Change search
ReferencesLink to record
Permanent link

Direct link
Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study
Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
Number of Authors: 4
2015 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, 348-355 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. Methods: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. Results: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. Conclusions: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated.

Place, publisher, year, edition, pages
2015. Vol. 43, no 4, 348-355 p.
Keyword [en]
Survey, aged 65 and over, postal questionnaire, non-response, generalizability, register, gender differences, mortality, hospitalization
National Category
Health Sciences Sociology
Research subject
URN: urn:nbn:se:su:diva-117768DOI: 10.1177/1403494815575340ISI: 000353977800003OAI: diva2:817693
Available from: 2015-06-05 Created: 2015-06-01 Last updated: 2015-10-02Bibliographically approved
In thesis
1. Gotta survey somebody: Methodological challenges in population studies of older people
Open this publication in new window or tab >>Gotta survey somebody: Methodological challenges in population studies of older people
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Conducting representative surveys of older people is challenging. This thesis aims to analyze a) the characteristics of individuals at risk of being underrepresented in surveys of older people, b) the systematic errors likely to occur as a result of these selections, and c) whether these systematic errors can be minimized by weighting adjustments.  

In Study I, we investigated a) who would be missing from a survey that excluded those living in institutions and that did not use indirect interviews, b) how prevalence rates would be affected by these exclusions, and c) whether post-stratifying the data by sex and age (weighting adjustment) would correct for any systematic measurement error.

In Study II, we compared mortality and hospitalization rates in those who responded to a postal questionnaire with rates in the target population. In addition, we tested whether a weighting variable created with a number of auxiliary variables could correct for the differences.  

In Study III, we followed a longitudinal cohort sample for 43 years. By recalculating baseline characteristics at each follow-up, we investigated how the sample changed after a) selective mortality and b) survey non-participation.

In Study IV, we investigated whether the systematic non-participation that is likely to occur in surveys of older people affects the association between education and health.

In sum, the results of these four studies show that people in the oldest age groups, women, those of low socioeconomic position, and those with the poorest health tend to be underrepresented in surveys of older people. This systematic underrepresentation might lead to an underestimation of poor health and function, a bias that is unlikely to be corrected by weighting adjustments, and to an underestimation of health inequality between educational groups. The results also show that the selective mortality that occurs in longitudinal samples might be compounded by selective non-participation among the most disadvantaged groups.

Place, publisher, year, edition, pages
Stockholm University, 2015. 75 p.
Stockholm studies in sociology, ISSN 0491-0885 ; N.S.,60
Population studies, Older people, Representativeness, Survey design, Non-response, Sample selection, Selective attrition, Social inequality, Health outcomes
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Research subject
urn:nbn:se:su:diva-121167 (URN)978-91-7649-271-0 (ISBN)
Public defence
2015-11-20, De Geersalen, Geovetenskapens hus, Svante Arrhenius väg 14, Stockholm, 13:00 (English)

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Manuscript. Paper 2: Manuscript.

Available from: 2015-10-28 Created: 2015-09-26 Last updated: 2015-10-26Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Kelfve, Susanne
By organisation
Department of SociologyAging Research Center (ARC), (together with KI)
In the same journal
Scandinavian Journal of Public Health
Health SciencesSociology

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 23 hits
ReferencesLink to record
Permanent link

Direct link