Study on Global Ageing and Adult Health 2009-2010 - Mexico

Abstract
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Purpose:
The multi-country Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Innovation, Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is compiling longitudinal data on the health and well-being of adult populations, and the ageing process, through primary data collection and secondary data analysis. SAGE baseline data (Wave 0, 2002/3) was collected as part of WHO's World Health Survey http://www.who.int/healthinfo/survey/en/index.html (WHS). SAGE Wave 1 (2007/10) provides a comprehensive data set on the health and well-being of adults in six low and middle-income countries: China, Ghana, India, Mexico, Russian Federation and South Africa.

Objectives:
To obtain reliable, valid and comparable health, health-related and well-being data over a range of key domains for adult and older adult populations in nationally representative samples
To examine patterns and dynamics of age-related changes in health and well-being using longitudinal follow-up of a cohort as they age, and to investigate socio-economic consequences of these health changes
To supplement and cross-validate self-reported measures of health and the anchoring vignette approach to improving comparability of self-reported measures, through measured performance tests for selected health domains
To collect health examination and biomarker data that improves reliability of morbidity and risk factor data and to objectively monitor the effect of interventions

Additional Objectives:
To generate large cohorts of older adult populations and comparison cohorts of younger populations for following-up intermediate outcomes, monitoring trends, examining transitions and life events, and addressing relationships between determinants and health, well-being and health-related outcomes
To develop a mechanism to link survey data to demographic surveillance site data
To build linkages with other national and multi-country ageing studies
To improve the methodologies to enhance the reliability and validity of health outcomes and determinants data
To provide a public-access information base to engage all stakeholders, including national policy makers and health systems planners, in planning and decision-making processes about the health and well-being of older adults

Methods:
SAGE's first full round of data collection included both follow-up and new respondents in most participating countries. The goal of the sampling design was to obtain a nationally representative cohort of persons aged 50 years and older, with a smaller cohort of persons aged 18 to 49 for comparison purposes. In the older households, all persons aged 50+ years (for example, spouses and siblings) were invited to participate. Proxy respondents were identified for respondents who were unable to respond for themselves. Standardized SAGE survey instruments were used in all countries consisting of five main parts: 1) household questionnaire; 2) individual questionnaire; 3) proxy questionnaire; 4) verbal autopsy questionnaire; and, 5) appendices including showcards. A VAQ was completed for deaths in the household over the last 24 months. The procedures for including country-specific adaptations to the standardized questionnaire and translations into local languages from English follow those developed by and used for the World Health Survey.

Content:
Household questionnaire
0000 Coversheet
0100 Sampling Information
0200 Geocoding and GPS Information
0300 Recontact Information
0350 Contact Record
0400 Household Roster
0450 Kish Tables and Household Consent
0500 Housing
0600 Household and Family Support Networks and Transfers
0700 Assets and Household Income
0800 Household Expenditures
0900 Interviewer Observations

Individual questionnaire
1000 Socio-Demographic Characteristics
1500 Work History and Benefits
2000 Health State Descriptions and Vignettes
2500 Anthropometrics, Performance Tests and Biomarkers
3000 Risk Factors and Preventive Health Behaviours
4000 Chronic Conditions and Health Services Coverage
5000 Health Care Utilization
6000 Social Cohesion
7000 Subjective Well-Being and Quality of Life (WHOQoL-8 and Day Reconstruction Method)
8000 Impact of Caregiving
9000 Interviewer Assessment

Geographic coverage
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National coverage

Analysis unit
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- Households;
- Individuals.

Universe
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The household section of the survey covered all households in all 32 federal states in Mexico. Institutionalised populations are excluded. The individual section covered all persons aged 18 years and older residing within individual households. As the focus of SAGE is older adults, a much larger sample of respondents aged 50 years and older were selected with a smaller comparative sample of respondents aged 18-49 years.

Kind of data
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Sample survey data [ssd]

Sampling procedure
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In Mexico strata were defined by locality (metropolitan, urban, rural).
A sub-sample of 211 PSUs were selected from the 797 WHS PSUs.
The Basic Geo-Statistical Areas (AGEB) defined by the National Institute of Statistics (INEGI) constitutes a PSU.

PSUs were selected probability proportional to three factors:
a) (WHS/SAGE Wave 0 50plus): number of WHS/SAGE Wave 0 50-plus interviewed at the PSU,
b) (State Population): population of the state to which the PSU belongs,
c) (WHS/SAGE Wave 0 PSU at county): number of PSUs selected from the county to which the PSU belongs for the WHS/SAGE Wave 0;
The first and third factors were included to reduce geographic dispersion. Factor two affords states with larger populations a greater chance of selection.

All WHS/SAGE Wave 0 individuals aged 50 years or older in the selected rural or urban PSUs and a random sample 90% of individuals aged 50 years or older in metropolitan PSUs who had been interviewed for the WHS/SAGE Wave 0 were included in the SAGE Wave 1 ''primary'' sample. The remaining 10% of WHS/SAGE Wave 0 individuals aged 50 years or older in metropolitan areas were then allocated as a ''replacement'' sample for individuals who could not be contacted or did not consent to participate in SAGE Wave 1. A systematic sample of 1000 WHS/SAGE Wave 0 individuals aged 18-49 across all selected PSUs was selected as the ''primary'' sample and 500 as a ''replacement'' sample.

This selection process resulted in a sample which had an over-representation of individuals from metropolitan strata; therefore, it was decided to increase the number of individuals aged 50 years or older from rural and urban strata. This was achieved by including individuals who had not been part of WHS/SAGE Wave 0 (which became a ''supplementary'' sample), although the household in which they lived included an individual from WHS/SAGE Wave 0. All individuals aged 50 or over were included from rural and urban ''18-49 households'' (that is, where an individual aged 18-49 was included in WHS/SAGE Wave 0) as part of the ''primary supplementary'' sample. A systematic random sample of individuals aged 50 years or older was then obtained from urban and rural households where an individual had already been selected as part of the 50 years and older or 18-49 samples. These individuals then formed part of the ''primary supplementary'' sample and the remainder (that is, those not systematically selected) were allocated to the ''replacement supplementary'' sample. Thus, all individuals aged 50 years or older who lived in households in urban and rural PSUs obtained for SAGE Wave 1 were selected as either a primary or replacement participant. A final ''replacement'' sample for the 50 and over age group was obtained from a systematic sample of all individuals aged 50 or over from households which included the individuals already selected for either the 50 and over or 18-49. This sampling strategy also provided participants who had not been included in WHS/SAGE Wave 0, but lived in a household where an individual had been part of WHS/SAGE Wave 0 (that is, the ''supplementary'' sample), in addition to follow-up of individuals who had been included in the WHS/SAGE Wave 0 sample.

Strata: Locality = 3
PSU: AGEBs = 211
SSU: Households = 4 968 surveyed
TSU: Individual = 5 449 surveyed

Mode of data collection
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Face-to-face [f2f], CAPI

Research instrument
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The questionnaires were based on the WHS Model Questionnaire with some modification and many new additions. A household questionnaire was administered to all households eligible for the study. A Verbal Autopsy questionnaire was administered to households that had a death in the last 24 months. An Individual questionniare was administered to eligible respondents identified from the household roster. A Proxy questionnaire was administered to individual respondents who had cognitive limitations. The questionnaires were developed in English and were piloted as part of the SAGE pretest in 2005. All documents were translated into Spanish. All SAGE generic questionnaires are available as external resources.

Cleaning operations
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Data editing took place at a number of stages including:
(1) office editing and coding
(2) during data entry
(3) structural checking of the FoxPro files
(4) range and consistency secondary edits in Stata

Response rate
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Household: Response rate=59%
Individual: Response rate=51%

摘要
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目的:
世界卫生组织创新、信息、证据与研究集群的多国研究单位负责执行全球老龄化和成年人健康（SAGE）的多国研究。SAGE是该单位纵向研究项目的一部分，该项目通过原始数据收集和次级数据分析，汇编关于成年人群体健康与福祉以及老龄化进程的纵向数据。SAGE基线数据（第0波，2002/3）作为世界卫生组织全球卫生调查（WHS）的一部分进行收集。

SAGE第1波（2007/10）为六个低收入和中等收入国家的成年人健康与福祉提供了一个综合数据集：中国、加纳、印度、墨西哥、俄罗斯联邦和南非。

目标：

获取关于国家代表性样本中成年人和老年人群体在多个关键领域的可靠、有效和可比的健康、健康相关和福祉数据

通过追踪队列成员随年龄增长的健康和福祉变化模式与动态，以及探究这些健康变化的社会经济后果

通过为所选健康领域的测量表现测试补充和交叉验证自我报告的健康测量以及锚定情境法，以提高自我报告测量的可比性

收集改善疾病和风险因素数据可靠性的健康检查和生物标志物数据，并客观监测干预措施的效果

附加目标：

生成大量老年人群体和比较队列，以追踪中间结果、监测趋势、考察转变和生活事件，并解决决定因素与健康、福祉以及健康相关结果之间的关系

建立将调查数据与人口监测点数据相连接的机制

与其他国家和多国老龄化研究建立联系

改进提高健康结果和决定因素数据可靠性和有效性的方法

提供一个公共访问的信息库，以涉及所有利益相关者，包括国家政策制定者和健康系统规划者，在关于老年人健康与福祉的规划与决策过程中发挥作用

方法：

SAGE的第一轮全面数据收集包括大多数参与国家的新受访者以及追踪受访者。抽样设计的目的是获取一个国家代表性的50岁及以上人群队列，以及一个较小的18至49岁人群队列进行比较。在老年家庭中，邀请所有50岁及以上的人（例如，配偶和兄弟姐妹）参与。为无法自行回答的受访者确定了代理受访者。所有国家都使用了标准化的SAGE调查工具，包括五个主要部分：1）家庭问卷；2）个人问卷；3）代理问卷；4）口头尸检问卷；5）附录，包括展示卡。对于过去24个月内家庭中的死亡情况，完成了VAQ。将针对标准化问卷的国家特定调整和从英语翻译成当地语言的程序，遵循由世界卫生调查开发和使用的程序。

内容：
家庭问卷
0000 封面
0100 抽样信息
0200 地理编码和GPS信息
0300 复访信息
0350 联系记录
0400 家庭名单
0450 Kish表和家庭同意
0500 住房
0600 家庭和家庭支持网络及转移
0700 资产和家庭收入
0800 家庭支出
0900 采访者观察

个人问卷
1000 社会人口学特征
1500 工作历史和福利
2000 健康状态描述和情景
2500 人体测量学、表现测试和生物标志物
3000 风险因素和预防健康行为
4000 慢性病和医疗服务覆盖
5000 医疗保健利用
6000 社会凝聚力
7000 主观福祉和生活质量（WHOQoL-8和日重建法）
8000 护理影响
9000 采访者评估

地理覆盖范围
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国家覆盖
分析单元
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- 家庭；
- 个人。
总体
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调查的家庭部分涵盖了墨西哥所有32个联邦州的全部家庭。排除机构化人口。个人部分涵盖了居住在个人家庭中的所有18岁及以上的人。由于SAGE的关注点是老年人，因此选择了大量50岁及以上的受访者样本，以及较小的18-49岁受访者比较样本。

数据类型
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样本调查数据 [ssd]
抽样程序
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在墨西哥，根据地域（大都市、城市、农村）定义层。从797个WHS PSU中选择了211个PSU的子样本。
由国家统计局（INEGI）定义的基本地理统计区域（AGEB）构成了一个PSU。

PSU的选择基于三个因素的几率：
a）(WHS/SAGE Wave 0 50plus)：在PSU中接受WHS/SAGE Wave 0 50-plus采访的人数，
b）(州人口)：PSU所属州的常住人口，
c）(WHS/SAGE Wave 0 PSU at county)：为WHS/SAGE Wave 0选定县中的PSU数量；
前两个因素包括在内以减少地理分散。因素二赋予人口较多的州更大的选择机会。

所有WHS/SAGE Wave 0中50岁或以上的选定农村或城市PSU的个人以及90%的WHS/SAGE Wave 0中50岁或以上的大都市PSU的个人（已接受WHS/SAGE Wave 0采访）均纳入SAGE Wave 1的“初级”样本。然后，将大都市地区WHS/SAGE Wave 0中50岁或以上的剩余10%（即未能联系或不同意参加SAGE Wave 1的个人）分配为“替代”样本。从所有选定的PSU中选择1000名WHS/SAGE Wave 0的18-49岁个人作为“初级”样本，500名作为“替代”样本。

这种选择过程导致样本中来自大都市层的个人比例过高；因此，决定增加来自农村和城市层的50岁及以上个人的数量。这是通过包括那些没有成为WHS/SAGE Wave 0一部分的人（这成为“补充”样本）来实现的，尽管他们居住的家庭中有一个来自WHS/SAGE Wave 0的人。从农村和城市“18-49家庭”（即，其中有一个18-49岁的个人在WHS/SAGE Wave 0中）选择了所有50岁或以上的个人作为“初级补充”样本。然后，从已经作为50岁及以上或18-49岁样本的一部分被选中的城市和农村家庭中获取了50岁或以上的个人随机样本。这些个人然后成为“初级补充”样本的一部分，而剩余的人（即未系统选择的）被分配到“替代补充”样本。因此，所有居住在城市和农村PSU中的50岁及以上的人，无论是作为主要还是替代参与者，都被选中。最后，从包括已选择50岁及以上或18-49岁的人的家庭中获取了50岁及以上人群的“替代”样本。这种抽样策略还提供了那些没有包括在WHS/SAGE Wave 0中，但居住在有一个WHS/SAGE Wave 0个人（即“补充”样本）的家庭中的参与者，以及追踪WHS/SAGE Wave 0样本中包括的个人。

层：地域 = 3
PSU：AGEBs = 211
SSU：已调查的家庭 = 4,968
TSU：已调查的个人 = 5,449

数据收集方式
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面对面 [f2f]，CAPI
研究工具
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问卷基于WHS模型问卷进行了修改和大量补充。对所有符合研究条件的家庭进行了家庭问卷。对于过去24个月内家庭中有死亡情况的家庭，进行了口头尸检问卷。对从家庭名单中确定的合格受访者进行了个人问卷。对有认知限制的个人进行了代理问卷。问卷以英语编写，并于2005年作为SAGE预测试的一部分进行了试点。所有文件均翻译成西班牙语。所有SAGE通用问卷均作为外部资源提供。

数据清理操作
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数据编辑发生在多个阶段，包括：（1）办公室编辑和编码；（2）数据录入期间；（3）FoxPro文件的结构性检查；（4）Stata中的范围和一致性二级编辑。

响应率
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家庭：响应率=59%
个人：响应率=51%