© 1998 Oxford University Press
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Non-response bias in a study of cardiovascular diseases, functional status and self-rated health among elderly men
1Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment PO Box I, 3720 BA Bilthoven, The Netherlands
2Institute of Social Medicine, Academic Medical Centre, University of Amsterdam Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
N. Hoeymans. Fax: (+31) 30 2744450. E-mail: Nancy.Hoeymans{at}rivm.nl
Objectives: to investigate to what extent differences in health status between respondents and drop-outs affected the associations between cardiovascular diseases and functional status and self-rated health in a population-based longitudinal health survey in elderly men.
Methods: during the 1993 survey of the Zutphen Elderly Study, a non-response survey was carried out. The prevalence of myocardial infarction and stroke, disabilities in basic activities of daily living (BADL) and mobility, and self-rated health were compared between non-respondents (n = 99) and respondents (n = 381). Associations between myocardial infarction and stroke on the one hand and functional status and self-rated health on the other were calculated for the total population and for the respondents to assess the amount of under- or overestimation of these associations.
Results: the health of non-respondents was worse than that of respondents in terms of stroke, disabilities in BADL and mobility and self-rated health. Due to this selective non-response, the associations between cardiovascular diseases and functional status and self-rated health were biased. Although most of the associations were slightly overestimated, the most important bias was the underestimation by 57% of the association between stroke and disabilities in BADL [total population: odds ratios (OR) = 6.1, 95% confidence interval (CI) = 2.7–13.9; respondents only: OR = 2.6, CI = 0.7–9.9].
Conclusion: selective non-response might lead to bias in the prevalence of disease, disabilities and self-rated health as well as in the associations between disease and functional status and self-rated health. The direction and magnitude of this bias varies according to type of disease and health outcome and is therefore difficult to predict. The need to minimize non-response and to investigate its implications is recommended in every study.
Keywords: functional status, non-respondents, myocardial infarction, stroke, study design
Received January 22, 1997;
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