Losses to Follow-Up in a Nationally Representative Study of Community-Living Older Americans: Two Approaches to...

In the National Health and Aging Trends Study (NHATS), use of its Sensitive files leads to incomplete ascertainment of mortality, largely because of losses to follow-up. To account for these losses, we compared two censoring approaches for evaluating mortality.

In a hybrid approach, most participants were censored at the time of last contact, while the remainder were censored at the time of last completed interview. In the other approach, all participants were censored at the time of last completed interview (LCI). All-cause mortality was evaluated among 7608 and 7498 community-living members of the 2011 (over 10 years) and 2015 (over 5 years) cohorts based on the Sensitive files, with linked Medicare data serving as the reference standard.

Using the hybrid and LCI approaches, the median (IQR) follow-up times among nondecedents were 7.7 (5.9-8.7) and 8.8 (6.3-9.9) years shorter for the Sensitive files than Medicare data in the 2011 cohort. The corresponding values in the 2015 cohort were 2.9 (1.8-3.8) and 4.0 (2.2-4.9) years. For both cohorts, cumulative mortality based on the Sensitive files relative to the Medicare data was modestly lower for the hybrid approach but comparable for the LCI approach. The incidence rate ratios (95% CI) for the Sensitive files relative to the Medicare data in the 2011 and 2015 cohorts, respectively, were 0.89 (0.87, 0.91) and 0.89 (0.86, 0.93) for the hybrid approach and 0.98 (0.95, 1.00) and 0.97 (0.94, 1.00) for the LCI approach. However, the numbers of participants at risk for death overtime were considerably smaller for the latter than the former approach.

When evaluating mortality using the NHATS Sensitive files, investigators should consider censoring all participants who are lost to follow-up at the time of the last completed interview, recognizing potential trade-offs in terms of reductions in power and precision.