Department of Health Statistics, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
Health Qual Life Outcomes. 2020 Mar 18;18(1):75. doi: 10.1186/s12955-020-01325-z.
Proxy respondent-someone who assists the intended respondent or responds on their behalf-are widely applied in the measurement of health-related quality of life (HRQL). However, proxies may not provide the same responses as the intended respondents, which may bias the findings.
To determine whether the use of proxies is related to socio-demographic characteristics of the intended respondent, and to assess the possible proxy response bias of Chinese version of EQ-5D-3 L in general population.
A cross-sectional study based on a provincially representative sample from 2013 National Health Service Survey (NHSS) in Shaanxi, China was performed. HRQL was measured by Chinese version of EQ-5D-3 L. Propensity score matching (PSM) was used to get matched pairs of self-reports and proxy-reports. Before and after PSM, univariate logistic and linear models including the indicator of proxy response as the only independent variable, were employed to assess the possible proxy response bias of the dimensional and overall health status of EQ-5D-3 L respectively.
19.9% of the responses involved a proxy. Before PSM, the proxy-report group was younger in age and reported less unhealthy lifestyle, lower prevalence of disease, and less hospitalization than the self-report group. After PSM, it showed that the proxy-report group was statistically more likely to report health problem on each dimension of EQ-5D-3 L, with odds ratios larger than one comparing with self-report group. The means of EQ-5D-3 L index and EQ VAS of proxy-report group were 0.022 and 0.834 lower than self-report group.
Significantly negative proxy response bias was found in Chinese EQ-5D-3 L in general population, and the magnitude of the bias was larger in physical dimensions than psychological dimensions after using PSM to control confounders.
代理应答者-即协助目标应答者或代表其进行应答的人-在健康相关生活质量（HRQL）的测量中被广泛应用。然而，代理应答者的回答可能与目标应答者不同，这可能会导致研究结果产生偏差。
确定代理应答者的使用是否与目标应答者的社会人口统计学特征有关，并评估中文版 EQ-5D-3L 在一般人群中的可能代理应答偏差。
本研究采用基于 2013 年陕西省国家卫生服务调查（NHSS）的省级代表性样本的横断面研究。使用中文版 EQ-5D-3L 测量 HRQL。采用倾向评分匹配（PSM）获得自我报告和代理报告的匹配对。在 PSM 前后，使用包含代理应答作为唯一自变量的单变量逻辑和线性模型，分别评估 EQ-5D-3L 的维度和整体健康状况的可能代理应答偏差。
19.9%的应答涉及代理应答者。在 PSM 之前，代理应答组比自我报告组年龄更小，报告的不健康生活方式更少，疾病患病率更低，住院率也更低。在 PSM 之后，结果显示，与自我报告组相比，代理应答组在 EQ-5D-3L 的每个维度上报告健康问题的可能性更大，优势比大于 1。代理应答组的 EQ-5D-3L 指数和 EQ VAS 的平均值比自我报告组低 0.022 和 0.834。
在一般人群中，中文版 EQ-5D-3L 存在显著的负向代理应答偏差，且在使用 PSM 控制混杂因素后，这种偏差在生理维度上大于心理维度。
