Cohort profile: Follow-up longitudinal observational study on risk factors and health in adults (FLORA)

The Follow-up Longitudinal Observational study on Risk factors and Health in Adults (FLORA) is a prospective cohort established in Guangzhou, China, in 2008 to investigate the impact of rapid urbanization, environmental transitions, and macrosocial changes on non-communicable diseases (NCDs) in working-age and older adults. The cohort comprises 7,855 participants aged 19–83 years at baseline, drawn from the city’s annual mandatory health examination system for civil servants. Followup integrates passive annual electronic health record linkage with active questionnaire surveys, covering a period that spans three major pandemics (H1N1, H7N9, COVID-19) and key national environmental policies. FLORA also includes a biobank for future mechanistic research. The cohort provides a unique platform to examine how macrolevel societal transformations interact with individual-level risk factors in shaping NCD trajectories in a dynamic megacity setting.