Statistical modelling of selective non-participation in health examination surveys
Health examination surveys aim to collect reliable information on the health and risk factors of a population of interest. Missing data occur when some invitees do not participate the survey. If non-participation is associated with the variables to be studied, then the estimates based only on the participants cannot be generalised to the population of interest. In this case, the estimates have selection bias, which misleads the decision-makers. The purpose of this thesis is to develop statistical methods to reduce the selection bias in the cross-sectional data using additional data sources. The data, which we use, comes from the National FINRISK Study, and we aim to estimate the prevalences of self-reported daily smoking and self-reported heavy alcohol consumption. The sources of additional information are follow-up data consisting of hospitalisations and causes of deaths, and questionnaire data collected from the non-participants of health examination by contacting them again, called re-contact data. Follow-up data give indirect information after the follow-up period about the health behaviour of non-participants during the health examination while the re-contact data give information similar to the health examination survey. This thesis presents methods for utilising these sources of additional information. Multiple imputation has been applied for the use of re-contact data, and Bayesian statistical modelling has been implemented for the use of follow-up data. The thesis demonstrates that the use of additional data sources and these statistical methods leads to prevalence estimates for daily smoking and heavy alcohol consumption that are higher than those obtained from the participants only. Multiple imputation can be utilised for prevalence estimation if the re-contact data are available. Bayesian modelling is appropriate for the situation where re-contact data are not available but the follow-up data are and have follow-up period long enough to indicate about the diﬀerences between the participants and non-participants. This thesis presents means for reducing the selection bias caused by non-participation. It is important to reduce the magnitude of the bias for obtaining more reliable information for example to support decision making. The statistical methods used in this thesis can also be applied to other ﬁelds of research than in the health studies. ...
PublisherUniversity of Jyväskylä
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Recommendations for design and analysis of health examination surveys under selective non-participation Karvanen, Juha; Härkänen, Tommi; Reinikainen, Jaakko; Tolonen, Hanna (Oxford University Press, 2019)Background The decreasing participation rates and selective non-participation peril the representativeness of health examination surveys (HESs). Methods Finnish HESs conducted in 1972–2012 are used to demonstrate that ...
Non-participation modestly increased with distance to the examination clinic among adults in Finnish health examination surveys Reinikainen, Jaakko; Saarsalmi, Perttu; Härkänen, Tommi; Jousilahti, Pekka; Karvanen, Juha; Männistö, Satu; Tolonen, Hanna (Sage, 2018)Aims: Health examinaton surveys (HES) provide important informaton about populaton health and health related factors, but declining partcipaton rates threaten the representatveness of collected data. It is hard to conduct ...
Kopra, Juho; Härkänen, Tommi; Tolonen, Hanna; Jousilahti, Pekka; Kuulasmaa, Kari; Reinikainen, Jaakko; Karvanen, Juha (Sage, 2018)Aims: A common objective of epidemiological surveys is to provide population-level estimates of health indicators. Survey results tend to be biased under selective non-participation. One approach to bias reduction is ...
Participation rates by educational levels have diverged during 25 years in Finnish health examination surveys Reinikainen, Jaakko; Tolonen, Hanna; Borodulin, Katja; Härkänen, Tommi; Jousilahti, Pekka; Karvanen, Juha; Koskinen, Seppo; Kuulasmaa, Kari; Männistö, Satu; Rissanen, Harri; Vartiainen, Erkki (Oxford University Press, 2018)Background Declining participation rates in health examination surveys may impair the representativeness of surveys and introduce bias into the comparison of results between population groups if participation rates differ ...
Kotamäki, Niina (University of Jyväskylä, 2018)Decision-making at different phases of adaptive river basin management planning rely largely on the information that is gained through environmental monitoring. The aim of this thesis was to develop and test statistical ...