Cull William L, O'Connor Karen G, Sharp Sanford, Tang Suk-fong S
Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, IL 60007, USA.
Health Serv Res. 2005 Feb;40(1):213-26. doi: 10.1111/j.1475-6773.2005.00350.x.
To track response rates across time for surveys of pediatricians, to explore whether response bias is present for these surveys, and to examine whether response bias increases with lower response rates.
DATA SOURCE/STUDY SETTING: A total of 63,473 cases were gathered from 50 different surveys of pediatricians conducted by the American Academy of Pediatrics (AAP) since 1994. Thirty-one surveys targeted active U.S. members of the AAP, six targeted pediatric residents, and the remaining 13 targeted AAP-member and nonmember pediatric subspecialists. Information for the full target samples, including nonrespondents, was collected using administrative databases of the AAP and the American Board of Pediatrics.
To assess bias for each survey, age, gender, location, and AAP membership type were compared for respondents and the full target sample. Correlational analyses were conducted to examine whether surveys with lower response rates had increasing levels of response bias.
Response rates to the 50 surveys examined declined significantly across survey years (1994-2002). Response rates ranged from 52 to 81 percent with an average of 68 percent. Comparisons between respondents and the full target samples showed the respondent group to be younger, to have more females, and to have less specialty-fellow members. Response bias was not apparent for pediatricians' geographical location. The average response bias, however, was fairly small for all factors: age (0.45 years younger), gender (1.4 percentage points more females), and membership type (1.1 percentage points fewer specialty-fellow members). Gender response bias was found to be inversely associated with survey response rates (r=-0.38). Even for the surveys with the lowest response rates, amount of response bias never exceeded 5 percentage points for gender, 3 years for age, or 3 percent for membership type.
While response biases favoring women, young physicians, and nonspecialty-fellow members were found across the 52-81 percent response rates examined in this study, the amount of bias was minimal for these factors that could be tested. At least for surveys of pediatricians, more attention should be devoted by investigators to assessments of response bias rather than relying on response rates as a proxy of response bias.
追踪儿科医生调查的随时间变化的回复率,探讨这些调查中是否存在回复偏差,并检验回复偏差是否随回复率降低而增加。
数据来源/研究背景:自1994年以来,从美国儿科学会(AAP)对儿科医生进行的50项不同调查中收集了总共63473个案例。31项调查针对美国AAP的在职会员,6项针对儿科住院医师,其余13项针对AAP会员和非会员儿科专科医生。使用AAP和美国儿科学会委员会的行政数据库收集了包括未回复者在内的完整目标样本的信息。
为评估每项调查的偏差,对回复者和完整目标样本的年龄、性别、地点和AAP会员类型进行了比较。进行了相关性分析,以检验回复率较低的调查是否具有更高水平的回复偏差。
在所研究的50项调查中,回复率在各调查年份(1994 - 2002年)显著下降。回复率范围为52%至81%,平均为68%。回复者与完整目标样本之间的比较显示,回复者群体更年轻,女性更多,专科会员更少。儿科医生的地理位置不存在明显的回复偏差。然而,所有因素的平均回复偏差都相当小:年龄(年轻0.45岁)、性别(女性多1.4个百分点)和会员类型(专科会员少1.1个百分点)。发现性别回复偏差与调查回复率呈负相关(r = -0.38)。即使对于回复率最低的调查,性别回复偏差量从未超过5个百分点,年龄回复偏差量从未超过3岁,会员类型回复偏差量从未超过3%。
虽然在本研究中52% - 81%的回复率范围内发现了有利于女性、年轻医生和非专科会员的回复偏差,但对于这些可测试因素,偏差量极小。至少对于儿科医生的调查,研究者应更多地关注回复偏差的评估,而不是将回复率作为回复偏差的替代指标。