Marital status, educational level and household income explain part of the excess mortality of survey non-respondents

Comparison of the Incidence of Functional Disability Correlated With Social Participation Among Older Adults in Japan

BACKGROUND

Japan, which has the world's longest life expectancy, has been reporting rejuvenation of physical function among its older adult population. However, evidence for the incidence of functional disability is limited. This study aimed to investigate the comparison in the incidence of functional disability.

DESIGN

We used data from the Japan Gerontological Evaluation Study.

SETTING AND PARTICIPANTS

The participants were 2 nonoverlapping cohorts of 22,522 (2010-2013 cohort) and 26,284 (2016-2019 cohort) individuals aged 65 years and older from 5 municipalities who were followed for 3 years each.

METHODS

The incidence rates of functional disability during the 3-year follow-up period were compared between cohorts. To examine the incident differences between the cohorts, we adjusted for social participation and 9 additional factors that would be expected to improve with social participation using the Weibull survival models adjusting for municipalities as random effects. The analysis was stratified by age groups (65-74 years old and ≥75).

RESULTS

The incidence rate of functional disability per 10,000 person-years decreased from 68.6 (2010-2013 cohort) to 51.4 (2016-2019 cohort) in the 65 to 74 years old group and 380.0 (2010-2013 cohort) to 282.6 (2016-2019 cohort) in the ≥75 group; the hazard ratios (95% CIs) were 0.75 (0.64-0.89) and 0.73 (0.67-0.80), respectively. However, these significant decreases disappeared with adjustments for social participation and additional factors.

CONCLUSIONS AND IMPLICATIONS

The incidence of functional disability decreased in a recent cohort, which may be explained by social participation and possibly related factors. Promoting social participation could contribute to a decreasing incidence of functional disability among older adults.

Investigating sources of non-response bias in a population-based seroprevalence study of vaccine-preventable diseases in the Netherlands

BACKGROUND

PIENTER 3 (P3), conducted in 2016/17, is the most recent of three nationwide serological surveys in the Netherlands. The surveys aim to monitor the effects of the National Immunisation Programme (NIP) by assessing population seroprevalence of included vaccine preventable diseases (VPDs). The response rate to the main sample was 15.7% (n = 4,983), following a decreasing trend in response compared to the previous two PIENTER studies (P1, 55.0%; 1995/1996 [n = 8,356] and P2, 33.0%; 2006/2007 [n = 5,834]). Non-responders to the main P3 survey were followed-up to complete a "non-response" questionnaire, an abridged 9-question version of the main survey covering demographics, health, and vaccination status. We assess P3 representativeness and potential sources of non-response bias, and trends in decreasing participation rates across all PIENTER studies.

METHODS

P3 invitees were classified into survey response types: Full Participants (FP), Questionnaire Only (QO), Non-Response Questionnaire (NRQ) and Absolute Non-Responders (ANR). FP demographic and health indicator data were compared with Dutch national statistics, and then the response types were compared to each other. Random forest algorithms were used to predict response type. Finally, FPs from all three PIENTERs were compared to investigate the profile of survey participants through time.

RESULTS

P3 FPs were in general healthier, younger and higher educated than the Dutch population. Random forest was not able to differentiate between FPs and ANRs, but when predicting FPs from NRQs we found evidence of healthy-responder bias. Participants of the three PIENTERs were found to be similar and are therefore comparable through time, but in line with national trends we found P3 participants were less inclined to vaccinate than previous cohorts.

DISCUSSION

The PIENTER biobank is a powerful tool to monitor population-level protection against VPDs across 30 years in The Netherlands. However, future PIENTER studies should continue to focus on improving recruitment from under-represented groups, potentially by considering alternative and mixed survey modes to improve both overall and subgroup-specific response. Whilst non-responder bias is unlikely to affect seroprevalence estimates of high-coverage vaccines, the primary aim of the PIENTER biobank, other studies with varied vaccination/disease exposures should consider the influence of bias carefully.

Assessing targeted invitation and response modes to improve survey participation in a diverse New York City panel: Healthy NYC

BACKGROUND

Healthy NYC is an innovative survey panel created by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) that offers a cost-effective mechanism for collecting priority and timely health information. Between November 2020 and June 2021, invitations for six different surveys were sent to Healthy NYC panelists by postal mail, email, and text messages. Panelists had the option to complete surveys online or via paper survey.

METHODS

We analyzed whether panelists varied by sociodemographic characteristics based on the contact mode they provided and the type of invitation that led to their response using logistic regression models. Poisson regression models were used to determine whether the number of invitations received before participating in a survey was associated with sociodemographic characteristics.

RESULTS

Younger age and higher education were positively associated with providing an email or text contact. Furthermore, age, race, and income were significant predictors for invitation modes that led to a survey response. Black panelists had 72% greater odds (OR 1.72 95% CI: 1.11-2.68) of responding to a mail invite and 33% lesser odds (OR 0.67, 95% CI: 0.54-0.83) of responding to an email invite compared with White panelists. Additionally, in five of the six surveys, more than half of the respondents completed surveys after two invites. Email invitations garnered the highest participation rates.

CONCLUSIONS

We recommend using targeted invitation modes as an additional strategy to improve participation in panels. For lower-income panelists who do not provide an email address, it may be reasonable to offer additional response options that do not require internet access. Our study's findings provide insight into how panels can tailor outreach to panelists, especially among underrepresented groups, in the most economical and efficient ways.

Use and storage of pesticides at home in France (the Pesti'home survey 2014)

Some epidemiological studies have raised health concerns following the chronic exposure of pregnant women and children to pesticides in the domestic environment. In France very little is known about potential exposure to pesticides at home. An observational study called Pesti'home was carried out in continental France between July and November 2014. The residential use of pesticides was investigated and an inventory of pesticides and active ingredients used and stored at home was drawn up. Plant protection products, biocides, and human and animal external pest control products were listed during face-to-face interviews. A random sample of households including at least one adult (18-79 years old) was selected following a two-stage stratified random sampling method using the national census database. Within each household, an adult was appointed to answer survey questions. Data related to the interviewee's sociodemographic and housing characteristics, the reported use of pesticides at home, and a visual inventory of all stored pesticides were collected. Overall, 1507 households participated. The participation rate was between 36% and 57% according to the definition chosen. Over the previous 12 months, 75% of households declared that they had used at least one pesticide. Households who used and stored at least one product most frequently used an insecticide (84%). The active ingredients most frequently used by these households as insecticides were pyrethroids, namely tetramethrin and permethrin. The Pesti'home survey collected detailed data on the residential use of pesticides for risk assessment at national and European levels.

Alcohol Drinking Patterns and Laboratory Indices of Health: Does Type of Alcohol Preferred Make a Difference?

Although excessive alcohol consumption is a highly prevalent public health problem the data on the associations between alcohol consumption and health outcomes in individuals preferring different types of alcoholic beverages has remained unclear. We examined the relationships between the amounts and patterns of drinking with the data on laboratory indices of liver function, lipid status and inflammation in a national population-based health survey (FINRISK). Data on health status, alcohol drinking, types of alcoholic beverages preferred, body weight, smoking, coffee consumption and physical activity were recorded from 22,432 subjects (10,626 men, 11,806 women), age range 25-74 years. The participants were divided to subgroups based on the amounts of regular alcohol intake (abstainers, moderate and heavy drinkers), patterns of drinking (binge or regular) and the type of alcoholic beverage preferred (wine, beer, cider or long drink, hard liquor or mixed). Regular drinking was found to be more typical in wine drinkers whereas the subjects preferring beer or hard liquor were more often binge-type drinkers and cigarette smokers. Alcohol use in all forms was associated with increased frequencies of abnormalities in the markers of liver function, lipid status and inflammation even at rather low levels of consumption. The highest rates of abnormalities occurred, however, in the subgroups of binge-type drinkers preferring beer or hard liquor. These results demonstrate that adverse consequences of alcohol occur even at moderate average drinking levels especially in individuals who engage in binge drinking and in those preferring beer or hard liquor. Further emphasis should be placed on such patterns of drinking in policies aimed at preventing alcohol-induced adverse health outcomes.

Predictive validity of the modified Kihon Checklist for the incidence of functional disability among older people: A 3-year cohort study from the JAGES

AIM

The original Kihon Checklist, validated to predict the incidence of functional disability, has been modified to capture both functional ability (can/cannot) and performing state (do/do not). However, the predictive validity of the modified Kihon Checklist remains unverified. Therefore, this study intends to verify the predictive validity of the modified Kihon Checklist and to clarify whether predictive discrimination differs between the classification method of functional ability and performing state.

METHODS

The participants comprised 67 398 older people who responded to the Japan Gerontological Evaluation Study (2016). They were followed for 3.1 years on average. Cox's proportional hazards model with incidence of functional disability as the endpoint was used to calculate the hazard ratio, adjusted for sex and age. The independent variables were judged by two classification methods, functional ability and performing state, using nine indicators based on the modified Kihon Checklist. Additionally, we examined whether the two classification methods produced different C-index estimates.

RESULTS

Incidence of functional disability occurred in 6232 participants (9.2%). The adjusted hazard ratio of those to whom the nine indicators applied was significantly higher than that of those to whom they did not. The range of the hazard ratio was 1.50-3.82 for both classification methods. The C-index was slightly higher when the classification was based on performing state than when it was based on on functional ability.

CONCLUSIONS

Although predictive discrimination was slightly higher for the performing state than for functional ability, the predictive validity of the modified Kihon Checklist was confirmed for both. Geriatr Gerontol Int 2022; ••: ••-••.

Predictors of non-response to successive waves of surveys in the Japan Environment and Children's Study during the 3-year postpartum period: a longitudinal cohort study

OBJECTIVES

We examined changes in factors related to non-response to successive waves of the nationwide birth cohort study, the Japan Environment and Children's Study (JECS), during the first 3 years after childbirth.

DESIGN

Longitudinal cohort study.

SETTING

As the baseline survey, mothers completed self-administered questionnaires distributed by hand during pregnancy or 1 month after delivery. The self-administered questionnaires that we used in this study were then distributed by mail every 6 months until the children were 3 years old, for a total of six times.

PARTICIPANTS

Of 103 060 mothers who consented to participate in the JECS during pregnancy, 88 489 mothers were included in the study after excluding those with multiple births, miscarriages or stillbirths and those who withdrew from the study within 3 years after providing informed consent.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were collected at the baseline survey on participants' socioeconomic status, medical history, health status, health-related behaviours and their children's health conditions and living situations. The strength of the impact of related factors and the prediction of response status were examined and compared using binominal logistic regression analysis.

RESULTS

For all six follow-up questionnaire surveys, higher maternal age was strongly associated with providing a response. Factors that were strongly associated with mothers not providing a response were smoking after childbirth and having more children. The concordance rate of response status based on the presented model was about 70%, suggesting that the response status for the first 3 years after birth can be predicted from the information collected in the baseline survey.

CONCLUSION

By identifying predictors of non-response from information obtained in baseline surveys, researchers may be able to reduce non-response to successive survey waves by issuing reminders, reviewing data collection methods and providing appropriate financial and/or non-financial incentives.

The relationship between ocular and oral dryness in a cohort from the 65-year-old population in Norway

In the present study, the relationship between dry eyes and dry mouth was explored in 150 65-year-old subjects randomly selected from the general population in Oslo, Norway. The number of drugs, including xerogenic drugs, and current and previous systemic diseases were recorded. Ocular parameters recorded were the McMonnies Dry Eye Questionnaire, the Ocular Surface Disease Index, the Schirmer I Test, tear film break-up time and ocular surface staining. The oral parameters were xerostomia frequency, Summated Xerostomia Inventory, Clinical Oral Dryness Score, and unstimulated and stimulated whole saliva. The participants with current or previous systemic diseases had significantly more ocular and oral symptoms and significantly more oral clinical findings than the participants without a history of disease. Moreover, correlation and factor analyses demonstrated an association between subjective ocular and oral parameters. A significant correlation between the total number of drugs and the presence of ocular and oral symptoms was also noted. When the participants were categorized based on their ocular symptoms, poorer values were found for the oral parameters among the participants more troubled with dry eyes. The results in the present study call for increased awareness and an interdisciplinary approach in matters related to dry eyes and dry mouth.

The impact of non-response weighting in health surveys for estimates on primary health care utilization

Background

Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years.

Methods

Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents.

Results

Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%.

Conclusions

Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.

Frequency, clinical features, inflammatory cytokines and genetic background of latent autoimmune diabetes in youth in youth-onset type 2 diabetes: Results from a nationwide, multicentre, clinic-based, cross-sectional study (LADA China)

AIM

To investigate the frequency, clinical phenotype, inflammatory cytokine levels and genetics of glutamic acid decarboxylase autoantibody (GADA)-positive phenotypic youth-onset type 2 diabetes.

MATERIALS AND METHODS

This nationwide, multicentre, cross-sectional study included 5324 newly diagnosed subjects with phenotypic type 2 diabetes aged 15 years or older enrolled in the LADA China study. GADA was screened in 248 subjects with youth-onset type 2 diabetes aged 15-29 years. Subjects who presented as GADA-positive were defined as having latent autoimmune diabetes in youth (LADY). We added subjects with LADY, type 1 diabetes, type 2 diabetes and controls from the Diabetes Center of Central South University, and measured serum concentrations of interleukin-6, lipocalin 2, high-sensitivity C-reactive protein, adiponectin and human leukocyte antigen (HLA) genotyping in subjects with LADY, age- and sex-matched GADA-negative type 2 diabetes, type 1 diabetes and controls.

RESULTS

Twenty-nine of the 248 subjects (11.7%) were GADA positive. Compared with subjects with type 2 diabetes, subjects with LADY were less probable to have metabolic syndrome (27.6% vs. 59.4%; p = .001). The fasting C-peptide levels tended to be lower in subjects with LADY than in subjects with type 2 diabetes, but the difference was not statistically significant (LADY vs. type 2 diabetes: 0.21 [0.17-0.64] vs. 0.47 [0.29-0.77] nmol/L; p = .11). The cytokine levels of subjects with LADY were indistinguishable from subjects with type 1 diabetes, but subjects with LADY presented increased adiponectin levels compared with subjects with type 2 diabetes after adjusting for age, sex and body mass index (7.19 [4.05-11.66] vs. 3.42 [2.35-5.74] μg/mL; p < .05). The frequency of total susceptible HLA genotypes (DR3/3, -3/9 and -9/9) in subjects with LADY and type 1 diabetes were similarly higher than controls (LADY and type 1 diabetes vs. controls: 21.4% and 30.8% vs. 2.6%, respectively; p < .001).

CONCLUSIONS

A high GADA positivity was observed in youth-onset type 2 diabetes subjects in China. As subjects with LADY had an increased susceptible HLA genetic load and different cytokine levels compared with subjects with type 2 diabetes, differentiating LADY from phenotypic type 2 diabetes subjects is important.

Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS)

PURPOSE

We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic.

METHODS

Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics.

RESULTS

We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates.

CONCLUSIONS

Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.

Revisiting the continuum of resistance model in the digital age: a comparison of early and delayed respondents to the Norwegian counties public health survey

Background

The continuum of resistance model’s premise is that delayed respondents to a survey are more similar to non-respondents than early respondents are. For decades, survey researchers have applied this model in attempts to evaluate and adjust for non-response bias. Despite a recent resurgence in the model’s popularity, its value has only been assessed in one large online population health survey.

Methods

Respondents to the Norwegian Counties Public Health Survey in Hordaland, Norway, were divided into three groups: those who responded within 7 days of the initial email/SMS invitation (wave 1, n = 6950); those who responded after 8 to 14 days and 1 reminder (wave 2, n = 4950); and those who responded after 15 or more days and 2 reminders (wave 3, n = 4045). Logistic regression analyses were used to compare respondents’ age, sex and educational level between waves, as well as the prevalence of poor general health, life dissatisfaction, mental distress, chronic health problems, weekly alcohol consumption, monthly binge drinking, daily smoking, physical activity, low social support and receipt of a disability pension.

Results

The overall response to the survey was 41.5%. Respondents in wave 1 were more likely to be older, female and more highly educated than those in waves 2 and 3. However, there were no substantial differences between waves for any health outcomes, with a maximal prevalence difference of 2.6% for weekly alcohol consumption (wave 1: 21.3%, wave 3: 18.7%).

Conclusions

There appeared to be a mild continuum of resistance for demographic variables. However, this was not reflected in health and related outcomes, which were uniformly similar across waves. The continuum of resistance model is unlikely to be useful to adjust for nonresponse bias in large online surveys of population health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10764-2.

Sociodemographic Factors Influenced Response to the 2015 National Nutrition Survey on Preschool Children: Results From Linkage With the Comprehensive Survey of Living Conditions

BACKGROUND

The National Nutrition Survey on Preschool Children, Japan (NNSPC) provides fundamental information for policy making for child nutrition. However, the response rate and background characteristics of subjects are unclear. Here, we examined response rate and sociodemographic factors related with response to the survey and evaluated the magnitude of bias due to selective response in the survey estimates of the NNSPC.

METHODS

This study was based on two national surveys conducted in 2015: the NNSPC and the Comprehensive Survey of Living Conditions (CSLC). Because potential survey participants of the NNSPC were children aged <6 years and their households that answered the CSLC, we examined response rates and respondent characteristics by linking the data of the NNSPC and CSLC. Multiple logistic regression analysis was used to identify sociodemographic factors associated with response. Potential bias caused by non-response in the survey estimates was examined after considering missingness through multiple imputation.

RESULTS

Among the 5,343 children who participated in the CSLC, 3,426 children responded to the NNSPC (response rate = 64.1%). Variables associated with response were living in a smaller city, a large number of children, three-generation family structure, older maternal age, and a non-working mother. The prevalence of overweight was underestimated by 20%, but the bias for almost all variables examined was small.

CONCLUSIONS

Response to the survey varied by sociodemographic characteristics. Some biases, mostly small, were seen in survey estimates of the 2015 NNSPC. Further insight into the effect of selective response is important to assess associations between variables more precisely.

36-year trends in educational inequalities in self-rated health among Finnish adults

Health inequalities exist across countries and populations, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among Finnish adults, considering individual covariates and macro-economic fluctuations. Our data were derived from representative annual cross-sectional surveys in 1979-2014 conducted among adult men and women. Participants aged 25-64 were included and nine periods used (n = 8870-14235). Our health outcome was less-than-good self-rated health (SRH) and our socioeconomic indicator was completed years of education as a continuous variable. Educational inequalities in self-rated health were analysed using the relative index of inequality (RII) and the slope index of inequality (SII). Nine time-variant sociodemographic and health-related covariates were included in the analyses. Linear trends suggested stable or slightly curvilinear overall trends in both absolute and relative health equalities over 36 years. Among men, absolute and relative inequalities narrowed immediately after economic recession in Finland in 1993-1994. Among women, inequalities narrowed during financial crisis in 2008-2009. Adjusting for most covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the temporal patterning of health inequalities. Educational inequalities in self-rated health remained during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance of the trends calls for novel and powerful measures to tackle health inequalities.

Factors of non-responsive or lost-to-follow-up Japanese mothers during the first year post partum following the Japan Environment and Children's Study: a longitudinal cohort study

OBJECTIVES

We examined the factors related to lost-to-follow-up of a birth cohort study during the first year after delivery.

DESIGN

Longitudinal cohort study.

SETTING

Questionnaires were provided by mail. Mothers answered the questionnaires about the children twice: at 6 months and 1 year.

PARTICIPANTS

Of 103 062 pregnancies who consented to participate in the Japan Environment and Children's Study (JECS), 93 417 mothers were included in the study after excluding those with multiple births, miscarriages or stillbirths and those who withdrew from the study within 1 year after providing informed consent.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants' socioeconomic status, medical history, health status, health-related behaviours, their children's health conditions and living situations were collected by self-administered questionnaires during pregnancy or 1 month after delivery as the baseline survey. In addition, two self-administered questionnaires were distributed 6 months and 1 year after delivery. Using the response status of the two questionnaires after delivery, participants' follow-up status was divided into four groups. The related factors were examined using logistic regression analysis.

RESULTS

Factors positively correlated with lost-to-follow-up to the questionnaires were postpartum physical conditions, psychological distress during pregnancy, the child's health status at birth, the child's primary caregiver and the number of siblings of the child. Partners' active participation in JECS was associated with a lower lost-to-follow-up rate to the two questionnaires, whereas inactive participation was positively associated with a higher lost-to-follow-up rate.

CONCLUSION

The response rate to the questionnaires seems to be related to the interest and understanding of participants' partners. In addition, the response rates are related to participants' physical conditions and living conditions. To decrease lost-to-follow-up rates in consecutive questionnaire surveys within a cohort study, it may be important for investigators to recognise that participants and their motivation in research can be influenced by perceptions they may have regarding the objectives of the research.

Patient-reported outcomes item selection for bladder cancer patients in chemo- or immunotherapy

Background

Selection of specific patient-reported outcomes (PROs) for cancer patients requires careful consideration to the purpose and population at aim. Here we report the process of choosing which items to include in a bladder cancer population in chemo- or immunotherapy based on the Patient-Reported Outcomes Version of the Common Terminology Criteria of Adverse Events (PRO-CTCAE).

Methods

Initial PRO-CTCAE symptoms were chosen through 1) medical record audit 2) patient interviews 3) summary of product characteristics from European Medicines Agency and Food and Drug Administration for the applied chemotherapies, and 4) toxicity reporting from Phase 2 and 3 trials for immunotherapies applied in patients with urothelial cancer. The selected questions were applied in a prospective cohort of 78 bladder cancer patients receiving chemo- or immunotherapy at Rigshospitalet and Herlev Hospital, Denmark. Symptoms tested in this population were selected for the final module if they appeared in ≥3 of the following groupings a) the most prevalent PRO-CTCAE symptoms grade ≥ 2 overall during treatment b) the PRO-CTCAE symptoms reported in conjunction with hospital admissions or mentioned in focus group interviews discussing which symptoms were prevalent in this patient group with specialized c) nurses or d) physicians. The authors also included symptoms in the final module if they were present in two of the above groups and defined as actionable by clinicians.

Results

From the initial selection of PRO-CTCAE symptoms, a total of 45 PRO-CTCAE symptoms explored by 84 PRO-CTCAE questions were retrieved. Through the second selection process based on the described criteria, the study group agreed on 15 PRO-CTCAE symptoms explored by 30 PRO-CTCAE items to be appropriate and relevant for the bladder population during medical oncological treatment.

Conclusions

The selection of disease specific PROs in a bladder cancer population was feasible. The process revealed several steps of selection needed in order to reach a final module for clinical application.

Electronic supplementary material

The online version of this article (10.1186/s41687-019-0141-2) contains supplementary material, which is available to authorized users.

Analysis of non-respondent pregnant women who were registered in the Japan Environment and Children's Study: a longitudinal cohort study

OBJECTIVES

Non-response to questionnaires in a longitudinal study reduces the effective sample size and introduces bias. We identified the characteristics of non-respondent pregnant women, and compared them with respondents in the Japan Environment and Children's Study (JECS) during the gestational period.

DESIGN

This was a questionnaire-based, longitudinal cohort study.

SETTING

Questionnaires were provided by research coordinators to mothers at prenatal examinations (at obstetrics clinics) or by mail. Mothers were measured twice: during the first trimester and during the second/third trimester.

PARTICIPANTS

Data were collected from the 10 129 participating mothers of the 10 288 children surveyed in the 2011 baseline JECS. We excluded responses from mothers who had a miscarriage or stillbirth; therefore, we analysed data from 9649 participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data concerning demographics, medical history, health characteristics, health-related behaviour and environmental exposure were collected via self-administered questionnaires. The response status of participants' partners and contact with their obstetrician were also examined. Multivariate logistic regression analysis was used to examine factors related to non-response.

RESULTS

Response was associated with living with one's mother-in-law (ORs: 0.47, 95% CIs: 0.24 to 0.85), positive participation of participants' partner (OR: 0.25, 95% CI: 0.17 to 0.35) and multiple visits to the obstetrician (OR: 0.02, 95% CI: 0.02 to 0.03). Participants who had a medical history of allergic rhinitis, had body pain or drank alcohol had higher odds of responding (ORs: 0.68, 0.96 and 0.36, 95% CIs: 0.48 to 0.95 and 0.95 to 0.98 and 0.16 to 0.72, respectively); those exposed to secondary smoke had lower odds of responding (OR: 1.59, 95% CI: 1.12 to 2.23).

CONCLUSIONS

The non-response rate decreased when participants reported health-related behaviour or characteristics. Obtaining the understanding of people around each participant might help increase response rates.

Adjusting for non-response in the Finnish Drinking Habits Survey

Aim: We aim to compare four different weighting methods to adjust for non-response in a survey on drinking habits and to examine whether the problem of under-coverage of survey estimates of alcohol use could be remedied by these methods in comparison to sales statistics. Method: The data from a general population survey of Finns aged 15–79 years in 2016 (n=2285, response rate 60%) were used. Outcome measures were the annual volume of drinking and prevalence of hazardous drinking. A wide range of sociodemographic and regional variables from registers were available to model the non-response. Response propensities were modelled using logistic regression and random forest models to derive two sets of refined weights in addition to design weights and basic post-stratification weights. Results: Estimated annual consumption changed from 2.43 litres of 100% alcohol using design weights to 2.36–2.44 when using the other three weights and the estimated prevalence of hazardous drinkers changed from 11.4% to 11.4–11.8%, correspondingly. The use of weights derived by the random forest method generally provided smaller estimates than use of the logistic regression-based weights. Conclusions: The use of complex non-response weights derived from the logistic regression model or random forest are not likely to provide much added value over more simple weights in surveys on alcohol use. Surveys may not catch heavy drinkers and therefore are prone for under-reporting of alcohol use at the population level. Also, factors other than sociodemographic characteristics are likely to influence participation decisions.

The Third French Individual and National Food Consumption (INCA3) Survey 2014-2015: method, design and participation rate in the framework of a European harmonization process

OBJECTIVE

Assessing dietary exposure or nutrient intakes requires detailed dietary data. These data are collected in France by the cross-sectional Individual and National Studies on Food Consumption (INCA). In 2014-2015, the third survey (INCA3) was launched in the framework of the European harmonization process which introduced major methodological changes. The present paper describes the design of the INCA3 survey, its participation rate and the quality of its dietary data, and discusses the lessons learned from the methodological adaptations.

DESIGN

Two representative samples of adults (18-79 years old) and children (0-17 years old) living in mainland France were selected following a three-stage stratified random sampling method using the national census database.

SETTING

Food consumption was collected through three non-consecutive 24 h recalls (15-79 years old) or records (0-14 years old), supplemented by an FFQ. Information on food supplement use, eating habits, physical activity and sedentary behaviours, health status and sociodemographic characteristics were gathered by questionnaires. Height and body weight were measured.ParticipantsIn total, 4114 individuals (2121 adults, 1993 children) completed the whole protocol.

RESULTS

Participation rate was 41·5% for adults and 49·8% for children. Mean energy intake was estimated as 8795 kJ/d (2102 kcal/d) in adults and 7222 kJ/d (1726 kcal/d) in children and the rate of energy intake under-reporters was 17·8 and 13·9%, respectively.

CONCLUSIONS

Following the European guidelines, the INCA3 survey collected detailed dietary data useful for food-related and nutritional risk assessments at national and European level. The impact of the methodological changes on the participation rate should be further studied.

Breakfast in Denmark. Prevalence of Consumption, Intake of Foods, Nutrients and Dietary Quality. A Study from the International Breakfast Research Initiative

Breakfast is considered by many to be the most important meal of the day. This study examined the intake of nutrients and foods at breakfast among Danes and the relation to the overall dietary quality. Data were derived from the Danish National Survey on Diet and Physical Activity 2011–2013, a cross-sectional national food consumption study. A total of 3680 participants aged 6–75 years were included in the analyses of breakfast consumption. The Nutrient Rich Food Index 9.3 method was used to examine the overall dietary quality of the diet. The intake of nutrients and foods at breakfast were compared across dietary quality score tertiles by ANCOVA adjusted for energy and socio economic status. Breakfast was eaten frequently by children and adults and contributed with 18–20% of total energy intake. Breakfast was relatively high in dietary fibre, B vitamins, calcium and magnesium and low in added sugar, total fat, sodium, vitamin A and D. A decrease in the intake of added sugar, total fat and saturated fat and an increase in the intake of dietary fibre and most micronutrients were seen across tertiles of dietary quality scores. Commonly consumed foods provided at breakfast in Denmark included bread, breakfast cereals and dairy products as well as water, coffee and juice, while intakes of fruits, vegetables, cakes and soft drinks were low.

Research recruitment: A marketing framework to improve sample representativeness in health research

AIMS

This discussion paper proposes a five-part theoretical framework to inform recruitment strategies. The framework is based on a marketing model of consumer decision-making.

BACKGROUND

Respondents in surveys are typically healthier than non-respondents, which has an impact on the availability of information about those most in need. Previous research has identified response patterns, provided theories about why people participate in research and evaluated different recruitment strategies. Social marketing has been applied successfully to recruitment and promotes focus on the needs of the participant, but little attention has been paid to the periods before and after participant-researcher contact (during advertising and following completion of studies). We propose a new model which conceptualises participation as a decision involving motivation, perception of information, attitude formation, integration of intention and action and finally evaluation and sharing of experience.

DESIGN

Discussion paper.

DATA SOURCES

This discussion paper presents a critical review. No literature was excluded on date and the included citations span the years 1981-2017.

IMPLICATIONS FOR NURSING

The proposed framework suggests that researchers could engage a broader demographic if they shape research design and advertising to perform functions that participants are seeking to achieve. The framework provides a novel and useful conceptualisation of recruitment which could help to inform public engagement in research design, researcher training and research policy.

CONCLUSION

This framework challenges researchers to investigate the goals of the potential participants when designing a study's advertising and procedures.

Adjustment for survey non-representativeness using record-linkage: refined estimates of alcohol consumption by deprivation in Scotland

BACKGROUND AND AIMS

Analytical approaches to addressing survey non-participation bias typically use only demographic information to improve estimates. We applied a novel methodology which uses health information from data linkage to adjust for non-representativeness. We illustrate the method by presenting adjusted alcohol consumption estimates for Scotland.

DESIGN

Data on consenting respondents to the Scottish Health Surveys (SHeSs) 1995-2010 were linked confidentially to routinely collected hospital admission and mortality records. Synthetic observations representing non-respondents were created using general population data. Multiple imputation was performed to compute adjusted alcohol estimates given a range of assumptions about the missing data. Adjusted estimates of mean weekly consumption were additionally calibrated to per-capita alcohol sales data.

SETTING

Scotland.

PARTICIPANTS

13 936 male and 18 021 female respondents to the SHeSs 1995-2010, aged 20-64 years.

MEASUREMENTS

Weekly alcohol consumption, non-, binge- and problem-drinking.

FINDINGS

Initial adjustment for non-response resulted in estimates of mean weekly consumption that were elevated by up to 17.8% [26.5 units (18.6-34.4)] compared with corrections based solely on socio-demographic data [22.5 (17.7-27.3)]; other drinking behaviour estimates were little changed. Under more extreme assumptions the overall difference was up to 53%, and calibrating to sales estimates resulted in up to 88% difference. Increases were especially pronounced among males in deprived areas.

CONCLUSIONS

The use of routinely collected health data to reduce bias arising from survey non-response resulted in higher alcohol consumption estimates among working-age males in Scotland, with less impact for females. This new method of bias reduction can be generalized to other surveys to improve estimates of alternative harmful behaviours.

Investigating Respondents and Nonrespondents of a Postal Breast Cancer Questionnaire Survey Regarding Differences in Age, Medical Conditions, and Therapy

BACKGROUND

Collecting patient-reported data via postal questionnaires is a common and frequently used technique. Selection bias may occur through lost data from nonrespondents. This study investigated differences in characteristics between respondents and nonrespondents of a postal breast cancer survey.

PATIENTS AND METHODS

The investigation was based on a cross-sectional postal questionnaire survey for the mandatory annual routine (re-)certification of accredited breast centers in North Rhine-Westphalia in 2010. Out of 4,444 patients meeting the inclusion criteria who gave their consent to participate, 3,856 respondents sent back a questionnaire and 588 nonrespondents did not. Using logistic regression, differences between respondents and nonrespondents regarding information gathered through hospital staff concerning age, affected breast, UICC (Union for International Cancer Control) staging and grading, ASA (American Society of Anesthesiologists) classification, neoadjuvant chemotherapy, and type of surgery were assessed.

RESULTS

Very young and very old patients sent back their questionnaire significantly less frequently, as did patients who showed a later cancer stage and poorer general health and those who underwent mastectomy.

CONCLUSION

Differences exist between respondents and nonrespondents with regard to age, disease, and therapy characteristics that need to be considered for the interpretation and generalizability of survey results due to selection bias.

What is wrong with non-respondents? Alcohol-, drug- and smoking-related mortality and morbidity in a 12-year follow-up study of respondents and non-respondents in the Danish Health and Morbidity Survey

AIM

Response rates in health surveys have diminished over the last two decades, making it difficult to obtain reliable information on health and health-related risk factors in different population groups. This study compared cause-specific mortality and morbidity among survey respondents and different types of non-respondents to estimate alcohol-, drug- and smoking-related mortality and morbidity among non-respondents.

DESIGN

Prospective follow-up study of respondents and non-respondents in two cross-sectional health surveys.

SETTING

Denmark.

PARTICIPANTS

A total sample of 39 540 Danish citizens aged 16 years or older.

MEASUREMENTS

Register-based information on cause-specific mortality and morbidity at the individual level was obtained for respondents (n = 28 072) and different types of non-respondents (refusals n = 8954; illness/disabled n = 731, uncontactable n = 1593). Cox proportional hazards models were used to examine differences in alcohol-, drug- and smoking-related mortality and morbidity, respectively, in a 12-year follow-up period.

FINDINGS

Overall, non-response was associated with a significantly increased hazard ratio (HR) of 1.56 [95% confidence interval (CI) = 1.36-1.78] for alcohol-related morbidity, 1.88 (95% CI = 1.38-2.57) for alcohol-related mortality, 1.55 (95% CI = 1.27-1.88) for drug-related morbidity, 3.04 (95% CI = 1.57-5.89) for drug-related mortality and 1.15 (95% CI = 1.03-1.29) for smoking-related morbidity. The hazard ratio for smoking-related mortality also tended to be higher among non-respondents compared with respondents, although no significant association was evident (HR = 1.14; 95% CI = 0.95-1.36). Uncontactable and ill/disabled non-respondents generally had a higher hazard ratio of alcohol-, drug- and smoking-related mortality and morbidity compared with refusal non-respondents.

CONCLUSION

Health survey non-respondents in Denmark have an increased hazard ratio of alcohol-, drug- and smoking-related mortality and morbidity compared with respondents, which may indicate more unfavourable health behaviours among non-respondents.

Reduction in pedometer-determined physical activity in the adult Danish population from 2007 to 2012

AIMS

To examine the development in pedometer-determined physical activity from 2007-2008 to 2011-2012 in the adult Danish population.

METHODS

The study population comprised two random samples of 18-75-year-old individuals who took part in cross-sectional studies in 2007-2008 (n=224) and 2011-2012 (n=1515). Pedometer data (sealed Yamax SW 200) were obtained for seven consecutive days. Data for 1624 participants (48.2% men) were included in the analysis. An overall step-defined activity level was examined based on a graduated step index (sedentary, low active, somewhat active, active, highly active). The pedometer-determined outcomes were analysed using regression models.

RESULTS

A borderline significant decline (p=0.077) from 8788 to 8341 steps/day (-446 (95% confidence intervals -50, 943)) was found between 2007-2008 and 2011-2012. Furthermore, a 23.7% (95% confidence intervals -41.7%, -0.1%) lower overall step-defined activity level was observed in 2011-2012 compared to 2007-2008. These changes were primarily due to a reduced level of activity among women. The proportion of individuals taking ⩾10,000 steps/day decreased non-significantly from 34.8% to 29.3%, whereas the proportion taking <5000 steps/day did not differ between survey periods.

CONCLUSIONS

This nationally representative survey suggests an overall reduction in the physical activity level among Danish adults. The reduction was due to a shift in the population distribution from higher to lower levels of activity. If this shift is true, it is worrying from a public health perspective. Our study result needs, however, to be confirmed by other population studies.

Assessing the representativeness of population-sampled health surveys through linkage to administrative data on alcohol-related outcomes

Health surveys are an important resource for monitoring population health, but selective nonresponse may impede valid inference. This study aimed to assess nonresponse bias in a population-sampled health survey in Scotland, with a focus on alcohol-related outcomes. Nonresponse bias was assessed by examining whether rates of alcohol-related harm (i.e., hospitalization or death) and all-cause mortality among respondents to the Scottish Health Surveys (from 1995 to 2010) were equivalent to those in the general population, and whether the extent of any bias varied according to sociodemographic attributes or over time. Data from consenting respondents (aged 20–64 years) to 6 Scottish Health Surveys were confidentially linked to death and hospitalization records and compared with general population counterparts. Directly age-standardized incidence rates of alcohol-related harm and all-cause mortality were lower among Scottish Health Survey respondents compared with the general population. For all years combined, the survey-to-population rate ratios were 0.69 (95% confidence interval: 0.61, 0.76) for the incidence of alcohol-related harm and 0.89 (95% confidence interval: 0.83, 0.96) for all-cause mortality. Bias was more pronounced among persons residing in more deprived areas; limited evidence was found for regional or temporal variation. This suggests that corresponding underestimation of population rates of alcohol consumption is likely to be socially patterned.

Misperception of body weight among overweight Danish adults: trends from 1995 to 2008

OBJECTIVE

To examine changes in the prevalence of overweight and weight misperception among overweight Danes from 1995 to 2008, and to identify factors associated with weight misperception.

DESIGN

Cross-sectional studies, in which data on self-reported weight, height and self-perception of overweight status were obtained through face-to-face interviews. 'Overweight' includes obesity. Weight misperception was defined as overweight individuals who did not perceive themselves as overweight. The χ 2 test was used to analyse changes over time and multiple logistic regression analysis was applied to identify factors associated with weight misperception.

SETTING

The Danish National Survey of Diet and Physical Activity in three periods: 1995, 2000-2004 and 2005-2008.

SUBJECTS

A random sample of 9623 Danes aged 15-75 years.

RESULTS

The prevalence of overweight increased in men and women from 1995 to 2005-2008 (from 35·1 % to 43·0 %, P < 0·001). Concurrently, there was a reduction in the proportion of overweight men (from 77·5 % to 71·4 %, P = 0·001) and women (from 54·8 % to 51·9 %, P = 0·24) who misperceived their weight. Factors associated with weight misperception were 'never intend to eat healthily' (men), high levels of leisure-time physical activity, 'very good/excellent' self-rated health and survey year (higher misperception in 2000-2004 than 2005-2008; P < 0·05).

CONCLUSIONS

The increase in overweight from 1995 to 2005-2008 was accompanied by a reduction in the proportion of overweight men misperceiving their weight. This may indicate that more men see overweight as a personally relevant health problem. Our findings also suggest that overweight individuals who are more physically active and have better self-rated health may not consider their excess weight a health problem.

Education level is associated with mortality in male patients undergoing maintenance hemodialysis

BACKGROUND

Studies of the correlation between education levels and mortality in hemodialysis (HD) patients are rare. The aim of this multi-center study was to investigate the relationship between education levels and 3-year mortality rates in HD patients.

METHODS

A total of 935 HD patients from 3 HD centers participated in this 3-year prospective observational study. Education levels were categorized as either less than senior high school and above or equal to senior high school. The causes of death and mortality rates were also analyzed for each subgroup.

RESULTS

At the end of the 3-year follow-up period, 164 patients had died. In the male group, forward stepwise Cox regression analysis revealed that age, HD duration, hypertension, creatinine level, serum albumin level ≥3.6 g/dl, anuria, Kt/Vurea, and high education level were significant predictive factors for 3-year mortality rates.

CONCLUSION

This prospective observational study demonstrated that education level was associated with mortality in men undergoing HD.

Community participation and sustainability--evidence over 25 years in the Västerbotten Intervention Programme

Background

Selection bias and declining participation rates are of concern in many long-term epidemiological studies. The Västerbotten Intervention Programme (VIP) was launched in 1985 as a response to alarming reports on elevated cardiovascular disease (CVD) mortality in Västerbotten County in Northern Sweden. The VIP invites women and men to a health examination and health counselling during the year of their 40th, 50th, and 60th birthdays.

Objective

To evaluate trends in participation rates and determinants of participation in the VIP from 1990 to 2006.

Design

Registry data on socio-economic status from Statistics Sweden, and mortality and hospitalisation data from the National Board of Health and Welfare, both covering the whole Swedish population, were linked to the VIP and analysed for participants and non-participants.

Results

During 1990–2006, 117,710 individuals were eligible to participate in the VIP, and 40,472 of them were eligible to participate twice. There were 96,560 observations for participants and 61,622 for non-participants. The overall participation rate increased from 56 to 65%. Participants and non-participants had minimal differences in education and age. Initial small differences by sex and degree of urban residence decreased over time. Despite an increasing participation rate in all groups, those with low income or who were single had an approximately 10% lower participation rate than those with high or medium-income or who were married or cohabitating.

Conclusion

Sustainability of the VIP is based on organisational integration into primary health care services and targeting of the entire middle-aged population. This enables the programme to meet population expectations of health promotion and to identify high-risk individuals who are then entered into routine preventive health care services. This has the potential to increase participation rates, to minimise social selection bias, and to reinforce other community-based interventions.

The Generation R Study: design and cohort update 2012

The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on six areas of research: (1) maternal health; (2) growth and physical development; (3) behavioural and cognitive development; (4) respiratory health and allergies; (5) diseases in childhood; and (6) health and healthcare for children and their parents. Main exposures of interest include environmental, endocrine, genetic and epigenetic, lifestyle related, nutritional and socio-demographic determinants. In total, n = 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61 %, and general follow-up rates until the age of 6 years exceed 80 %. Data collection in mothers, fathers and children include questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome and epigenome wide association screen is available in the participating children. From the age of 5 years, regular detailed hands-on assessments are performed in a dedicated research center including advanced imaging facilities such as Magnetic Resonance Imaging. Eventually, results forthcoming from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.

Sampling bias in an internet treatment trial for depression

Internet psychological interventions are efficacious and may reduce traditional access barriers. No studies have evaluated whether any sampling bias exists in these trials that may limit the translation of the results of these trials into real-world application. We identified 7999 potentially eligible trial participants from a community-based health cohort study and invited them to participate in a randomized controlled trial of an online cognitive behavioural therapy programme for people with depression. We compared those who consented to being assessed for trial inclusion with nonconsenters on demographic, clinical and behavioural indicators captured in the health study. Any potentially biasing factors were then assessed for their association with depression outcome among trial participants to evaluate the existence of sampling bias. Of the 35 health survey variables explored, only 4 were independently associated with higher likelihood of consenting-female sex (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.05-1.19), speaking English at home (OR 1.48, 95% CI 1.15-1.90) higher education (OR 1.67, 95% CI 1.46-1.92) and a prior diagnosis of depression (OR 1.37, 95% CI 1.22-1.55). The multivariate model accounted for limited variance (C-statistic 0.6) in explaining participation. These four factors were not significantly associated with either the primary trial outcome measure or any differential impact by intervention arm. This demonstrates that, among eligible trial participants, few factors were associated with the consent to participate. There was no indication that such self-selection biased the trial results or would limit the generalizability and translation into a public or clinical setting.

Socio-economic differences in self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

Background

Over the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland.

Methods

The data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress.

Results

The overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002.

Conclusions

Self-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.

Barriers to participation in a patient satisfaction survey: who are we missing?

BACKGROUND

A common weakness of patient satisfaction surveys is a suboptimal participation rate. Some patients may be unable to participate, because of language barriers, physical limitations, or mental problems. As the role of these barriers is poorly understood, we aimed to identify patient characteristics that are associated with non-participation in a patient satisfaction survey.

METHODOLOGY

At the University Hospitals of Geneva, Switzerland, a patient satisfaction survey is regularly conducted among all adult patients hospitalized for >24 hours on a one-month period in the departments of internal medicine, geriatrics, surgery, neurosciences, psychiatry, and gynaecology-obstetrics. In order to assess the factors associated with non-participation to the patient satisfaction survey, a case-control study was conducted among patients selected for the 2005 survey. Cases (non respondents, n = 195) and controls (respondents, n = 205) were randomly selected from the satisfaction survey, and information about potential barriers to participation was abstracted in a blinded fashion from the patients' medical and nursing charts.

PRINCIPAL FINDINGS

Non-participation in the satisfaction survey was independently associated with the presence of a language barrier (odds ratio [OR] 4.53, 95% confidence interval [CI95%]: 2.14-9.59), substance abuse (OR 3.75, CI95%: 1.97-7.14), cognitive limitations (OR 3.72, CI95%: 1.64-8.42), a psychiatric diagnosis (OR 1.99, CI95%: 1.23-3.23) and a sight deficiency (OR 2.07, CI95%: 0.98-4.36). The odds ratio for non-participation increased gradually with the number of predictors.

CONCLUSIONS

Five barriers to non-participation in a mail survey were identified. Gathering patient feedback through mailed surveys may lead to an under-representation of some patient subgroups.

Representativeness of participants in a cross-sectional health survey by time of day and day of week of data collection

BACKGROUND

General population health examination surveys (HESs) provide a reliable source of information to monitor the health of populations. A number of countries across Europe are currently planning their first HES, or the first after a significant gap, and some of these intend offering appointments only during office hours and/or weekdays, raising concerns about representativeness of survey participants. It is important to ascertain whether personal characteristics of participants vary by time of day and day of week of data collection, in order to determine the association between time and day of interview and physical examination on the results of data collected in HES.

METHODS

Multivariable regression models were applied to national HES in England to examine socio-demographic and health variations in three combined day-time periods of interview and physical examination: weekday daytime; weekday evening; and weekend.

RESULTS

The characteristics of participants interviewed or visited by a nurse varied by both time of day and day of the week for age, ethnicity, marital status, income, socio-economic group, economic activity and deprivation. People seen during weekday working hours had higher rates of poor self-reported health, limiting longstanding illness and obesity, and higher alcohol consumption, BMI and systolic blood pressure; adjustment for socio-demographic characteristics eliminated or substantially reduced these differences.

CONCLUSION

People responsible for planning surveys should be aware of participant preference for the timing of data collection and ensure flexibility and choice in times and days offered to optimise participation rates and representativeness.

The Rotterdam Study: 2012 objectives and design update

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.

The number of persons with alcohol problems in the Danish population

Aims: A) To qualify the existing estimates of the prevalence of heavy drinking, harmful alcohol use and alcohol dependency by applying adjustment for non-participation. B) To describe socio-demographic correlates of heavy drinkers. Methods: Data came from the Danish Health Interview Survey 2005, which included a personal interview of 14,566 individuals (response rate 66.7 %), and of 5,552 individuals who completed a self-administered questionnaire containing the Alcohol Use Disorder Test (AUDIT) (response rate 50.9%). Heavy drinkers were defined as consuming >14/21 drinks/week (women/men). Identification of harmful alcohol users and dependent drinkers was based on the score of specific AUDIT questions (harmful alcohol use a score of ≥4 in questions 7—10, dependent drinkers ≥4 in questions 4—6). Adjustment for non-participation was performed using data from the Danish National Patient Registry. Results: In the Danish population, 20% were heavy drinkers (862,876 persons 95% confidence interval (95% CI): 672,002—1,195,069), 14% had harmful alcohol use (620,301 persons 95% CI: 439,221—944,992), 3% were dependent drinkers (147,528 persons 95% CI: 118,196—188,384). Being male was associated with heavy drinking (odds ratio (OR): 1.70; 95% CI: 1.53—1.89), as was being a single male (OR: 1.27; 95% CI: 1.01—1.61) and being a smoker (men: OR: 1.96; 95% CI: 1.67—2.30 / women: OR: 2.08; 95% CI: 1.72—2.52). Conclusions: The number of heavy drinkers in the Danish population and the number of people with harmful alcohol use is considerably higher than earlier prevalence estimates. The number of dependent drinkers is similar to earlier estimates.

The contribution of psychological distress to socio-economic differences in cause-specific mortality: a population-based follow-up of 28 years

BACKGROUND

Psychological factors associated with low social status have been proposed as one possible explanation for the socio-economic gradient in health. The aim of this study is to explore whether different indicators of psychological distress contribute to socio-economic differences in cause-specific mortality.

METHODS

The data source is a nationally representative, repeated cross-sectional survey, "Health Behaviour and Health among the Finnish Adult Population" (AVTK). The survey results were linked with socio-economic register data from Statistics Finland (from the years 1979-2002) and mortality follow-up data up to 2006 from the Finnish National Cause of Death Register. The data included 32,451 men and 35,420 women (response rate 73.5%). Self-reported measures of depression, insomnia and stress were used as indicators of psychological distress. Socio-economic factors included education, employment status and household income. Mortality data consisted of unnatural causes of death (suicide, accidents and violence, and alcohol-related mortality) and coronary heart disease (CHD) mortality. Adjusted hazard ratios were calculated using the Cox regression model.

RESULTS

In unnatural mortality, psychological distress accounted for some of the employment status (11-31%) and income level (4-16%) differences among both men and women, and for the differences related to the educational level (5-12%) among men; the educational level was associated statistically significantly with unnatural mortality only among men. Psychological distress had minor or no contribution to socio-economic differences in CHD mortality.

CONCLUSIONS

Psychological distress partly accounted for socio-economic disparities in unnatural mortality. Further studies are needed to explore the role and mechanisms of psychological distress associated with socio-economic differences in cause-specific mortality.