An Introduction to An Introduction to Social Environment and Biomarkers Social Environment and Biomarkers of Aging Study of Aging Study the SEBAS 2000 in Taiwan the SEBAS 2000 in Taiwan Yi-Li Chuang Bureau of Health Promotion Department of Health, Taiwan
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An Introduction to Social Environment and Biomarkers of Aging Study the SEBAS 2000 in Taiwan Yi-Li Chuang Bureau of Health Promotion Department of Health,
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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
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
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