An Introduction toAn Introduction to Social Environment and Biomarkers of Aging StudySocial Environment and Biomarkers of Aging Study

the SEBAS 2000 in Taiwanthe SEBAS 2000 in Taiwan

Yi-Li ChuangBureau of Health Promotion

Department of Health, Taiwan

About the SEBAS 2000 The SSocial EEnvironment and BBiomarkers of AAging SStudy

an extension of the Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan

a collaborative project of the Bureau of Health Promotion, the Georgetown University and the Princeton University

a five year project from 1999 to 2004 granted by NIA and additional budget form Taiwan Government

integrating biological measurements based on medical exams and assays of blood and urine specimens into questionnaire interview surveys of health and aging

The Establishment of the BHP

Department of HealthDepartment of Health

Bureau of Health Promotion

Institute of Family Planning

Bureau of Health Promotion and

Protection

Institute of Public Health

Institute of Maternal and Child Health

Bureau of Health PromotionBureau of Health Promotion

July, 2001

1971 1959 1964 1959

A Brief to the Survey of Health and Living Status of the Near Elderly and Elderly in Taiwan

a longitudinal survey with a national representative sample of non-aboriginal townships

initiated in 1989 under the Institute of Family Planning* (*: merged into the BHP in 2001)

in collaboration with the Population Studies Center and the Institute of Gerontology, University of Michigan

Baseline19894049(60+)

2nd wave19933155(64+)

3rd wave19962669(67+)2462(50-66)

4th wave19992310(70+)2130(53-69)

5th wave2003-2004(74+)(57-73)(50-56)

5th wave2003-2004(74+)(57-73)(50-56)

SEBAS is an extension to the elderly survey series

1st wave19894049(60+)

2nd wave19933155(64+)

3rd wave19962669(67+)2462(50-66)

4th wave19992310(70+)2130(53-69)

5th wave2003-2004(74+)(57-73)(50-56)

1998 Pilot Study4 townships in TaichungSample size: 100

2000 PretestPingtung citySample size: 50

2000 SEBASSample size: 1497 (interviewed)1023 (biomed. information)

Life ChallengesSources of Stress

Physical & MentalHealth & Illness

Position in Social HierarchiesSocial Connection and Networks

Social Environment

Research Model

Some Limitations of Existing Research Infrequent follow-up (if any) of sample Select (non-representative) samples Lack of detailed data on health status at baseline Dubious quality of self-reported data Lack of detailed information on social environment

(e.g., networks vs. support; positive vs. negative support)

Little attention to physiological parameters that help to identify pathways of influence

Life ChallengesSources of Stress

Physical & MentalHealth & Illness

Position in Social HierarchiesSocial Connection and Networks

Social Environment

Adding Physiology Response to the Model

Physiological Response

Goals of SEBAS

To elucidate pathways among challenges, social environment, and a range of mental and physical health outcomes the relationship between life challenge and health? how the social environment affects the relationship? how incorporating biological markers of health and stress

can enhance our understanding of the relationships?

The Strength of the Study Use of large, non-clinical population-based sample Add information to existing social science surveys Consider a broad range of social factors together with

biological information Breadth of data (social ties, self-reported health) and available

longitudinal survey data Strong field team, continuity of personnel, high quality data and

high response rates Compare results from Western populations to cultural different

Taiwan population

Sampling Design sub-sample of respondents to the 1999 wave

three-stage equal probability sample nationally representative for aged 54 and above over‑sampling by urban residence and age group

sample size: Sample selected: 1713 (in 27 townships) interviewed:1497

Response rate: 92% (among survivors) Biomedical data collected: 1023

Response rate 68% (among respondents)

Organizations involve in SEBAS Organized by Taiwan Provincial Institute of Family Planning

(now BHP) , Princeton University, Georgetown University Technique supported by University of California-Los Angeles

and University of Michigan Assistant Units include:

County/City Health Bureau Local health stations and public health nurses Local reputable hospitals Central Lab (contracted commercial lab).

Fieldwork Operation July, 2000 ~ December, 2000 3 mission oriented working teams

7 staffs and 2 drivers for each task spending a couple of weeks in each PSU working with public health nurses and people in hospitals each team is responsible for fieldwork in 7-9 PSUs

Task involvesYears ahead Identification of central lab Conduction of pilot studyMonths ahead Finalize standard operation protocol Pretest of final protocol Sampling operation Formal visit to County/City Health Bureau Identification of hospitals Training of local public health nurses Individual interview by public health nurses

Packing ice for 12 hour urine collection set

Task involves (Cont.)Day before medical exam Preparation and delivery of urine collection containers Instruction on 12 hour urine collection Obtain informed consent Help on participant’s transportation arrangement to hospitalDay of medical exam Participants pick up and collection of urine containers Hospital visit

Short questionnaire Interview Collection of blood and random urine specimens Measurement and physician check up Pretreatment of blood and urine specimens Delivery of specimens to central lab

Blood pressure station in Hospital

Blood-drawing station in hospital

▄

Measuring waist & hip circumference in hospital

Completing questionnaires & forms in hospital

Urine samples pretreatment in hospital

Task involves (Cont.)

Weeks after the medical exam Sending health examination results to participants Data entry and file construction

Mission of Public Health Nurse conduct questionnaire interview explain study to the respondents and get their consent evaluate R’s condition for specimen collection schedule physical exam for participants

Elements to achieve the mission Structured form and questionnaire Standardized procedure Systematic training

Mission of Central Lab Immediate shipment of the specimens to lab in Taipei Follow standard laboratory protocols for assays Provide results within two weeks Quality assurance for assays

Keep daily report of quality control Spot check for compliance Blind duplicate samples for intra-lab and inter-lab control

Content of Questionnaire chronic conditions physical functioning psychological well-being cognitive capacity health services utilization social networks and support stressful life events socioeconomic status demographic characteristics

Health Exam Items & Biomarkers Measurements

Waist/hip ratio blood pressure readings

Blood test items HDL & total cholesterol DHEA-S Glycosylated hemoglobin Other experimental items

12 Hour Urine Collection Cortisol Epinephrine, norepinephrine

Physical exam & lab test items similar to National Health Exam abdominal ultrasound

Reasons for not participating in health exam and collection of biomarkers Not eligible for health examination* 111 (7.4%)

Living in an institution 10 (0.7%) Seriously ill 61 (4.1%) Catheter or diaper 23 (1.5%) On kidney dialysis 7 (0.5%) Other health condition that precludes blood drawing 33 (2.2%)

Refused to participate ** 363 (24.2%) * Respondents may have more than one health condition that makes them ineligible for

health examination **The 363 refusals may have provided multiple reasons for refusing to participate

Major reasons for non-participation in physical exam

Just received or has regular health exams R or family thinks R is healthy/no need for exam Too ill/frail Will be out of town/no time within scheduled days Too much trouble