R., Wu, F., Li, L., & on behalf of the China Kadoorie Biobank (CKB) collaborative group
- Affiliations
- Chinese Center For Disease Control and Prevention (CN)
- Corresponding author
- Chen, Z.
- Li, L.
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-21
- Volume
- 40
- Issue
- 6
- Pages
- 1652-1666
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC3235021
- OpenAlex
- W2105079646
- Cited by
- 1,034
- References
- 43
- Citations by year
- 2026: 109 · 2025: 122 · 2024: 134 · 2023: 110 · 2022: 107 · 2021: 116 · 2020: 75 · 2019: 66 · 2018: 55 · 2017: 51 · 2016: 30 · 2015: 26 · 2014: 14 · 2013: 12 · 2012: 6
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Wellcome Trust (088158/Z/09/Z)
- Cancer Research UK
- British Heart Foundation
- Chinese Center for Disease Control and Prevention
- Kadoorie Charitable Foundation
- Centers for Disease Control and Prevention
- Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Keywords
- China Kadoorie Biobank, prospective cohort, biobanks, baseline characteristics, smoking prevalence, blood pressure, body mass index, diabetes prevalence, cause-specific mortality, hospitalization, chronic disease, Chinese adults
- MeSH terms
- Adult, Age Factors, Aged, Blood Pressure, Body Weights and Measures, China, Chronic Disease, Data Collection, Environment, Female, Follow-Up Studies, Genetic Testing, Humans, Life Style, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Residence Characteristics, Rural Population, Sex Factors, Smoking, Socioeconomic Factors, Health Behavior, Body Mass Index, Databases, Factual, Genetic Predisposition to Disease, Databases, Genetic
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