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Addressing geographical variation in the progression of non-communicable diseases in Peru: the CRONICAS cohort study protocol
  1. J Jaime Miranda1,2,
  2. Antonio Bernabe-Ortiz1,3,
  3. Liam Smeeth1,4,
  4. Robert H Gilman1,5,6,
  5. William Checkley1,5,7,
  6. CRONICAS Cohort Study Group*
  1. 1CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  2. 2Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  3. 3Epidemiology Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
  4. 4Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
  6. 6Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
  7. 7Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr J Jaime Miranda; jaime.miranda{at}


Background The rise in non-communicable diseases in developing countries has gained increased attention. Given that around 80% of deaths related to non-communicable diseases occur in low- and middle-income countries, there is a need for local knowledge to address such problems. Longitudinal studies can provide valuable information about disease burden of non-communicable diseases in Latin America to inform both public health and clinical settings.

Methods The CRONICAS cohort is a longitudinal study performed in three Peruvian settings that differ by degree of urbanisation, level of outdoor and indoor pollution and altitude. The author sought to enrol an age- and sex-stratified random sample of 1000 participants at each site. Study procedures include questionnaires on socio-demographics and well-known risk factors for cardiopulmonary disease, blood draw, anthropometry and body composition, blood pressure and spirometry before and after bronchodilators. All participants will be visited at baseline, at 20 and 40 months. A random sample of 100 households at each site will be assessed for 24 h particulate matter concentration. Primary outcomes include prevalence of risk factors for cardiopulmonary diseases, changes in blood pressure and blood glucose over time and decline in lung function.

Discussion There is an urgent need to characterise the prevalence and burden of non-communicable diseases in low- and middle-income countries. Peru is a middle-income country currently undergoing a rapid epidemiological transition. This longitudinal study will provide valuable information on cardiopulmonary outcomes in three different settings and will provide a platform to address potential interventions that are locally relevant or applicable to other similar settings in Latin America.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • * Members of the CRONICAS Cohort Study Group listed in appendix 1.

  • To cite: Miranda JJ, Bernabe-Ortiz A, Smeeth L, et al. Addressing geographical variation in the progression of non-communicable diseases in Peru: the CRONICAS cohort study protocol. BMJ Open 2012;2:e000610. doi:10.1136/bmjopen-2011-000610

  • Funding This study was supported by the National Heart, Lung, and Blood Institute Global Health Initiative under the contract Global Health Activities in Developing Countries to Combat Non-Communicable Chronic Diseases (project number 268200900033C-1-0-1). Study design; collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication will be/are all independent of the funders. Ultimate authority for these activities will lie with principal investigators.

  • Competing interests None.

  • Patient consent Obtained.

  • Contributors JJM and AB-O drafted the first version of the manuscript. JJM, LS, RHG and WC conceived, designed and supervised the overall study. All authors participated in writing of the manuscript, provided important intellectual content and gave their final approval of the version submitted for publication.

  • Provenance and peer review Not commissioned; internally peer reviewed.