IJE Advance Access originally published online on January 12, 2007
International Journal of Epidemiology 2007 36(2):302-306; doi:10.1093/ije/dyl279
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Cohort Profile: The Florey Adelaide Male Ageing Study (FAMAS)
1 Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia 5005.
2 Division of Geriatric Medicine, Saint Louis University School of Medicine, MO 63104, USA.
3 Population Research and Outcome Studies Unit, Department of Health, Government of South Australia, SA, Australia 5000.
4 Department of Public Health, University of Adelaide, Adelaide, SA, Australia 5005.
The FAMAS (Florey Adelaide Male Ageing Study) Members include: Gary Wittert, Janet Hiller, Anne Taylor, Villis Marshall, Wayne Tilley, Peter O'Loughlin, Megan Warin, Matthew Haren.
* Corresponding author. Discipline of Medicine, School of Medicine, University of Adelaide, SA 5005, Australia. E-mail: gary.wittert{at}adelaide.edu.au
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How did the Florey Adelaide Male Ageing Study (FAMAS) come about? |
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Compared with women, Australian men have higher rates of physical and psychological disease and death.1,2 Generally, men are also less likely than women to adopt a healthier lifestyle.3 Coupled with the well-documented needs of an ageing population, there existed a need for a comprehensive examination into the health of ageing men in Australia, leading to a number of peak and government bodies to call for a comprehensive men's health longitudinal study.4–6
Following seed funding from a number of government and industry sources, an investigation into the health status and health-related behaviours of a representative group of men from the North West regions of Adelaide commenced in 2001 (the North West Adelaide Men's Health Study). The selected sampling area, covering approximately half of the city's population and over a third of the State's, broadly reflects the demographic profile of South Australia, whose population are amongst the most elderly in the nation.7 In late 2003, the Florey Foundation awarded the study team a 3-year grant with the study subsequently renamed as the Florey Adelaide Male Ageing Study (FAMAS).
In conjunction with our collaborative partners (namely The University of Adelaide, Central Northern Adelaide Health Service and the Institute of Medical & Veterinary Science), recruitment for a second phase of participants began in 2004. FAMAS also expanded its collaborative efforts with the commencement of a number of sub-studies with selected investigators in addition to annual follow-up questionnaires. Now entering its fifth year, FAMAS is planning to commence follow-up clinics in late 2007.
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What does FAMAS cover? |
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FAMAS is a multi-disciplinary population cohort study examining the health and health-related behaviours of 1195 randomly selected men, aged 35–80 years and living in the North West regions of Adelaide. It employs a broad range of investigative procedures in assessing the biomedical, socio-demographic, behavioural, physical and psychological interactions that contribute to the health and health-related behaviours of men. The principal aims of FAMAS are to investigate: (i) incidence of and risk factors associated with chronic physical and psychological disorders in a representative group of Australian men; (ii) endocrinology of the ageing male and its relationship with age, health status and male-specific conditions (e.g. prostate health, erectile function, lower urinary tract symptoms) and (iii) determinants of the utilization of health services amongst males. In addition, the project involves a number of cross-sectional sub-studies investigating specific age-related conditions. These include investigations into ocular health, cognitive function, obesity and nutrigenomics, motor function in ageing and osteoarthritis.
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How often have they been followed up? |
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Clinic visits are scheduled to occur at 5-year intervals. In the interim, participants are also asked to complete annual questionnaires documenting any changes to their contact and physician details as well including repeated measures on health, physical, social and demographic information. In addition to repeated measures, stable variables (e.g. birth weight) are regularly included in questionnaires to better characterize the cohort. A number of sub-studies have also commenced with researchers from various fields to further foster collaborative efforts and broaden scope (see subsequently).
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Who is in the FAMAS sample? |
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Participants in the study were required to be male, aged between 35 and 80 years at the time of recruitment, living in the defined catchment area of North and West Adelaide with a connected telephone and number listed in the Electronic White Pages (EWP), be willing and able to comply with the protocol and give written, informed consent. Exclusion criteria were limited to living outside the catchment area and telephone numbers that belonged to non-residential properties (i.e. businesses, institutions and residential-care facilities). Recruiters were also instructed to exclude responders if they were: (i) of insufficient mental or physical ability to understand the requirements of participation or adequately participate; (ii) ill or otherwise incapacitated to attend clinics; (iii) currently residing in an institution (e.g. aged care facility) and (iv) non-English speaking. In total, 1195 men were recruited for participation in the study. Table 1 summarizes the key indicators of the cohort.
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Participant's data were compared with the 2001 Australian Census in order to assess, where possible, the representativeness of the cohort with the local and national populations. Overall, FAMAS participants were comparable with men in the same age group from the North West Adelaide and Australian regions. The men in our cohort were found to be under-represented in the younger age group and over-represented in the elder bracket, a common finding in studies of this type.8,9 In addition, there was an under-representation of men who had never married, reflecting previous findings that men without live-in support systems tended not to participate in health studies.10 The FAMAS cohort displayed both a higher proportion of men with some form of post-school qualification (specifically, trade and tertiary qualifications) as well as men from the lowest income bracket, both previously demonstrated as predictors of study involvement.11,12
Attrition to date has been relatively low, with an annual loss to follow-up rate of only 1.1%. Whilst it is acknowledged that the second wave of clinics is yet to be commenced, we have nonetheless been able to maintain a good rate of contact with most of the cohort to date through a variety of measures such as birthday and Christmas cards, newsletters and the inclusion of follow-up questionnaires in addition to standard cohort retention strategies.13
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What has been measured? |
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Data collected by FAMAS is summarized in Table 2. All investigations were carried out according to strict protocols. Where possible, well-validated and standardized measurements were used. Clinic visits occurred in the morning following an overnight fast by participants at either one of two locations, depending on their residence. In addition to samples collected for immediate testing, an aliquot of whole blood was stored and DNA was extracted for later analysis. Following clinics, participants received copies of the results of investigations that would be considered part of routine care, with recommendations for referral as appropriate. On an annual basis, participants are asked to complete follow-up questionnaires to track changes in their health status, behavioural and socio-demographic circumstances. Contact details (including personal, secondary and physician details) were also updated.
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In addition to the primary research aims of FAMAS, a number of sub-studies have commenced in collaboration with researchers from various fields (Table 2). Projects were required to be broadly related to the aims of FAMAS and to avoid excessive contact.
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What has it found? Key findings and publications |
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Baseline data collection commenced in August 2002 with the final baseline clinic held in April 2005, bringing the total number of participants to 1195. To date, analyses have centred on the initial cross-sectional data.
Preliminary investigations on the health status of the cohort present an alarming picture, reflective of the generally poor health of men. There was a very high prevalence of obesity. Using Body Mass Index (BMI) as a measure, 19.9% were of normal body weight (20–24.9 kg/m2), 47.3% were overweight (25–29.9 kg/m2) and 31.5% (
30 kg/m2) were obese. The mean BMI for the entire cohort was 28.5 ± 4.5 kg/m2. Physical activity levels were also of concern. Overall, most participants (61%) did not get sufficient physical activity according to the guidelines of the national Physical Activity Survey;14 44% were sedentary and obtained no physical activity each week, 17% did <150 min of activity each week, and only 39% obtained at least 150 min/week.
There was a significant burden of chronic disease and a high prevalence of cardiovascular risk factors within the cohort. Over one-third of men in the study reported having been diagnosed by a physician with hypercholesterolemia, a further 14.2% had total cholesterol levels above the recommended level of 5.5 mmol/l as detected at baseline clinics. Similarly, 9.5% of men self-reported having diabetes, with both fasting blood glucose (at 7.2 mmol/l) and/or glycated haemoglobin (6.2%) results taken at clinic indicating a further 4.4% also had the condition. There was also a high incidence of elevated blood pressure with 30.2% of men having been diagnosed with hypertension. Furthermore, 29.3% of those men who reported no previous history of hypertension had a mean blood pressure 140 (systolic) and/or 90 (diastolic) mmHg when measured at clinic.
Psychological disorders were also common, with one out of every three men examined reported having being diagnosed with depression (12.5%), anxiety (9.3%) or insomnia (11%). Based on participant's responses to the Beck Depression Inventory (BDI), a further 6.2% met the criteria for clinical depression in a general population setting.15
The sexual health and function of participants was another area of focus. Of those men surveyed, 57.2% reported at least some degree of erectile dysfunction as assessed by the International Index of Erectile Function (IIEF).16 Despite this, <10% of men expressed no interest in sex with a partner.
Future research from FAMAS will focus on the variety of characteristics that contribute to the health and health-related behaviours of men. These will include investigations into the biomedical, socio-demographic and behavioural predictors of the outcome measures of data collected so far. In addition to existing sub-studies, collaborative efforts focusing on associated aspects of the ageing male (e.g. sleep, stress, fertility) will continue. Clinical visits are scheduled to recommence in late 2007.
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What are the main strengths and weaknesses? |
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Our cohort is exclusively male. Whilst it could be argued that such a focus may limit the applicability of findings to the broader population, we would posit that the dearth of male ageing studies in this country warrants such an approach. In addition, this is one of the few ageing studies to incorporate younger participants in the cohort design. The urban-specific focus of the study may also limit the broader applicability of study results, however incorporating rural participants into the study design was not practical at the time, given the enormous logistical and financial costs involved (not to mention the associated impacts on response rates, participant compliance etc.). Moreover, the North West region of Adelaide appears an ideal community in which to investigate the ageing process, with a population that is largely reflective of the state with the highest proportion of elderly in Australia.
An a priori target of around 1200 participants was selected before recruitment ensuring sufficient power for the main outcome variables. Even relatively minor correlations between outcomes could be reliably detected. Whilst this cohort size may be smaller in comparison to other longitudinal studies of ageing we would argue that the single gender and high stability of the cohort observed to date (in part, due to the conscious efforts to minimize losses to follow-up) will ensure an adequate number of active, participating subjects for the duration of the study.
The study involves researchers from a variety of disciplines (including Epidemiology, Medicine, Molecular and Biomedical, Neuromotor, Ophthalmology, Orthopaedics, Public Health, Politics, Psychology, Statistics and Surgical) across a number of institutions. This broad investigative scope has allowed the cohort to be well characterized, collecting an extensive array of factors (biomedical, physical, lifestyle, behavioural, socio-demographic) that contribute to the health and health status of participants. Samples from participants (serum, DNA, urine) have also been stored for future analysis. In addition, the study design includes data linkage with Australia's largest medical database, allowing a tracking of participant's usage of health care and pharmaceutical services.
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Can I get hold of the data? Where can I find out more? |
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All collected source data are maintained and stored at the FAMAS Office. All linked data is stored electronically and managed externally by The University of Adelaide's Data Management and Analysis Centre (DMAC). Plans are currently being drafted for the establishment of a FAMAS website. Initial approaches or enquiries regarding the study can be made to either the Chief Investigator (gary.wittert{at}adelaide.edu.au) or the Project Coordinator (sean.martin{at}adelaide.edu.au). All applications for access to data and collaboration are also considered by the FAMAS Executive and Investigator Committee. Collaborators are then required to complete and submit the FAMAS Access and Publication guidelines.
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References |
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1 Fletcher R. Testosterone Poisoning or Terminal Neglect? The Men's Health Issue. In: Parliamentary Research Service (Research Paper No. 22) (1995) Canberra: Commonwealth of Australia.
2 Australian Institute of Health and Welfare. Australia's health 2004. (2004) Canberra: AIHW. (AIHW Catalogue No. AUS 44.)
3 Jacomb P, Jorm A, Korten A, Rodgers B, Henderson S, Christensen H. GP attendance by elderly Australians: evidence for unmet need in elderly men. Med J Aust (1997) 166:123–26.[ISI][Medline]
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6 Mathers C. Health differentials between Australian males and females: A statistical profile. National Men's Health Conference, 10–11 August 1995: Melbourne.
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8 Eastwood BJ, Gregor RD, MacLean DR, Wolf HK. Effects of recruitment strategy on response rates and risk factor profile in two cardiovascular surveys. Int J Epidemiol (1996) 25:763–69.
9 Rosengren A, Wilhelmsen L, Berglund G, Elmfeldt D. Non-participants in a general population study of men, with special reference to social and alcoholic problems. Acta Med Scand (1987) 21:243–51.
10 Engstrom G, Hedblad B, Nilsson P, Wollmer P, Berglund G, Janzon L. Lung function, insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study. J Intern Med (2003) 253:574–81.[CrossRef][ISI][Medline]
11 Brambilla DJ, McKinlay SM. A comparison of responses to mailed questionnaires and telephone interviews in a mixed mode health survey. Am J Epidemiol (1987) 126:962–71.
12 Brown WJ, Bryson L, Byles JE, et al. Women's Health Australia: recruitment for a national longitudinal cohort study. Women Health (1998) 28:23–40.[CrossRef][ISI][Medline]
13 Dillman DA. Mail and Telephone Surveys: the total design method (1978) New York: Wiley-Interscience (Wiley & Sons),
14 Armstrong T, Bauman A, Davies J. Physical activity patterns of Australian adults. In: Results of the 1999 Physical Activity Survey (2000) Canberra: Australian Institute of Health and Welfare.
15 Lasa L, Ayuso-Mateos JL, Vázquez-Barquero JL, Díez-Manrique FJ, Dowrick CF. The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis. J Affect Disord (2000) 57:261–65.[CrossRef][ISI][Medline]
16 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology (1997) 49:822–30.[CrossRef][ISI][Medline]
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