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Predictors of decline in self-reported health: addressing non-ignorable dropout in longitudinal studies of ageing
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0002-9107-6486
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0003-0556-1483
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0003-3187-1987
2018 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 15, no 2, p. 211-220Article in journal (Refereed) Published
Abstract [en]

Predictors of decline in health in older populations have been investigated in multiple studies before. Most longitudinal studies of aging, however, assume that dropout at follow-up is ignorable (missing at random) given a set of observed characteristics at baseline. The objective of this study was to address non-ignorable dropout in investigating predictors of declining self-reported health (SRH) in older populations (50 years or older) in Sweden, the Netherlands, and Italy. We used the SHARE panel survey, and since only 2895 out of the original 5657 participants in the survey 2004 were followed up in 2013, we studied whether the results were sensitive to the expectation that those dropping out have a higher proportion of decliners in SRH. We found that older age and a greater number of chronic diseases were positively associated with a decline in self-reported health in the three countries studies here. Maximum grip strength was associated with decline in self-reported health in Sweden and Italy, and self-reported limitations in normal activities due to health problems were associated with decline in self-reported health in Sweden. These results were not sensitive to non-ignorable dropout. On the other hand, although obesity was associated with decline in a complete case analysis, this result was not confirmed when performing a sensitivity analysis to non-ignorable dropout. The findings, thereby, contribute to the literature in understanding the robustness of longitudinal study results to non-ignorable dropout while considering three different population samples in Europe.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 15, no 2, p. 211-220
Keywords [en]
Longitudinal studies, Dropout, Sensitivity analysis, Chronic disease, Body mass index, SHARE
National Category
Probability Theory and Statistics Public Health, Global Health, Social Medicine and Epidemiology Gerontology, specialising in Medical and Health Sciences
Research subject
Statistics
Identifiers
URN: urn:nbn:se:umu:diva-127118DOI: 10.1007/s10433-017-0448-xISI: 000433224700010PubMedID: 29867305OAI: oai:DiVA.org:umu-127118DiVA, id: diva2:1043962
Projects
Paths to Healthy and Active Ageing
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-2506
Note

Originally included in thesis in manuscript form.

Available from: 2016-11-01 Created: 2016-10-31 Last updated: 2018-06-25Bibliographically approved
In thesis
1. Uncertainty intervals and sensitivity analysis for missing data
Open this publication in new window or tab >>Uncertainty intervals and sensitivity analysis for missing data
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis we develop methods for dealing with missing data in a univariate response variable when estimating regression parameters. Missing outcome data is a problem in a number of applications, one of which is follow-up studies. In follow-up studies data is collected at two (or more) occasions, and it is common that only some of the initial participants return at the second occasion. This is the case in Paper II, where we investigate predictors of decline in self reported health in older populations in Sweden, the Netherlands and Italy. In that study, around 50% of the study participants drop out. It is common that researchers rely on the assumption that the missingness is independent of the outcome given some observed covariates. This assumption is called data missing at random (MAR) or ignorable missingness mechanism. However, MAR cannot be tested from the data, and if it does not hold, the estimators based on this assumption are biased. In the study of Paper II, we suspect that some of the individuals drop out due to bad health. If this is the case the data is not MAR. One alternative to MAR, which we pursue, is to incorporate the uncertainty due to missing data into interval estimates instead of point estimates and uncertainty intervals instead of confidence intervals. An uncertainty interval is the analog of a confidence interval but wider due to a relaxation of assumptions on the missing data. These intervals can be used to visualize the consequences deviations from MAR have on the conclusions of the study. That is, they can be used to perform a sensitivity analysis of MAR.

The thesis covers different types of linear regression. In Paper I and III we have a continuous outcome, in Paper II a binary outcome, and in Paper IV we allow for mixed effects with a continuous outcome. In Paper III we estimate the effect of a treatment, which can be seen as an example of missing outcome data.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. p. 13
Series
Statistical studies, ISSN 1100-8989 ; 50
Keywords
missing data, missing not at random, non-ignorable, set identification, uncertainty intervals, sensitivity analysis, self reported health, average causal effect, average causal effect on the treated, mixed-effects models
National Category
Probability Theory and Statistics
Research subject
Statistics
Identifiers
urn:nbn:se:umu:diva-127121 (URN)978-91-7601-555-1 (ISBN)
Public defence
2016-11-25, Hörsal E, Humanisthuset, Umeå Universitet, Umeå, 10:00 (English)
Opponent
Supervisors
Available from: 2016-11-04 Created: 2016-10-31 Last updated: 2018-06-09Bibliographically approved

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Genbäck, MinnaNg, Nawide Luna, Xavier

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Probability Theory and StatisticsPublic Health, Global Health, Social Medicine and EpidemiologyGerontology, specialising in Medical and Health Sciences

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