Comparison of mortality between respondents and non-respondents in a mail survey

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.

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.

The characteristics of non-respondents and respondents of a mental health survey among evacuees in a disaster: The Fukushima Health Management Survey

The Fukushima Medical University conducted a mental health care program for evacuees after the Fukushima Daiichi nuclear power plant accident. However, the mental health status of non-respondents has not been considered for surveys using questionnaires. Therefore, the aim of this study was to clarify the characteristics of non-respondents and respondents. The target population of the survey (FY2011-2013) is people living in the nationally designated evacuation zone of Fukushima prefecture. Among these, the participants were 967 people (20 years or older). We examined factors that affected the difference between the groups of participants (i.e., non-respondents and respondents) using multivariate logistic regression analysis. Employment was higher in non-respondents (p=0.022) and they were also more socially isolated (p=0.047) when compared to respondents; non-respondents had a higher proportional risk of psychological distress compared to respondents (p<0.033). The results of the multivariate logistic regression analysis showed that, within the participants there was a significant association between employment status (OR=1.99, 95% confidence interval [CI]:1.12-3.51) and psychological distress (OR=2.17, 95% CI:1.01-4.66). We found that non-respondents had a significantly higher proportion of psychological distress compared to the respondents. Although the non-respondents were the high-risk group, it is not possible to grasp the complexity of the situation by simply using questionnaire surveys. Therefore, in the future it is necessary to direct our efforts towards the mental health of non-respondents and respondents alike.

Trends in health indicators in the urban middle-aged population in the Czech Republic in 1998-2010

OBJECTIVES

To track the trends in general health indicators and the prevalence of cardiovascular diseases (CVD), high blood pressure and elevated blood cholesterol in the middle-aged urban population in the Czech Republic in 1998-2010.

STUDY DESIGN

Cross-sectional study.

METHODS

The following data from the three-phase HELEN (HEalth - Lifestyle - ENvironment) study, a prevalence questionnaire survey, were analysed: data collected from 8214 subjects in phase I, 6107 subjects in phase II, and 4389 subjects in phase III. The study subjects were aged 45-54 years and the study period spanned from 1998 to 2010. The differences in the indicators between phases were evaluated by binary and ordinal logistic regression models at a significance level of 0.01.

RESULTS

Over the study period, a significant increase was observed in the proportion of respondents who self-rated their health as very good or good: from 46.6% to 51.0% in males (P = 0.006) and from 45.5% to 49.9% in females (P < 0.001). At the same time, the rates of respondents under long-term medical follow-up rose significantly from 36.3% to 44.3% (P < 0.001) and from 46.4% to 56.2% (P < 0.001), respectively. CVD prevalence did not change although the percentage of males and females with high blood pressure (from 29.3% to 36.6% and from 26.0% to 31.2%, respectively) and elevated total cholesterol (from 29.0% to 36.6% and from 27.3% to 32.4%, respectively) increased significantly.

CONCLUSIONS

Self-rated health among the middle-aged population in the Czech Republic improved during the 1998-2010 period, but, at the same time, more people needed to be followed up for a disease. The proportions of respondents with hypertension and elevated blood cholesterol increased while the CVD rates did not vary significantly.

Sample selection, recruitment and participation rates in health examination surveys in Europe--experience from seven national surveys

Background

Health examination surveys (HESs), carried out in Europe since the 1950’s, provide valuable information about the general population’s health for health monitoring, policy making, and research. Survey participation rates, important for representativeness, have been falling. International comparisons are hampered by differing exclusion criteria and definitions for non-response.

Method

Information was collected about seven national HESs in Europe conducted in 2007–2012. These surveys can be classified into household and individual-based surveys, depending on the sampling frames used. Participation rates of randomly selected adult samples were calculated for four survey modules using standardised definitions and compared by sex, age-group, geographical areas within countries, and over time, where possible.

Results

All surveys covered residents not just citizens; three countries excluded those in institutions. In two surveys, physical examinations and blood sample collection were conducted at the participants’ home; the others occurred at examination clinics. Recruitment processes varied considerably between surveys. Monetary incentives were used in four surveys. Initial participation rates aged 35–64 were 45 % in the Netherlands (phase II), 54 % in Germany (new and previous participants combined), 55 % in Italy, and 65 % in Finland. In Ireland, England and Scotland, household participation rates were 66 %, 66 % and 63 % respectively. Participation rates were generally higher in women and increased with age. Almost all participants attending an examination centre agreed to all modules but surveys conducted in the participants’ home had falling responses to each stage. Participation rates in most primate cities were substantially lower than the national average. Age-standardized response rates to blood pressure measurement among those aged 35–64 in Finland, Germany and England fell by 0.7-1.5 percentage points p.a. between 1998–2002 and 2010–2012. Longer trends in some countries show a more marked fall.

Conclusions

The coverage of the general population in these seven national HESs was good, based on the sampling frames used and the sample sizes. Pre-notification and reminders were used effectively in those with highest participation rates. Participation rates varied by age, sex, geographical area, and survey design. They have fallen in most countries; the Netherlands data shows that they can be maintained at higher levels but at much higher cost.

Increasing health examination survey participation rates by SMS reminders and flexible examination times

AIMS

Declining participation rates are an increasing problem in population surveys. Different kinds of methods have been used to ensure participation rates as high as possible. Monetary incentives and reminders have been found to be effective ways to increase participation rates, but these are rather expensive to implement in large population surveys. There is a need for cheaper ways to motivate survey invitees to participate.

METHODS

The Kuusamo Health Examination Survey was conducted in May-June 2011. A random sample of 250 people was selected for the survey. Mobile phone numbers, when available, were obtained for people within the sample. For a random sample of 50% of survey invitees with a mobile phone number, a short message service (SMS) reminder was sent prior to their appointment. All survey participants were asked to fill in a feedback questionnaire.

RESULTS

Participation rate was 58% for men and 74% for women. Mobile phone numbers were available for 66% of the sample. Among those receiving an SMS reminder about their appointment, participation rates were up to 25 percentage points higher than among the group not receiving a reminder. In the feedback questionnaire, 9% of the survey participants reported that they would not have participated without the SMS reminder they received. Participants preferred morning hours and Monday-Tuesday as time and day options for the examinations.

CONCLUSIONS

SMS reminder about the appointment time was an effective way to increase participation rate, especially among the youngest age groups also, providing flexible office hours for the examination clinic may increase participation rate.

Effects of community based cardiac rehabilitation: Comparison with a hospital-based programme

BACKGROUND

With typically fewer than 35% of eligible patients attending outpatient cardiac rehabilitation (CR), more accessible provision is required. Community-based cardiac rehabilitation is one option but its effects need to be compared with those of hospital-based CR.

AIMS

The purpose of this study was to compare changes in health-related quality of life (HRQOL), anxiety and depression, and exercise and smoking rates, between attendees at community-based and hospital-based CR programmes.

METHOD

A prospective comparative cohort design was used. Consecutive patients admitted to Aberdeen Royal Infirmary and eligible for CR were recruited and followed up by self-report questionnaire. Outcomes were health status (RAND-36), Hospital Anxiety and Depression Scale (HADS), Godin Leisure-Time Exercise and smoking status.

RESULTS

There were 136 of 179 (75%) attenders at community-based CR, compared to 169 of 209 (80%) at hospital-based CR (p=0.242). In univariate analysis, there were no significant differences between the two groups in health status, HADS, and frequency or intensity of exercise immediately after the CR programme or six months later. Adjusting for other significant factors, patients who attended community CR reported higher RAND-36 energy scores at six months compared with attenders at hospital CR (p=0.020), but were less likely to undertake frequent exercise (p=0.041).

CONCLUSIONS

Community-based CR appears to achieve similar attendance rates and effects on health status and health behaviour as hospital-based CR. This option might help overcome the poor attendance of patients with long travelling times to hospital-based CR.

Serum uric acid shows a J-shaped trend with coronary mortality in non-insulin-dependent diabetic elderly people. The CArdiovascular STudy in the ELderly (CASTEL)

The relationship between serum uric acid (SUA) and risk of coronary heart disease (CHD) mortality remains controversial, particularly in diabetic subjects. The aim of the present study is to evaluate whether SUA independently predicts CHD mortality in non-insulin-dependent elderly people from the general population and to investigate the interactions between SUA and other risk factors. Five hundred and eighty-one subjects aged >/=65 years with non-insulin-dependent diabetes mellitus were prospectively studied in the frame of the CArdiovascular STudy in the ELderly (CASTEL). Historical and clinical data, blood tests and 12-year fatal events were recorded. SUA as a continuous item was divided into tertiles and, for each tertile, adjusted relative risk (RR) with 95% confidence intervals (CI) was derived from multivariate Cox analysis. CHD mortality was predicted by SUA in a J-shaped manner. Mortality rate was 7.9% (RR 1.28, CI 1.05-1.72), 6.0% (reference tertile) and 12.1% (RR 1.76, CI 1.18-2.27) in the increasing tertiles of SUA, respectively, without any difference between genders. In diabetic elderly subjects, SUA independently predicts the risk of CHD mortality in a J-shaped manner.

Smoking, exercise and dietary behaviors among mothers of elementary school-aged children in a rural North Carolina county

Tobacco use, poor diet, and physical inactivity are risk behaviors established during childhood and influenced by parents. Improving health habits of rural families poses particular challenges because resources may be limited in number and reach. To characterize the kinds of prevention programs needed by rural families, 501 surveys were mailed to caregivers of elementary school children living in a rural North Carolina county. Health behaviors, related attitudes, and demographic characteristics were assessed. Risk behaviors were defined as eating less than 5 fruits and vegetables a day, exercising less than 20 minutes 3 times a week, and being a smoker. Two hundred and sixty-one adults (55%) completed the surveys. Two hundred and forty-four (93%) were female, with a mean age of 37 years, 55% had a high school or less education, 89% reported at least one risk behavior, and 57% reported 2 or more risk behaviors. Female caregivers with multiple risk behaviors had lower educational levels (p < 0.007) and placed less importance on children's health behaviors (p < 0.009) than other caregivers. Female caregivers with multiple risk behaviors were no less confident they could change their behavior than those with only one risk behavior. The majority of female caregivers of elementary school children in this rural population engaged in and modeled multiple health risk behaviors for their children. Health promotion activities that address multiple risk factors and involve children are needed by young families in rural communities.

Comparison of cause-specific mortality between respondents and nonrespondents in a population-based prospective study: ten-year follow-up of JPHC Study Cohort I. Japan Public Health Center

To evaluate the magnitude and duration of the "healthy volunteer effect" (HVE) in a middle-aged general population in Japan, we followed 54,396 subjects (26,998 men, 27,398 women) of the JPHC Study Cohort I from 1990 through 1999, and compared cause-specific mortality between respondents (79%) and nonrespondents to a baseline questionnaire survey. Age and area-adjusted RRs of mortality were higher among nonrespondents for all causes (2.02, 95% CI = 1.83-2.24), all cancers (1.43, 1.20-1.71), all circulatory system diseases (2.26, 1.86-2.74), and cerebrovascular disease (2.73, 2.04-3.66) in men, and 1.63 (1.39-1.92), 1.22 (0.94-1.58), 1.53 (1.07-2.20), and 1.65 (1.02-2.65), respectively, in women. These effects were not observed for ischemic heart disease. RR elevation for cancer was observed only in the first 2 years of follow-up (4.14, 2.74-6.26 versus 1.14, 0.93-1.40 after 2 years), while that for cerebrovascular disease was relatively stable for the entire period. In conclusion, HVE differed according to the causes and length of follow-up.

Attitudes toward smoking and family-based health promotion among rural mothers and other primary caregivers who smoke

The family milieu provides a potential context for integrating smoking cessation and prevention activities to complement school-based efforts. In this study, surveys were mailed to caregivers of elementary school children to assess demographics, smoking characteristics and attitudes, and receptivity to and preferred format for health promotion programs. Fifty-three percent (n = 276) of 501 caregivers responded. Among smokers, most did not want their children to smoke, and they wanted to quit themselves; 91% considered it important to involve their children in their smoking cessation attempts; and 70% expressed willingness to participate in health promotion for the entire family. Written materials either mailed home or brought home from school were the preferred program formats. These findings suggest the feasibility of a program in which adults and children work together at home on smoking cessation and prevention activities that might increase the effectiveness of school-based smoking prevention messages.

Serum uric acid as a cardiovascular risk factor for heart disease

Cardiovascular risk factors are those environmental, behavioral, genetic, and/or personal factors whose presence indicates a heightened risk of subsequent vascular disease events. Smoking, hypertension, and hyperlipidemia, initially identified by astute clinicians, were all subsequently confirmed and defined as risk factors through formal prospective epidemiologic study, long before evidence of causality was available. Ultimately, clinical trials demonstrated a reversible contribution of both high blood pressure and elevated lipids to stroke and heart disease. As a result, these risk factors are now the cornerstones for both assessment of relative cardiovascular risk and targets for preventive intervention. The criterion for risk factor status is a strong, consistent, timely, and statistically significant association to disease events that is independent of and unconfounded by other known risk factors. The purpose of this review is to assess available data to determine whether or not serum uric acid meets the standard for designation as a risk factor.