Self-Report as an Indicator of Incident Disease
Introduction
In epidemiological studies, the prevalence of a disease (i.e., the proportion of people with a disease in a population) and its incidence (i.e., the proportion of new disease cases during a follow-up in an initially disease-free population) can be established in many ways, including questionnaires, interviews, clinical screening, and medical records. While prevalent diseases are often determined through a clinical examination in large cohort studies, this is not necessarily the case for incident events, which may be, in part, determined by self-reports. Furthermore, because of feasibility, economy, and convenience, many large-scale studies and health interview surveys have entirely relied on self-administered questionnaires 1, 2, 3, 4, 5.
Validation studies have supported the accuracy of self-reports as a measure of prevalent chronic diseases 1, 3, 6, 7. However, less is known about the accuracy of self-reports in ascertaining incident disease despite their frequent use in epidemiological studies 8, 9, 10, 11, 12. The measurement of prevalent disease needs to correctly identify the disease at one point in time only. By contrast, the accuracy of self-reported information on incident diseases is actually affected by the accuracy of self-report at two stages: baseline and follow-up. Thus the assessment of incident disease with self-reports may be more open to measurement error than the self-report assessment of prevalent disease, primarily because the measurement requires both an accurate determination of the disease-free population at baseline and an accurate detection of new-onset disease at follow-up.
The aim of our study was to examine the accuracy of self-reports as the sole source of information in detecting new cases of common chronic diseases of public health importance: hypertension, diabetes, asthma, coronary heart disease, and rheumatoid arthritis. Survey methods are typically used to study these chronic diseases. We compared self-reports from two repeated surveys to records from national health registers (considered as independent gold standard) in a large occupational cohort of Finnish public sector workers.
Section snippets
The Finnish Public Sector Study
Data were derived from the Finnish Public Sector Study 13, 14. The baseline survey in 2000–2002 was agreed to answer by 48,598 employees (response rate 68%). The follow-up survey targeted 46,414 identifiable employees who were still in the service of the target organizations and alive in 2004 through 2005 and 35,914 (77%) of them responded. We excluded those with missing data on the selected self-reported physician-diagnosed diseases in either of the surveys (n = 1,298). Thus, the final cohort
Results
As shown in Table 1, our cohort included 28,545 women and 6,071 men, of whom 488 (1.4%), 3,833 (11.1%), and 1403 (4.1%) fulfilled the set register-criteria for diabetes, hypertension, and asthma, respectively, at baseline. Coronary heart disease and rheumatoid arthritis were less frequent, 273 (0.8%) and 224 (0.7%) cases, respectively. Table 1 also indicates that 1% to 3% of the diabetes, hypertension, and asthma cases were documented in the Hospital Discharge registers. As expected, for the
Discussion
The accuracy of self-reported hypertension, diabetes, asthma, coronary heart disease, and rheumatoid arthritis was examined in a large occupational cohort by using records in comprehensive national health registers as an external reference. Data from repeated surveys showed equally good specificity but lower sensitivity for self-reported disease incidence at follow-up compared to self-reported prevalence at baseline. The sensitivity rates for incident diseases ranged from 55% to 63%, and these
Conclusions
Given the widespread use of self-administered questionnaires in epidemiology, it is important to understand the extent to which self-reports validly determine the prevalence and incidence of a given disease. Our prospective study indicates that the sensitivity of self-reports is substantially worse for incident than prevalent diseases. The low sensitivity (55% to 63%) of self-reports in determining incident disease is an important source of bias in epidemiological studies leading potentially
References (36)
- et al.
Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure
J Clin Epidemiol
(2004) - et al.
Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly: a study on the accuracy of patients' self-reports and on determinants of inaccuracy
J Clin Epidemiol
(1996) - et al.
Cardiovascular diseases and risk factors in a population-based study in The Netherlands: agreement between questionnaire information and medical records
Neth J Med
(1999) - et al.
Validity of self-reported history of doctor-diagnosed angina
J Clin Epidemiol
(1999) - et al.
Validation of self-reported cancer incidence at follow-up in a prospective cohort study
Ann Epidemiol
(2009) - et al.
Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women
Am J Epidemiol
(1986) - et al.
Validation of patient recall of doctor-diagnosed heart attack and stroke: A postal questionnaire and record review comparison
Am J Epidemiol
(1998) - et al.
Do health interview surveys yield reliable data on chronic illness among older respondents?
Am J Epidemiol
(2000) - et al.
Is questionnaire valid in the study of a chronic disease such as diabetes? The Nord-Trøndelag diabetes study
J Epidemiol Community Health
(1992) - et al.
Validity of self-reported cancer history: a comparison of health interview data and cancer registry records
Am J Epidemiol
(2001)
Accuracy of recall of hip fracture, heart attack and cancer: a comparison of postal survey data and medical records
Am J Epidemiol
Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly men and women
Am J Epidemiol
Home outdoor NO2 and new onset of self-reported asthma in adults
Epidemiology
Depression and risk for onset of type II diabetes. A prospective population-based study
Diabetes Care
A prospective study of pregravid determinants of gestational diabetes mellitus
JAMA
Are patients with asthma at increased risk of coronary heart disease?
Int J Epidemiol
Smoking and the risk of hemorrhagic stroke in men
Stroke
Socioeconomic position, co-occurrence of behavior-related risk factors, and coronary heart disease: the Finnish Public Sector Study
Am J Public Health
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