Taiwan - Biodemography of Health, Social Factors, and Life Challenge
SEBAS - (Social Environment and Biomarkers of Aging Study)


Demographic processes, the social environment, and life challenge are intimately interlocked with functional status and illness. The social environment, encompassing position in social hierarchies as well as linkages within social networks and support systems, interacts with exposure to challenge to influence physical and mental wellbeing.

The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan was initially developed to explore how understanding the relationships among life challenge, the social environment, and health can be enhanced by incorporating biological markers of health and stress. Specific aims of the initial study included:
  1. Investigating the extent to which biological markers of stress and chronic illness are related to reports of life events;
  2. Examining the extent to which biological markers help to explain variation in health across social hierarchies and networks; and
  3. Exploring the associations among the biological markers, data from physicians' examinations, and self-reported health status, and their links to survival.
With the addition of longitudinal data, the goals of the project have expanded to understanding the antecedents, correlates, and consequences of levels and changes in biological measures, health and survival. (Cornman et al., 2014, click here to view the Cohort Profile in the International Journal of Epidemiology).

SEBAS comprises a nationally representative longitudinal survey of Taiwanese adults age 54 and over.

It adds the collection of biomarkers and performance assessments to the Taiwan Longitudinal Study of Aging (TLSA), a nationally representative study of adults age 60 and over, including the institutionalized population. The TLSA began in 1989 with follow-ups approximately every three years; younger refresher cohorts were added in 1996 and 2003. The first wave of SEBAS, based on a sub-sample of respondents from the 1999 TLSA, was conducted in 2000. A total of 1023 respondents completed both a face-to-face home interview and, several weeks later, a hospital-based physical exam. In addition to a 12-hour (7pm-7am) urine specimen collected the night before the exam and a fasting blood specimen during the exam, trained staff measured blood pressure, height, weight, waist, and hip circumference. A second wave of SEBAS was conducted in 2006 using a similar protocol to SEBAS 2000, but with the addition of performance assessments conducted by the interviewers at the end of the home interview. (Cornman et al., 2014)

The interlocking architecture of the TLSA and SEBAS surveys is shown in Figure 1. "Both waves of SEBAS also included measures of health status (physical, emotional, cognitive), health behaviors, social relationships, and exposure to stressors. The SEBAS data, which are publicly available from the ICPSR, allow researchers to explore the relationships among life challenge, the social environment, and health and to examine the antecedents, correlates, and consequences of change in biological measures and health (Cornman et al., 2014)."

First Wave (SEBAS 2000)

The first wave of SEBAS, based on a sub-sample of respondents from the 1999 TLSA, was conducted in 2000" and represented a national sample of Taiwanese adults aged 54 and older. Like TLSA, it included an in-home interview, but was supplemented by collection of biomarkers. "A total of 1023 respondents completed both a face-to-face home interview and, several weeks later, a hospital-based physical exam. (Cornman et al., 2014)

Second Wave (SEBAS 2006)

A second wave of SEBAS was conducted in 2006 using a similar protocol to SEBAS 2000, but with the addition of performance assessments conducted by the interviewers at the end of the home interview...The targeted sample included the 1023 respondents who had completed both the home interview and the health exam in 2000 as well as a refresher cohort of 660 respondents aged 53-60 in 2006 who were first interviewed in the 2003 TLSA. Thus, the 2006 SEBAS comprised a representative cross-section of the Taiwanese population aged 53 and older. The 2006 in-home interview was completed by 1284 respondents, 1036 of whom also participated in the physical exam. (Cornman et al., 2014)


Table 1 lists selected measures collected in TLSA and SEBAS. "Both waves of SEBAS included measures of health status (physical, emotional, cognitive), health behaviors, social relationships, and exposure to stressors" (Cornman et al., 2014) based on the in-home interview. Data from the hospital visit include anthropometry, blood pressure, and laboratory assays of fasting blood and 12 hr overnight urine specimens. "Comparisons of the laboratory assay results for duplicate specimens sent to the lab in Taiwan (Union Clinical Laboratory) indicate high intra-lab correlations (>= 0.9) for most markers tested, with a few notable exceptions (e.g., IGF-1, sICAM-1). Based on comparisons with results from a lab in the U.S. (Quest Diagnostics), inter-lab correlations were also generally high (>= 0.9). For details, see Table 2.2 in the "SEBAS User Guide." (Cornman et al., 2014) The DNA specimens have already been assayed for APOE, 5-HTTLPR, and telomere length. An additional 164 targeted genes and single nucleotide polymorphisms (SNPs) are currently being processed. See Table 2 for a full list.


Perhaps the most notable strength of the data is the detail and breadth of the available indicators related to health, the social environment, and life challenges. First, the data contain an unusually large array of biological markers, including several genetic markers. Current work includes assays for additional genes and SNPs; the public use data file will be updated for these markers when the work is complete. Second, self-reported measures cover multiple dimensions of health status (physical, emotional, and cognitive); several health-related behaviors; and use of biomedical and traditional health-care facilities and providers. Third, interviewer-administered health assessments offer yet another method for evaluating the respondent’s health. Fourth, the data include high quality information for determining survival status. Finally, SEBAS includes indicators of both objective and subjective socioeconomic status, social relationships, and exposure to stressors ranging from daily hassles to trauma. Other strengths include a relatively large, nationally-representative sample; an age range that includes persons as young as 53; high participation rates; and longitudinal follow-up with low loss to follow-up. Nonetheless, the data also have limitations. As with any study of an older population, those who died at relatively early ages are not represented; yet, the proportion of the Taiwanese population dying before age 53 is small: 7.5% in 2006 (HMD, accessed April 2, 2014). (Cornman et al., 2014)

How to Obtain Access to the Data

A public use dataset and full documentation for the biomarker study are available from the ICPSR (persistent URL: doi.org/10.3886/ICPSR03792.v7). "The dataset includes information from the: a) 2000 SEBAS for the N = 1023 respondents who completed the home interview and the physical exam; and b) 2006 SEBAS for the N = 1284 respondents who completed the home interview (including clinical data for those who also participated in the exam: N = 1036). Users interested in obtaining and using these data must complete a Data Use Agreement form available by contacting ICPSR User Support (734-647-2200) or by downloading the form at the website noted above. Upon receipt of the data use agreement and supporting documents, a copy of the data will be sent to the primary user." (Cornman et al., 2014)


The Social Environment and Biomarkers of Aging Study (SEBAS) presented June 20, 2016. Access the webinar here: https://www.youtube.com/watch?v=vCDmbMNEVuc&feature=youtu.be


Cornman, J.C., D.A. Glei, N. Goldman, M-C. Chang, H-S. Lin, Y-L. Chuang, B-S. Hurng, Y-H. Lin, S-H. Lin, I-W. Liu, H-Y. Liu, M. Weinstein. (2014). Cohort Profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan. International Journal of Epidemiology.



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  67. Glei, Dana A., Noreen Goldman, Germán Rodríguez and Maxine Weinstein. 2014. Beyond Self Reports: Changes in Biomarkers as Predictors of Mortality. Population and Development Review 40(2):331-360. DOI: 10.1111/j.1728-4457.2014.00676.x. [Supplementary Material] PMCID: PMC4117355
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  69. Hwang, A.-C., Peng, L.-N., Wen, Y.-W., Tsai, Y.-W., Chang, L.-C., Chiou, S.-T., Chen, L.-K. 2014. Predicting all-cause and cause-specific mortality by static and dynamic measurements of allostatic load: A 10-year population-based cohort study in Taiwan. Journal of the American Medical Directors Association 15( 7):490-496. DOI: 10.1016/j.jamda.2014.02.001. PMID: 24631353.
  70. Lee, Chioun, Germán Rodríguez, Dana A. Glei, Maxine Weinstein, and Noreen Goldman. 2014. Increases in Blood Glucose in Older Adults: The Effects of Spousal Health. Journal of Aging and Health 26(6):952-968. DOI: 10.1177/0898264314534894. PMCID: PMC404267.
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  83. Glei, Dana A., Noreen Goldman and Maxine Weinstein. Forthcoming. Health as Reflected by Biomarkers in Older Populations. Chapter in: Demographic Studies on Survival and Health. Springer-Max Planck Series. Heidelberg: Springer Dordrecht.
  84. Blue, L. Submitted. Body weight, weight change, and mortality risk.
  85. Culverhouse, Robert, Nancy L. Saccone, Amy C. Horton, Yinjiao Ma, Kaarin J. Anstey, Tobias Banaschewski, Margit Burmeister, Bruno Etain, Helen Fisher, Noreen Goldman, Sébastien Guillaume, John Horwood, Gabriella Juhasz, Kathryn Lester, Laura Mandelli, Christel M. Middeldorp, Emilie Olié, Sandra Villafuerte, Tracy M. Air, Ricardo Araya, Lucy Bowes, Richard Burns, Enda M. Byrne, Carolyn Coffey, Sarah Cohen-Woods, William L. Coventry, Katerina Gawronski, Dana Glei, Alex Hatzimanolis, Jouke-Jan Hottenga, Isabelle Jaussent, Catharine Jawahar, Christine Jennen-Steinmetz, John R. Kramer, Mohamed Lajnef, Kerri Little, Henriette Meyer zu Schwabedissen, Matthias Nauck, Esther Nederhof, Peter Petschner, Wouter J. Peyrot, Christian Schwahn, Grant Sinnamon, David Stacey, Yan Tian, Catherine Toben, Sandra Van der Auwera, Nick Wainwright, Jen-Chyong Wang, Gonneke Willemsen, Ian M. Anderson, Volker Arolt, Cecilia Åslund, Gyorgy Bagdy, Bernhard T. Baune, Frank Bellivier, Dorret I. Boomsma, Philippe Courtet, Udo Dannlowski, Eco J.C. de Geus, John F. W. Deakin, Simon Easteal, Thalia Eley, David M. Fergusson, Alison M. Goate, Xenia Gonda, Hans J. Grabe, Claudia Holzman, Eric O. Johnson, Martin Kennedy, Manfred Laucht, Nick G. Martin, Grant W. Montgomery, Marcus Munafò, Kent W. Nilsson, Albertine J. Oldehinkel, Craig Olsson, Johan Ormel, Christian Otte, George Patton, Brenda W.J.H. Penninx, Karen Ritchie, Marco Sarchiapone, JM Scheid, Alessandro Serretti, Johannes H. Smit, Nicholas C. Stefanis, Paul G. Surtees, Henry Völzke, Maxine Weinstein, Mary Whooley, Naomi R. Wray, John Nurnberger, Jr, Naomi Breslau, Laura J. Bierut. Submitted. Collaborative Meta-analysis Finds No Evidence of a Strong Interaction Between Stress and 5-HTTLPR Genotype Contributing to the Development of Depression.
  86. Vasunilashorn, Sarinnapha. Submitted. Socioeconomic Status and Subjective Social Status are Associated with Physical and Pulmonary Function in Older Taiwanese Adults.


(Taiwan Longitudinal Study of Aging)

  1. Beckett, Megan, Maxine Weinstein, Noreen Goldman and Yu-Hsuan Lin. 2000. Do Health Interview Surveys Yield Reliable Data on Chronic Illness Among Older Respondents? American Journal of Epidemiology 151:315-323.
  2. Beckett, M., N. Goldman, M. Weinstein, I-F. Lin, and Y.-L. Chuang. 2002. Social Environment, Life Challenge, and Health Among the Elderly in Taiwan. Social Science and Medicine 55:191-209.
  3. Cornman, J. C., N. Goldman, M. Weinstein, D. Glei, and M.C. Chang. 2003. Social Ties and Perceived Support: Two Dimensions of Social Relationships and Health Among the Elderly in Taiwan. Journal of Aging and Health 15:616-644.
  4. Lin, I-F., N. Goldman, M. Weinstein, Y.-H. Lin, T. Gorrindo, and T. Seeman. 2003. Gender Differences in Adult Children’s Provision of Support to their Elderly Parents in Taiwan. Journal of Marriage and the Family 65(1):184-200.
  5. Cornman, J.C., S.M. Lynch, N. Goldman, M. Weinstein, and H.-S. Lin. 2004. Stability and Change in the Perceived Support of Older Taiwanese Adults. Journal of Gerontology: Social Sciences 59:S350-S357.
  6. Weinstein, M., D. Glei, A. Yamazaki, and M.-C. Chang. 2004. The Role of Intergenerational Relations in the Association between Life Stressors and Psychological Distress Among the Taiwanese Elderly. Research on Aging 26:511-530.
  7. Glei, D., D.A. Landau, N. Goldman, Y.-L. Chuang, G. Rodriguez, and M. Weinstein. 2005. Participating in Social Activities Helps Preserve Cognitive Function: An Analysis of a Longitudinal, Population-Based Study of the Elderly. International Journal of Epidemiology 34: 864-871.
  8. Tractenberg, R., P. Aisen, and Y.-L. Chuang. 2005. One-trial 10-item Free-recall Performance in Taiwanese Elderly and Near-elderly: A Potential Screen for Cognitive Decline. American Journal of Alzheimer’s Disease and Other Dementias 20:216-224.
  9. Tractenberg, R., M. Weinstein, M. Weiner, P. Aisen, J.-L. Fuh, N. Goldman and Y.-L. Chuang. 2005. Benchmarking a Test of Temporal Orientation with Data from American and Taiwanese Persons with Alzheimer’s Disease and American Normal Elderly. Neuroepidemiology 24:110-116.
  10. Lin, I-F., N. Goldman, M. Weinstein, Y.-H. Lin. 2006. Stability and Change in Patterns of Intergenerational Transfers in Taiwan. pp.63-87 in A.H. Gauthier, C.Y. Chu, and S. Tuljapurkar (eds.) Allocating Public and Private Resources across Generations: Riding the Age Waves – Volume 2. International Studies in Population, Vol 3. The Netherlands: Springer.
  11. Tractenberg, R., M. Weiner, and Y.-L. Chuang. 2007. CES-D Symptoms and DSM Criteria: A Method for Classifying Levels of Self-reported Depressive Symptoms in the Elderly. Journal of Chinese Clinical Medicine 2(1):1-10.
  12. Tsai, Alan Chung-Hong, Jenn-Chang Liou, Ming-Cheng Chang. 2007. Interview to study the determinants of hypertension in older adults in Taiwan: a population based cross-sectional survey. Asia Pacific Journal of Clinical Nutrition 16(2):338-345.
  13. Collins, A.L., N. Goldman, G. Rodríguez. 2008. Is Positive Well-Being Protective of Mobility Limitations Among Older Adults? Journals of Gerontology: Series B:Psychological Sciences and Social Sciences 63B:P321-P327. PMID: 19092034. PMCID: PMC3610529
  14. Chiao C, Weng LJ, Botticello A. 2009. Do older adults become more depressed with age in Taiwan? The role of social position and birth cohort. J Epidemiol Community Health. 63(8):625-32. DOI: 10.1136/jech.2008.082230. Epub 2009 Apr 12. PubMed PMID: 19364761.
  15. Collins, A.L., D. Glei and N. Goldman. 2009. The Role of Life Satisfaction and Depressive Symptoms in All-Cause Mortality. Psychology and Aging 24:696-702. PMCID: PMC2759085
  16. Liang, J., C.-N. Wang, X. Xu, H.-C. Hsu, H.-S., Y.-H. Lin. 2010. Trajectory of Functional Status Among Older Taiwanese: Gender and Age Variations. Social Science and Medicine 71:1208-1217. DOI: 10.1016/j.socsimed.2010.05.007
  17. Chiao, Chi, Li-Jen Weng, and Amanda L. Botticello. 2011. Social participation reduces depressive symptoms among older adults: an 18-year longitudinal analysis in Taiwan. BMC Public Health 11(1):292.
  18. Kuo SY, Lin KM, Chen CY, Chuang YL, Chen WJ. 2011. Depression trajectories and obesity among the elderly in Taiwan. Psychol Med. 41(8):1665-76. DOI: 10.1017/S0033291710002473. Epub 2011 Jan 5. PubMed PMID: 21208492.
  19. Chang, Hung-Hao, and Steven T. Yen. 2012. Association between obesity and depression: evidence from a longitudinal sample of the elderly in Taiwan. Aging & Mental Health 16(2):173-180.
  20. Chiao, Chi, Li-Jen Weng, and Amanda L. Botticello. 2012. Economic strain and well-being in late life: findings from an 18-year population-based longitudinal study of older Taiwanese adults. Journal of Public Health 34(2):217-227.
  21. Pham-Kanter, G., N. Goldman. 2012. Do Sons Reduce Parental Mortality? Journal of Epidemiology and Community Health 66(8):710-715. DOI:10.1136/jech.2010.123323. PMID: 21551178. PMCID: PMC3635093
  22. Zimmer, Zachary, Fen-Fang Chen. 2012. Social support and change in depression among older adults in Taiwan. Journal of Applied Gerontology 31(6):764-782. DOI: 10.1177/0733464811401353.
  23. Chang, Ken-Fu, and Li-Jen Weng. 2013. Screening for depressive symptoms among older adults in Taiwan: Cutoff of a short form of the Center for Epidemiologic Studies Depression Scale. Health 5:588.
  24. Glei, D.A., N. Goldman, I.-W. Liu, and M. Weinstein. 2013. Sex Differences in Trajectories of Depressive Symptoms Among Older Taiwanese: The Contribution of Stressors and Social Factors. Aging & Mental Health 17:773-783. PMCID: PMC4074914
  25. Ku LJ, Liu LF, Wen MJ. 2013. Trends and determinants of informal and formal caregiving in the community for disabled elderly people in Taiwan. Arch Gerontol Geriatr. 56(2):370-6. DOI: 10.1016/j.archger.2012.11.005. Epub 2012 Dec 3. PubMed PMID: 23218520.
  26. Lêng CH, Wang JD. 2013. Long term determinants of functional decline of mobility: an 11-year follow-up of 5464 adults of late middle aged and elderly. Arch Gerontol Geriatr. 57(2):215-20. DOI: 10.1016/j.archger.2013.03.013. Epub 2013 Apr 19. PubMed PMID: 23608344.
  27. Li YP, Chen YM, Chen CH. 2013. Volunteer transitions and physical and psychological health among older adults in Taiwan. J Gerontol B Psychol Sci Soc Sci. 68(6):997-1008.
  28. Tsai HJ. 2013. Nutrition risk, functional dependence, and co-morbidities affect depressive symptoms in Taiwanese aged 53 years and over: a population-based longitudinal study. J Psychosom Res. 75(2):173-7. DOI: 10.1016/j.jpsychores.2013.04.009. Epub 2013 May 26. PubMed PMID: 23915775.
  29. Tsai AC, Chi SH, Wang JY. 2013. Cross-sectional and longitudinal associations of lifestyle factors with depressive symptoms in = 53-year old Taiwanese – results of an 8-year cohort study. Prev Med. 57(2):92-7. DOI: 10.1016/j.ypmed.2013.04.021. Epub 2013 May 4. PubMed PMID: 23651861.
  30. Tsai AC, Chi SH, Wang JY. 2013. The association of perceived stress with depressive symptoms in older Taiwanese-Result of a longitudinal national cohort study. Prev Med. DOI:10.1016/j.ypmed.2013.08.019.[Epub ahead of print] PMID: 23988493.
  31. Vasunilashorn, S., D.A. Glei, M. Weinstein, N. Goldman. 2013. Perceived Stress and Mortality in a Taiwanese Older Adult Population. Stress, 16:600-606. DOI:10.3109/10253890.2013.823943. PMID: 23869432
  32. Wang JY, Tsai AC. 2013. The short-form mini-nutritional assessment is as effective as the full-mini nutritional assessment in predicting follow-up 4-year mortality in elderly Taiwanese. J Nutr Health Aging. 17(7):594-8. DOI:10.1007/s12603-013-0048-1. PubMed PMID: 23933869.
  33. Lee, Chioun, Dana A. Glei, Maxine Weinstein and Noreen Goldman. 2014. Death of a Child and Parental Wellbeing in Old Age: Evidence from Taiwan. Social Science and Medicine, 101:166-173. DOI: 10.1016/j.socscimed.2013.08.007. PMCID: PMC4042671.
  34. Tsai, Alan C., Wei-Chung Hsu, and Jiun-Yi Wang. 2014. The Mini Nutritional Assessment (MNA) predicts care need in older Taiwanese: results of a national cohort study. British Journal of Nutrition: 1-8.
  35. Zimmer, Z, L.G. Martin, B.L. Jones, D.S. Nagin. 2014. Examining late-life functional limitation trajectories and their associations with underlying onset, recovery, and mortality. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 69(2):275-286. DOI: 10.1093/geronb/gbt099.
  36. Hsu, Yu-Ching, Ching-Ju Chiu, Linda A. Wray, Elizabeth A. Beverly and Shuo-Ping Tseng. 2015. Impact of Traditional Chinese Medicine on Age Trajectories of Health: Evidence from the Taiwan Longitudinal Study on Aging. Journal of the American Geriatrics Society, 63:351-357. PMID: 25688607. DOI: 10.1111/jgs.13247.
  37. Lee, Miaw-Chwen, Huang, Nicole. 2015. Changes in Self-perceived Economic Satisfaction and Mortality at Old Ages: Evidence from a Survey of Middle-aged and Elderly Adults in Taiwan. Social Science and Medicine 130:1-8. DOI: 10.1016/j.socscimed.2015.01.047.
  38. Tsai, Alan C. and Shu-Hui Lee. 2015. Determinants of New-onset Diabetes in Older Adults-Results of a National Cohort Study. Clinical Nutrition, 34:937-942. PMID: 25453397.
  39. Vasunilashorn, S., Scott M. Lynch, Dana A. Glei, Maxine Weinstein, and Noreen Goldman. 2015. Exposure to Stressors and Trajectories of Perceived Stress and Exposure to Stressors Among Older Adults. Journal of Gerontology: Social Sciences 70(2):329-337. DOI: 10.1093/geronb/gbu065. PMCID: PMC4415078
  40. Yang, Ya-Ting, Usman Iqbal, Hua-Lin Ko, Chia-Rong Wu, Hsien-Tsai Chiu, Yi-Chieh Lin, Wender Lin, Yi-Hsin Elsa Hsu Usman Iqbal, Hua-Lin Ko, Chia-Rong Wu, Hsien-Tsai Chiu, Yi-Chieh Lin, Wender Lin, and Yi-Hsin Elsa Hsu. 2015. The Relationship Between Accessibility of Healthcare Facilities and Medical Care Utilization Among the Middle-aged and Elderly Population in Taiwan, International Journal for Quality in Health Care, 27(3):222-231. PMID: 25921336. DOI: http://dx.doi.org/10.1093/intqhc/mzv024.
  41. Yu, Hsiao-Wei, Duan-Rung Chen, Tung-Liang Chiang, Yu-Kang Tu, Ya-Mei Chen. 2015. Disability trajectories and associated disablement process factors among older adults in Taiwan. Archives of Gerontology and Geriatrics 60:272-280. PMID: 25547993
  42. Lee, Chioun, Dana A. Glei, Noreen Goldman, and Maxine Weinstein. Forthcoming. Children's Education and Parents' Trajectories of Psychological Wellbeing. Journal of Health and Social Behavior.
(last updated: 23 August, 2017)