Carey Felicia R, Hu Elaine Y, Stamas Nicole, Seelig Amber, Liu Lynne, Schneiderman Aaron, Culpepper William, Rull Rudolph P, Boyko Edward J
Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106-3521, USA.
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs, VA Puget Sound Healthcare System, Seattle, WA, USA.
BMC Med Res Methodol. 2025 Mar 27;25(1):81. doi: 10.1186/s12874-025-02529-x.
Surveys are a useful tool for eliciting self-reported health information, but the accuracy of such information may vary. We examined the agreement between self-reported health information and medical record data among 116,288 military service members and veterans enrolled in a longitudinal cohort.
Millennium Cohort Study participants who separated from service and registered for health care in the Veterans Health Administration (VHA) by September 18, 2020, were eligible for inclusion. Baseline and follow-up survey responses (2001-2016) about 39 medical conditions, health behaviors, height, and weight were compared with analogous information from VHA and military medical records. Medical record diagnoses were classified as one qualifying ICD code in any diagnostic position between October 1, 1999, and September 18, 2020. Additional analyses were restricted to medical record diagnoses occurring before survey self-report and using specific diagnostic criteria (two outpatient or one inpatient ICD code). Positive, negative, and overall (Youden's J) agreement was calculated for categorical outcomes; Bland-Altman plots were examined for continuous measures.
Among 116,288 participants, 71.8% self-reported a diagnosed medical condition. Negative agreement between self-reported and VHA medical record diagnoses was > 90% for most (80%) conditions, but positive agreement was lower (6.4% to 56.3%). Mental health conditions were more frequently recorded in medical records, while acute conditions (e.g., bladder infections) were self-reported at a higher frequency. Positive agreement was lower when analyses were restricted to medical record diagnoses occurring prior to survey self-report. Specific diagnostic criteria resulted in higher overall agreement.
While negative agreement between self-reported and medical record diagnoses was high in this population, positive and overall agreement were not strong and varied considerably by health condition. Though the limitations of survey-reported health conditions should be considered, using multiple data sources to examine health outcomes in this population may have utility for research, clinical planning, or public health interventions.
调查是获取自我报告健康信息的有用工具，但此类信息的准确性可能各不相同。我们在一个纵向队列中纳入的116288名军人和退伍军人中，研究了自我报告的健康信息与医疗记录数据之间的一致性。
符合条件纳入研究的是2020年9月18日前从军队退役并在退伍军人健康管理局（VHA）注册接受医疗保健的千年队列研究参与者。将关于39种医疗状况、健康行为、身高和体重的基线及随访调查答复（2001年至2016年）与VHA和军队医疗记录中的类似信息进行比较。医疗记录诊断被分类为1999年10月1日至2020年9月18日期间任何诊断位置的一个合格国际疾病分类代码。进一步分析仅限于在调查自我报告之前出现的医疗记录诊断，并采用特定诊断标准（两个门诊或一个住院国际疾病分类代码）。对分类结果计算阳性、阴性和总体（约登指数J）一致性；对连续测量值检查布兰德-奥特曼图。
在116288名参与者中，71.8%的人自我报告患有已确诊的医疗状况。自我报告与VHA医疗记录诊断之间的阴性一致性在大多数（80%）状况下大于90%，但阳性一致性较低（6.4%至56.3%）。心理健康状况在医疗记录中记录得更频繁，而急性状况（如膀胱感染）自我报告的频率更高。当分析仅限于在调查自我报告之前出现的医疗记录诊断时，阳性一致性较低。特定诊断标准导致总体一致性更高。
虽然在该人群中自我报告与医疗记录诊断之间的阴性一致性较高，但阳性以及总体一致性不强，且因健康状况差异很大。尽管应考虑调查报告的健康状况的局限性，但使用多个数据源来检查该人群的健康结果可能对研究、临床规划或公共卫生干预有用。
