NLM5008 Chap.4 Intergenerational Cohorts Around the World
Intergenerational Cohorts Around the World
The labels and the four designs
Week 2 introduces the notation used for the rest of the course: F0 for grandparents, F1 for parents and F2 for offspring. An intergenerational cohort collects data on linked generations, and the lecture sorts them into four types. A population-based cohort extended to three generations starts with adults and later recruits their children and grandchildren.
A birth cohort extended to three generations starts with pregnancies and their babies and later adds the babies' children. An integrated birth and three-generation cohort starts with pregnancies but also recruits the pregnant women's parents.
A three-generation cohort collects all three at the same stage.
Two cohorts in detail
The Framingham Heart Study began in 1948 by inviting two of every three families with members aged 30 to 59 in one Massachusetts town, and became the first large, multigenerational cohort for cardiovascular epidemiology in the United States.
It collects socioeconomic data, residential pollution, cardiovascular phenotypes and biomarkers, and its risk score has been recalibrated for Singapore.
The Tohoku Medical Megabank BirThree cohort in Japan, with 73,529 participants, began after the Great East Japan Earthquake to support regional recovery, recruiting pregnant women in Miyagi Prefecture with their parents, relatives, newborns and siblings.
The global picture from the readings
A 2024 scoping review found 28 multigenerational cohorts.
Fifteen were extended birth cohorts, the most common design, and the United States had the most, six. Twenty-six were in high-income countries. Almost all collected demographic, socioeconomic and lifestyle exposures, and the outcomes most often studied were obesity, cardiovascular disease and child health.
A 2025 analysis counted about 350 prospective cohorts reported in China by August 2024, most with fewer than 10,000 participants.
What remains unsolved
Comparing cohorts across countries needs data-sharing infrastructure, and few cohorts exist in low- and middle-income countries, where exposures and their associations with disease may differ.
Researchers increasingly extend birth cohorts using routinely kept administrative data. The lecture closes with Kierkegaard: life is understood looking back but lived looking forward, so the cohorts built today are resources for people not yet born.
What this chapter covers
- 01
F0, F1 and F2 as the generation labels
- 02
Four intergenerational cohort designs and where each starts
- 03
The Framingham Heart Study from 1948 to its third generation
- 04
The Tohoku BirThree cohort after the 2011 earthquake
- 05
What the 2024 scoping review found across 28 cohorts
- 06
Data sharing, low-income settings and administrative data
Worked example · free
Classifying a cohort from its recruitment story
- 1Classify the design.
- 2Label the three generations correctly.
- 2State one advantage.
Key terms
- F0 Generation
- The grandparent generation in an intergenerational cohort.
- Birth Cohort
- A cohort that begins by recruiting pregnancies or births and follows the children forward.
- Scoping Review
- A review that maps the extent and nature of research on a topic rather than pooling effect sizes.
- Risk Score
- A formula combining several risk factors to estimate a person's chance of a future event.
- Administrative Data
- Records routinely kept by institutions for their own purposes, reused for research.
- Lifelines Cohort
- A Dutch cohort of 167,729 people, the only one in the review with four integrated generations.
Intergenerational Cohorts Around the World FAQ
Which intergenerational design is most common?
The birth cohort extended to three generations, with fifteen of the twenty-eight cohorts in the 2024 scoping review. It starts with pregnancies and babies and later recruits the babies' own children, which suits questions about exposures in pregnancy.
Which country has the most multigenerational cohorts?
The United States, with six of the twenty-eight in the scoping review. China has many prospective cohorts, around 350 by one 2025 count, but most follow a single generation and have fewer than 10,000 participants.
Why did Framingham become a three-generation study?
It began in 1948 with adults in one town, and later recruited their offspring and then a third generation, turning a heart disease study into a population-based cohort extended across three generations whose members can be linked within families.
Why was the Tohoku BirThree cohort set up?
To assess health after the Great East Japan Earthquake and support regional recovery through advanced medicine. One publication found that parents' high BMI and current smoking were more common where house damage was more severe.
What stops cohorts from being compared across countries?
The lack of infrastructure for sharing data, differences in what exposures mean at different stages of economic development, and the shortage of cohorts in low- and middle-income countries, whose exposure and disease patterns may differ from richer settings.
Assessment move
Draw the four designs as rows with F0, F1 and F2 as columns and shade where each begins. Then place Framingham, the Dutch famine cohort and Tohoku on the correct rows without looking.
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