Study on Global Ageing and Adult Health

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The Study on Global Ageing and Adult Health (SAGE) is run by the World Health Organization's Multi-Country Studies unit in the Information, Evidence and Research Cluster. SAGE is part of the unit's Longitudinal Study Programme which is attempting to compile comprehensive longitudinal data on the health and well-being of adult populations, and the ageing process across different countries, through primary data collection and secondary data analysis.

SAGE baseline data (Wave 0, 2002–04) was collected as part of WHO's World Health Survey (WHS). A second round of data collection (Wave 1, 2007–10) is completed, expanding the sample sizes in each participating country (China, Ghana, India, Mexico, Russian Federation and South Africa). Wave 2 (2013) data collection starts in the first half of 2014 in all six countries.

SAGE Wave 0[edit]

A baseline cohort for the six participating countries was created as part of the WHS and contains data on the situation of 65,964 adults aged 18 years and older, including over 20,000 persons aged 50 years and older. Samples of these respondents were followed-up as a part of SAGE Wave 1 (2007–10) data collection in four of the six SAGE countries (Ghana, India, Mexico and the Russian Federation). Meta- and micro-data are in the public domain through WHO at www.who.int/healthinfo/sage/en/.

Countries collaborating with SAGE

SAGE Wave 1[edit]

Weighted data for China, Ghana, India, Mexico, Russian Federation and South Africa are in the public domain (see Study on global AGEing and Adult Health). SAGE's first full round of data collection included both follow-up and new respondents in four 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. The target sample size was 5000 households with at least one person aged 50+ years and 1000 households with an 18 to 49 year old respondent. 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. The pooled data set will include over 43,000 respondents (see table below).

Modules in the SAGE Questionnaires
Household Questionnaire
  • 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 Verbal Autopsy

Individual Questionnaire
  • 1000 Socio-Demographic Characteristics
  • 1500 Work History and Benefits
  • 2000 Health State Descriptions and Vignettes
  • 2500 Anthropometrics, Performance Tests and Biomarkers
    • Including: blood pressure, pulse rate, hip & waist circumferences, height, weight, grip strength, timed walk, vision, lung function, cognition, finger prick blood sample
  • 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 & the Day Reconstruction Method) See also: Happiness
  • 8000 Impact of Caregiving
  • 9000 Interviewer Assessment

Proxy Questionnaire
  • 0 Proxy Consent Form
  • 1 IQ Code
  • 2 Health State Descriptions
  • 4 Chronic Conditions and Health Services Coverage
  • 5 Health Care Utilization

Data collected, Wave 1[edit]

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 question by question guide (Survey Manual) is available. 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.

Country World Bank

economic category (2007)

Sample Size
China Lower-Middle 14785
Ghana Low 5573
India Low 12198
Mexico Upper-Middle 2734
Russian Federation Upper-Middle 4947
South Africa Upper-Middle 4227

Descriptive results from SAGE Wave 1 are available through a US Census Bureau/WHO report Shades of Gray: A Cross-Country Study of Health and Well-Being of the Older Populations in SAGE Countries, 2007-2010.

Background information on SAGE is also available through: Kowal P, Chatterji S, Naidoo N, Biritwum R, Wu Fan, Lopez Ridaura R, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Peltzer K, Williams S, Snodgrass JJ, Minicuci N, D'Este C, Boerma JT and the SAGE Collaborators. Cohort profile: The WHO Study on global AGEing and adult health (SAGE). Int J Epidemiol. 2012;41(6):1639-49. doi:10.1093/ije/dys210

SAGE Wave 2[edit]

Data collection for Wave 2 will start in the first half of 2014 in all six SAGE countries.

Links to other studies[edit]

SAGE adapted methods and instruments used by the WHS and/or from 16 surveys on ageing (including the US Health and Retirement Survey (HRS) and the UK English Longitudinal Study of Ageing (ELSA) to collect household data on persons aged 50 years and older in over 20 countries, as well as fostering links to other data collection efforts such as the Study on Health, Ageing and Retirement in Europe (SHARE), the Chinese Health and Retirement Survey (CHARLs), the Longitudinal Ageing Study in India (LASI).

SAGE-like surveys have been conducted as the World Health Survey Plus (WHS+) in the Gulf Cooperation Council countries (plus Yemen), as a short version of SAGE in eight demographic surveillance fieldsites INDEPTH; as a full SAGE in three INDEPTH fieldsites; and, as COURAGE in Europe in three European countries.

SAGE-Indepth[edit]

Data for the summary SAGE module added to Indepth census rounds in 2007 and 2008 is available through WHO SAGE and Indepth. These data include the SAGE health state descriptions, WHO Disability Assessment Schedule version 2 (WHODAS-II) and the WHO Quality of Life (WHOQoL) 8-item version as measures of health and subjective well-being, linked to selected sociodemographic data from the demographic surveillance fieldsites in eight countries (Bangladesh, Ghana, India, Indonesia, Kenya, South Africa, Tanzania and Viet Nam). The sample size is over 46,000 respondents. First results are published as 'Growing Older in Africa and Asia: Multicentre study on ageing, health and well-being' in the peer-reviewed open-access journal, Global Health Action.

Country (DSS Fieldsite) World Bank

economic category

Sample Size
Bangladesh (Matlab) Low 4037
Ghana (Navrongo) Lower-Middle 4584
India (Vadu) Lower-Middle 5430
Indonesia (Purworejo) Lower-Middle 12395
Kenya (Nairobi) Low 2072
South Africa (Agincourt) Upper-Middle 4085
Tanzania (Ifakara) Low 5131
Viet Nam (Filabavi) Lower-Middle 8535

SAGE-WOPS (HIV study)[edit]

The SAGE Well-being of Older People Study (WOPS) is a sub-study conducted in two countries, South Africa and Uganda. The study was conducted to provide data on the effects of HIV/AIDS among older people infected or affected by HIV. The aim of this study was to describe the health status, well being and functional status among older people either infected with HIV themselves, or affected by HIV/AIDS in their families. The impacts of caregiving and ART were also examined. Wave 1 was completed in 2010/11 and Wave 2 was completed in 2013. Wave 3 is planned for 2015.

Scholten F, Mugisha J, Seeley J, Kinyanda E, Nakubukwa S, Kowal P, Naidoo N, Boerma T, Chatterji S, Grosskurth H. Health and functional status among older people with HIV/AIDS in Uganda. BMC Pub Health. 2011;11:886.

Nyirenda M, Chatterji S, Falkingham J, Mutevedzi P, Hosegood V, Evandrou M, Kowal P, Newell M-L. An investigation of factors associated with the health and wellbeing of HIV-infected and HIV-affected older people in rural South Africa. BMC Pub Health. 2012;12:259.

Direction[edit]

The WHO's Multi-Country Studies unit runs SAGE and is headed by Dr Somnath Chatterji. The unit is under the direction of Dr Ties Boerma in the Department of Health Statistics and Information Systems. Dr Chatterji is SAGE Principal Investigator, Dr Paul Kowal is co-Principal Investigator, Ms Nirmala Naidoo is the lead statistician, with regular contributions from other members of the WHO SAGE team. Country Primary Investigators (Wu Fan, Shanghai CDC, China; Richard Biritwum, University of Ghana, Ghana; Perianayagam Arokiasamy, IIPS, India; Ruy Lopez Ridaura, Mara Tellez Rojo, Aaron Salinas Rodriguez and Betty Soledad Manrique Espinoza, INSP, Mexico; Tamara Maximova, RAMS, Russian Federation; and, Refilwe Nancy Phaswana-Mafuya and Karl Peltzer, HSRC, South Africa) and survey teams lead the efforts in each of the participating SAGE countries, from data collection and dissemination, to analysis and manuscript preparation.

Funding[edit]

SAGE and SAGE sub-studies are supported by the Division of Behavioral and Social Research at the National Institute on Aging (NIA BSR), US National Institutes of Health, through Interagency Agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO and a Research Project Grant R01 AG034479. NIA BSR has facilitated forums for in-depth discussions about study content, design and implementation. The NIA BSR has been instrumental in promoting linkages between longitudinal studies on ageing and adult health around the world.

Governments in three countries, South Africa, China and Mexico, have also provided financial support for SAGE. USAID funding contributed to an oversample of adult women in SAGE India Wave 1.

The European Commission under Seventh Framework Programme has provided financial support to implement a SAGE-like health status, quality of life and well-being study in Europe under the name "collaborative research on ageing in Europe (COURAGE in Europe)". Finland, Poland and Spain implemented the survey in 2010.

External links[edit]