The impact of attrition on the representativeness of cohort studies of older people

Brilleman, SL, Pachana, NA and Dobson, AJ (2010) The impact of attrition on the representativeness of cohort studies of older people. BMC Medical Research Methodology, 10 71-1-71-9. doi:10.1186/1471-2288-10-71

Author Brilleman, SL
Pachana, NA
Dobson, AJ
Title The impact of attrition on the representativeness of cohort studies of older people
Journal name BMC Medical Research Methodology   Check publisher's open access policy
ISSN 1471-2288
Publication date 2010-08
Sub-type Article (original research)
DOI 10.1186/1471-2288-10-71
Open Access Status DOI
Volume 10
Start page 71-1
End page 71-9
Total pages 9
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2011
Language eng
Formatted abstract
Background: There are well-established risk factors, such as lower education, for attrition of study participants. Consequently, the representativeness of the cohort in a longitudinal study may deteriorate over time. Death is a common form of attrition in cohort studies of older people. The aim of this paper is to examine the effects of death and other forms of attrition on risk factor prevalence in the study cohort and the target population over time.

Differential associations between a risk factor and death and non-death attrition are considered under various hypothetical conditions. Empirical data from the Australian Longitudinal Study on Women's Health (ALSWH) for participants born in 1921-26 are used to identify associations which occur in practice, and national cross-sectional data from Australian Censuses and National Health Surveys are used to illustrate the evolution of bias over approximately ten years.

The hypothetical situations illustrate how death and other attrition can theoretically affect changes in bias over time. Between 1996 and 2008, 28.4% of ALSWH participants died, 16.5% withdrew and 10.4% were lost to follow up. There were differential associations with various risk factors, for example, non-English speaking country of birth was associated with non-death attrition but not death whereas being underweight (body mass index < 18.5) was associated with death but not other forms of attrition. Compared to national data, underrepresentation of women with non-English speaking country of birth increased from 3.9% to 7.2% and over-representation of current and ex-smoking increased from 2.6% to 5.8%.

Deaths occur in both the target population and study cohort, while other forms of attrition occur only in the study cohort. Therefore non-death attrition may cause greater bias than death in longitudinal studies. However although more than a quarter of the oldest participants in the ALSWH died in the 12 years following recruitment, differences from the national population changed only slightly. © 2010 Brilleman et al; licensee BioMed Central Ltd.
Keyword Health
Cohort analysis
Comparative study
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article # 71

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
School of Psychology Publications
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Citation counts: TR Web of Science Citation Count  Cited 23 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 03 Oct 2010, 00:07:57 EST