Cohort profile: The Czech Health, Alcohol and Psychosocial factors In Eastern Europe study (HAPIEE-CZ)

Background : The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) is a population-based longitudinal prospective cohort study established to explore psychosocial, behavioural, and environmental risk factors of chronic conditions and ageing outcomes, including their trajectories, in middle aged and older urban populations. Methods : Four representative urban cohorts of middle-aged men and women were established in the Czech Republic (n = 8,856), Poland (n = 10,727), Lithuania (n = 10,940), and Russia (n = 9,363) in the early 2000s. This cohort profile update summarises the main design features across the four cohorts, followed by the recent re-examination of the Czech cohort in 2023-2024. At this most recent data collection, Czech participants aged 64-90 years completed postal questionnaire (n=2,350), performed physical and cognitive tests (n=1,519) and provided blood samples (n=1,388). Findings to date : The HAPIEE study is the largest multi-country cohort established in Eastern Europe, incorporating harmonized longitudinal data from four populations. The HAPIEE data have led to a considerable scientific contribution, including over 100 published papers in peer-reviewed journals. Large absolute and relative all-cause mortality inequalities in Eastern Europe were explained by measures of socio-economic position and material deprivation, including food access and living conditions. Additionally, increased frailty index, increased depressive symptoms, and poor cognitive functions were found as significant risk factors of all-cause mortality. The HAPIEE cohort contributed to development and validation of the ESC SCORE2 risk assessment model. Future directions: Data from all four cohorts were linked to national administrative registers offering a comprehensive view of the participants’ health status over more than 20 years. Additionally, geocoding of the participants’ addresses opened the opportunities to link data to numerous external exposome characteristics and census data. Lastly, DNA samples of Czech participants who provided blood sample at baseline underwent whole genome genotyping allowing investigation of the contribution of genetic predispositions (DNA polymorphisms, polygenic scores) to the various health conditions.