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Am J Public Health. 1996 May; 86(5): 706–711.
PMCID: PMC1380480

Differences in the misreporting of chronic conditions, by level of education: the effect on inequalities in prevalence rates.


OBJECTIVES: Many studies of socio-economic inequalities in the prevalence of chronic conditions rely on self-reports. For chronic nonspecific lung disease, heart disease, and diabetes mellitus, we studied the effects of misreporting on variations in prevalence rates by respondents' level of education. METHODS: In 1991, a health interview survey was conducted in the southeastern Netherlands with 2867 respondents. Respondents' answers were compared with validated diagnostic questionnaires in the same survey and the diagnoses given by the respondents' general practitioners. RESULTS: Misreporting of chronic lung disease, heart disease, and diabetes may be extensive. Depending on the condition and the reference data used, the confirmation fractions ranged between .61 and .96 and the detection fractions between .13 and .93. Misreporting varied by level of education, and although various patterns were observed, the dominant pattern was that of more underreporting among less educated persons. The effects on prevalence rates were to underestimate differences by level of education to a sometimes considerable degree. CONCLUSIONS: Misreporting of chronic conditions differs by respondents' level of education. Health interview survey data underestimate socioeconomic inequalities in the prevalence of chronic conditions.

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  • Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545–557. [PubMed]
  • Mackenbach JP. Socio-economic health differences in The Netherlands: a review of recent empirical findings. Soc Sci Med. 1992 Feb;34(3):213–226. [PubMed]
  • Harlow SD, Linet MS. Agreement between questionnaire data and medical records. The evidence for accuracy of recall. Am J Epidemiol. 1989 Feb;129(2):233–248. [PubMed]
  • Mackenbach JP, van de Mheen H, Stronks K. A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands. Soc Sci Med. 1994 Jan;38(2):299–308. [PubMed]
  • van der Lende R, Jansen-Koster EJ, Knijpstra S, Meinesz AF, Wever AM, Orie NG. Definitie van CARA in epidemiologie en preventie. Ned Tijdschr Geneeskd. 1975 Dec 13;119(50):1975–1980. [PubMed]
  • Rose GA, Blackburn H. Cardiovascular survey methods. Monogr Ser World Health Organ. 1968;56:1–188. [PubMed]
  • TRUSSELL RE, ELINSON J, LEVIN ML. Comparisons of various methods of estimating the prevalence of chronic disease in a community; the Hunterdon County study. Am J Public Health Nations Health. 1956 Feb;46(2):173–182. [PMC free article] [PubMed]
  • ELINSON J, TRUSSELL RE. Some factors relating to degree of correspondence for diagnostic information as obtained by household interviews and clinical examinations. Am J Public Health Nations Health. 1957 Mar;47(3):311–321. [PMC free article] [PubMed]
  • KRUEGER DE. Measurement of prevalence of chronic disease by household interviews and clinical evaluations. Am J Public Health Nations Health. 1957 Aug;47(8):953–960. [PMC free article] [PubMed]
  • SANDERS BS. Have morbidity surveys been oversold? Am J Public Health Nations Health. 1962 Oct;52:1648–1659. [PMC free article] [PubMed]
  • Meltzer JW, Hochstim JR. Reliability and validity of survey data on physical health. Public Health Rep. 1970 Dec;85(12):1075–1086. [PMC free article] [PubMed]
  • Chambers LW, Spitzer WO, Hill GB, Helliwell BE. Underreporting of cancer in medical surveys: a source of systematic error in cancer research. Am J Epidemiol. 1976 Aug;104(2):141–145. [PubMed]
  • Tretli S, Lund-Larsen PG, Foss OP. Reliability of questionnaire information on cardiovascular disease and diabetes: cardiovascular disease study in Finnmark county. J Epidemiol Community Health. 1982 Dec;36(4):269–273. [PMC free article] [PubMed]
  • Colditz GA, Martin P, Stampfer MJ, Willett WC, Sampson L, Rosner B, Hennekens CH, Speizer FE. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. 1986 May;123(5):894–900. [PubMed]
  • Olsson L, Svärdsudd K, Nilsson G, Ringqvist I, Tibblin G. Validity of a postal questionnaire with regard to the prevalence of myocardial infarction in a general population sample. Eur Heart J. 1989 Nov;10(11):1011–1016. [PubMed]
  • Linet MS, Harlow SD, McLaughlin JK, McCaffrey LD. A comparison of interview data and medical records for previous medical conditions and surgery. J Clin Epidemiol. 1989;42(12):1207–1213. [PubMed]
  • Midthjell K, Holmen J, Bjørndal A, Lund-Larsen G. Is questionnaire information valid in the study of a chronic disease such as diabetes? The Nord-Trøndelag diabetes study. J Epidemiol Community Health. 1992 Oct;46(5):537–542. [PMC free article] [PubMed]
  • Heliövaara M, Aromaa A, Klaukka T, Knekt P, Joukamaa M, Impivaara O. Reliability and validity of interview data on chronic diseases. The Mini-Finland Health Survey. J Clin Epidemiol. 1993 Feb;46(2):181–191. [PubMed]
  • Schrijvers CT, Stronks K, van de Mheen DH, Coebergh JW, Mackenbach JP. Validation of cancer prevalence data from a postal survey by comparison with cancer registry records. Am J Epidemiol. 1994 Feb 15;139(4):408–414. [PubMed]

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