How healthy are survey respondents compared with the general population? Using survey-linked death records to compare mortality outcomes

Keyes, K. M., Rutherford, C., Popham, F. , Martins, S. S. and Gray, L. (2018) How healthy are survey respondents compared with the general population? Using survey-linked death records to compare mortality outcomes. Epidemiology, 29(2), pp. 299-307. (doi: 10.1097/EDE.0000000000000775) (PMID:29389712) (PMCID:PMC5794231)

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Background: National surveys are used to capture US health trends and set clinical guidelines, yet the sampling frame often includes those in non-institutional households, potentially missing those most vulnerable for poor health. Declining response rates in national surveys also represent a challenge, and existing inputs to survey weights have limitations. We compared mortality rates between those who respond to surveys and the general population over time. Methods: Survey respondents from twenty waves of the National Health Interview Survey from 1990 through 2009 who have been linked to death records through 31 December 2011 were included. For each cohort in the survey, we estimated their mortality rates along with that cohort's mortality rate in the census population using vital statistics records and differences were examined using Poisson models. Results: In all years, survey respondents had lower mortality rates compared with the general population, when data were both weighted and unweighted. Among men, survey respondents in the weighted sample had 0.86 (95% C.I. 0.853-0.868) times the mortality rate of the general population (among women, RR=0.887; 95% C.I. 0.879-0.895). Differences in mortality are evident along all points of the life course. Differences have remained relatively stable over time. Conclusion: Survey respondents have lower death rates than the general US population, suggesting that they are a systematically healthier source population. Incorporating non-household samples and revised weighting strategies to account for sample frame exclusion and non-response may allow for more rigorous estimation of the US population's health.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Popham, Dr Frank and Gray, Dr Linsay
Authors: Keyes, K. M., Rutherford, C., Popham, F., Martins, S. S., and Gray, L.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Epidemiology
Publisher:Lippincott, Williams and Wilkins
ISSN (Online):1531-5487
Published Online:31 October 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Epidemiology 29(2):299-307
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU