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Gotta survey somebody: Methodological challenges in population studies of older people
Stockholm University, Faculty of Social Sciences, Department of Sociology. (Centrum för forskning om äldre och åldrande (ARC), (tills m KI))
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.
Series
Stockholm studies in sociology, ISSN 0491-0885 ; N.S.,60
Keyword [en]
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
Sociology
Identifiers
URN: urn:nbn:se:su:diva-121167ISBN: 978-91-7649-271-0 (print)OAI: oai:DiVA.org:su-121167DiVA: diva2:857663
Public defence
2015-11-20, De Geersalen, Geovetenskapens hus, Svante Arrhenius väg 14, Stockholm, 13:00 (English)
Opponent
Supervisors
Note

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
List of papers
1. Underestimated health inequalities among older people - A result of non-representative survey samples
Open this publication in new window or tab >>Underestimated health inequalities among older people - A result of non-representative survey samples
(English)Manuscript (preprint) (Other academic)
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-121166 (URN)
Available from: 2015-09-26 Created: 2015-09-26 Last updated: 2015-10-02
2. Getting better all the time? Selective attrion and compositional changes in longitudinal and life-course studies
Open this publication in new window or tab >>Getting better all the time? Selective attrion and compositional changes in longitudinal and life-course studies
(English)Manuscript (preprint) (Other academic)
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-121164 (URN)
Available from: 2015-09-26 Created: 2015-09-26 Last updated: 2015-10-02
3. Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study
Open this publication in new window or tab >>Do postal health surveys capture morbidity and mortality in respondents aged 65 years and older? A register-based validation study
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.

Keyword
Survey, aged 65 and over, postal questionnaire, non-response, generalizability, register, gender differences, mortality, hospitalization
National Category
Health Sciences Sociology
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-117768 (URN)10.1177/1403494815575340 (DOI)000353977800003 ()
Available from: 2015-06-05 Created: 2015-06-01 Last updated: 2017-12-04Bibliographically approved
4. Sampling and non-response bias on health-outcomes in surveys of the oldest old
Open this publication in new window or tab >>Sampling and non-response bias on health-outcomes in surveys of the oldest old
2013 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 10, no 3, 237-245 p.Article in journal (Refereed) Published
Abstract [en]

Surveys of the oldest old population are associated with several design issues. Place of residence and possible physical or cognitive impairments make it difficult to maintain a representative study population. Based on a Swedish nationally representative survey among individuals 77+, the present study analyze the potential bias of not using proxy interviews and excluding the institutionalized part of the population in surveys of the oldest old. The results show that compared to directly interviewed people living at home, institutionalized and proxy interviewed individuals were older, less educated and more likely to be female. They had more problems with health, mobility and ADL, and a significantly increased mortality risk. If the study had excluded the institutionalized part of the population and/or failed to use proxy interviews, the result would have been severely biased and resulted in underestimated prevalence rates for ADL, physical mobility and psychologic problems. This could not be compensated for weighting the data by age and sex. The results from this study imply that accurate population estimates require a representative study population, in which all individuals are included regardless of their living conditions, health status, and cognitive ability.

Keyword
Representative study population, Survey design, Proxy interviews, Institutionalized, Non-response, Oldest old
National Category
Geriatrics Gerontology, specializing in Medical and Health Sciences
Research subject
Sociology
Identifiers
urn:nbn:se:su:diva-93291 (URN)10.1007/s10433-013-0275-7 (DOI)000322722100009 ()
Note

AuthorCount:3;

Available from: 2013-09-06 Created: 2013-09-06 Last updated: 2017-12-06Bibliographically approved

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