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Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

August 10, 2016

Rochester Epidemiology Project – 50 Years of making a difference in health care, despite the “Lake Wobegon effect”

By Elizabeth Zimmermann

3209582_0201_silverlake1 In 2012, Rochester Epidemiology Project (REP) co-directors Walter Rocca, M.D., Mayo Clinic; and Barbara Yawn, M.D., Olmsted Medical Center; and their colleagues, published a paper describing the generalizability of epidemiological findings from one population to others.

Their premise - health and health care information derived from the largely ethnically homogeneous population in Olmsted County, Minnesota, and more recently in the 27 counties that comprise the REP, can indeed impact our ability to provide better care – regionally, nationally and beyond.

“We suffer from the Lake Wobegon effect,” laments Dr. Rocca. “People say, ‘ah yes, Minnesota, the place where all women are strong, all men are good looking, all children are above average, and you have a lot of cornfields – but what could you possibly tell me about my much more diverse population?’”

The REP team found that there were limitations – as there would be with any data source. “Epidemiological findings from any single population are best used when compared with findings from other populations in the United States or worldwide to investigate geographic similarities or differences in disease patterns.…[However,] in the absence of more general data, findings from these single populations can be used to guide our decisions in clinical practice or in public health,” said the authors.

What they did not touch on, but what is undeniable, is that the REP, a medical records-linkage system and 50-year community collaboration, has added value since its inception in 1966.REP LOGO BADGE copy

“This unique national resource is unmatched in our country in terms of the depth and breadth of information about a single population,” says Dr. Rocca, “And it does not have a lot of international equivalents either.”

The REP has led to more than 2,600 publications, looking at where, when, and how often various diseases occur; and finding causes and possible ways to prevent diseases.

“The Rochester Epidemiology Project allows us to answer questions that cannot be answered anywhere else,” says Dr. Rocca. “Without the foresight and collegial nature of the health care providers in Olmsted County 50 years ago, we never would be able to do what we do today – or to discover something new tomorrow.”

Over the years, the REP has added to our understanding of:

  • Brain Health – for example, because of the REP we know that head trauma earlier in life can lead to dementia, Parkinson’s, and epilepsy.
  • Cancer – we now know that people with inflammatory bowel disease, treated with immunomodulators, are at increased risk of developing melanoma during treatment.
  • Early childhood – it is a good idea to delay surgery for very young children if possible – anesthesia use can cause ADHD.
  • School age – those health screenings at school? Vision screenings are useful, scoliosis screenings can actually cause harm…this REP finding changed international school screening guidelines.
  • Immunizations – the REP showed that autism WAS NOT caused by immunizations; and more recently, we learned that with HPV immunizations, you should start them early (age 9 or 10), or you might not get them done, leaving your child unprotected from a number of cancers.
  • Sex and gender-related health issues – because of the REP we know that more people are developing skin cancer, and women between age 40 and 50 have considerably higher risk. We also know that men are more likely to develop Parkinson’s disease, which is also on the rise in general.
  • Aging – the REP supports the renowned Mayo Clinic Study on Aging, as well as other age-related research. One particular study showed that people who have mild cognitive impairment are more likely to die younger. Another – that chronic obstructive pulmonary disease (COPD) is related to the development of mild cognitive impairment.

“50 years is just the beginning,” says Dr. Rocca. “We will continue to build our understanding of diseases, health behaviors and environmental contributors, and their impact on future health status. With this information, we can then look for ways to prevent or change the course of diseases, and hopefully one day, eradicate them.”

The REP is administratively managed at Mayo Clinic, and is supported by the National Institutes of Health, as well as the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. For more information on the Rochester Epidemiology Project, visit the website.

To learn about using REP data, contact the current REP co-directors Walter Rocca, M.D., or Jenny St. Sauver, Ph.D.



Attn: Rochester Epidemiology Project
PO Box 115
Rochester, MN 55903


Tags: About, big data, Center for the Science of Health Care Delivery, population health, Rochester Epidemiology Project, Walter Rocca

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