Biosocial Surveys (2008) / Chapter Skim
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3 The Taiwan Biomarker Project--Ming-Cheng Chang, Dana A. Glei, Noreen Goldman, and Maxine Weinstein
3 The Taiwan Biomarker Project--Ming-Cheng Chang, Dana A. Glei, Noreen Goldman, and Maxine Weinstein
Pages 60-77
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From page 60... ...
The Taiwan biomarker project -- SEBAS (Social Environment and Biomarkers of Aging Study) for short -- owes its success to dedicated teams in both Taiwan and the United States.
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From page 61... ...
reciprocal relationships linking the social environment with stressful experience and with health outcomes, and in elaborating the physiological responses that lie between those links and between stressful experience and health outcomes. There are huge -- and growing -- literatures linking the social environment with exposure to challenge, linking the social environment with health outcomes, and some linking exposure to challenge with health outcomes.
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From page 62... ...
. Still, the pre-2000 surveys provided data that allowed us to take a longitudinal look at the effects of the social environment on the physiological markers and the effects of the social environment on health.
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The night before the hospital appointment, a BHP staff member together with a public health nurse delivered a urine collection container (for an overnight 12-hour urine specimen) to the respondent's home, explained the proper procedures, provided written instructions for urine collection, and answered questions.
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using a mercury sphygmomanometer on the right arm were taken at least 20 minutes after the participant arrived at the hospital. A physician performed a medical examination that included a third blood pressure reading, an abdominal ultrasound, and health counseling.
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, IGF-1, and IL-6 from the blood specimens. We used the 12-hour urine specimens for assays of cortisol, epinephrine, norepinephrine, dopamine, and creatinine.
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; however, for the second round, we have made a provision for an advisory board to review such requests. Moving forward to the second round of biomarker collection we have realized that one issue that we did not anticipate adequately is change in assay techniques.
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The most recent round of household interviews, carried out by BHP as part of the Study of Health and Living Status, was done in 2003, based on a questionnaire similar to those in earlier waves of the survey. The response rate of 92 percent is consistent with rates from previous waves of the survey, suggesting that previous participation in the biomarker study did not affect participation rates in the main longitudinal study. Our pretest for the second round of biomarker collection was conducted in September-October 2005.
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data. The problem arises because the biomarker study does not have any contractual arrangements with these researchers regarding release or dissemination of the longitudinal data.
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These results place an increased burden of proof on researchers who argue that psychosocial stress is an important link in the pathway linking low SES to poor health. In an effort to gain new insights into social disparities in health, the Taiwan survey incorporated a recently developed instrument of subjective social position.
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We are still struggling with a generally unwieldy set of analyses exploring associations between stressful experiences (such as the death of family members, relocation, and financial difficulties) and physiological dysregulation, as well as the potential moderating role of "vulnerability," defined in terms of social position, social networks, and coping mechanisms.
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From page 71... ...
These biomarkers include both clinical markers -- the cardiovascular and metabolic system measures customarily collected during physical examinations, which have well-defined clinical thresholds for normal function -- and nonclinical markers -- measures of neuroendocrine and immune dysfunction. The findings of this and an earlier analysis suggest that individuals may underestimate their probability of dying because they have no information about risk factors that act silently on the body and are not detected by clinical exams (Goldman, Glei, and Chang, 2004a)
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; one caveat is that the two studies used different types of dysregulation scores to capture extreme values of these nonclinical markers (grade-of-membership analysis versus more conventional cumulative dysregulation scores)
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Dried blood spots are now being used successfully in a number of studies; it is a technique that allows collection in the home, and while we would have been unable to perform all the assays we wanted, our understanding is that additional assays based on blood spots are being developed. We are currently exploring the possibility of using tandem mass spectrometry on our stored serum specimens to identify peptides associated with the stress response; plasma would be an alternative compartment.
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From page 74... ...
We know, too, that many of our biomarkers are affected by medication use; we have some of the relevant information that would allow us to disentangle these effects, but it is a complicated undertaking, made more complex by the difficulties in obtaining complete lists of medications, documenting the extensive array of traditional Chinese medicines, and identifying the effects of both traditional and Western medicines on the biomarkers. We remain concerned about the best way to measure physiological dysregulation; current scores -- our own and those of other researchers -- continue to have problems in terms of choice of cut points in the absence of clinical information, as well as potential biological interactions among these biomarkers.
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She generously provided the MacArthur protocols for blood and urine collection; these protocols served as the basis for the ones we used in Taiwan. Our technical decisions have also benefited from the accumulated wisdom of Chris Coe and Paul Aisen, who provided guidance on assays.
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. Results from the social environment and biomarkers of aging study (SEBAS)
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From page 77... ...
. Measurement of cumulative physiological dysregulation in an older population.
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