Cohort Profile: The Guangzhou Biobank Cohort Study, a Guangzhou–Hong Kong–Birmingham collaboration

The Guangzhou Biobank Cohort Study (GBCS), initiated by TH Lam (Hong Kong), CQ Jiang (Guangzhou), and KK Cheng (Birmingham), has been in part modelled on the Kadoorie Study of Chronic Disease in China (KSCDC) 1 and the UK Biobank. 2 Initial seed funding came from the Universities of Hong Kong and Birmingham, the Guangzhou No. 12 Hospital (Guangzhou Occupational Disease Prevention & Treatment Centre), the Guangzhou Public Health Bureau, and the Guangzhou Science and Technology Bureau. The Clinical Trials Service Unit at Oxford University has provided technical advice, especially in the planning and setting up of the project. Whereas the KSCDC recruits adults aged 35–74 years nationwide from five rural counties and five urban districts, the GBCS focuses on older people aged at least 50 years in a mega-city of ~10 million. Of these, 6.4 million are permanent residents with locally registered households and the remainder are mostly migrants from other parts of the country. Guangzhou, the provincial capital of Guangdong province in southern China, is one of the most economically developed regions of China (Figure 1). Uniquely, the lifetime experience of older urban residents in Guangzhou has straddled two macro-environments. Their parents were born into a preindustrial environment, where living standards had been essentially unchanged for millennia 3,4 and where male heights (an anthropometric marker of living standards) were similar to those in France at their pre-industrial nadir. 5–10 These circumstances largely continued until after the establishment of the People’s Republic of China (PRC) in 1949, although there were some isolated pockets of transient, haphazard economic growth along the eastern seaboard and around the treaty ports of Shanghai and to a lesser extent Guangzhou during the first half of the 20th century. 11,12 However, with the more inclusive route to economic development taken by the PRC, and in recent decades following the establishment of the special economic zones close to Hong Kong in 1978, Guangzhou has been transformed and its residents’ lives with it. Inevitably, this very rapid economic progress has been neither smooth nor comprehensive. There have been periods of significant hardships such as during the Japanese occupation in the 1940s, the Great Leap Forward in the late 1950s, 13 and the Cultural Revolution in the 1960s. There are also inequalities, and one specifically relevant to this study is the current difficulty of access to medical care after the large-scale privatization of health care facilities since the 1980s. 14 Nevertheless, despite rapid economic transformation, traditional aspects of Chinese culture and social norms have been retained, such as more communitarian values and a Confucian respect for authority, and specific dietary and lifestyle habits, such as low use of alcohol and low female smoking rates. 15