Schrijvers C T, Stronks K, van de Mheen D H, Coebergh J W, Mackenbach J P
Department of Public Health, Erasmus University Medical School, Rotterdam, The Netherlands.
Am J Epidemiol. 1994 Feb 15;139(4):408-14. doi: 10.1093/oxfordjournals.aje.a117013.
Data on self-reported cancer from a health interview survey carried out in 1991 in the southeastern Netherlands by means of a postal questionnaire (n = 17,940) were validated against records from a population-based cancer registry. The sensitivity of the questionnaire was 0.552 (95% confidence interval (CI) 0.507-0.597), and the specificity was 0.995 (95% CI 0.994-0.996). The survey underestimated cancer prevalence in the population by 25%. Of the 212 false negative cases, 46% were registered with non-melanoma skin cancer. After the exclusion of nonmelanoma skin cancer from cancer registry records, cancer prevalence was overestimated by the survey by a negligible 2%. The misclassification of cancer by the postal survey was differential according to age, sex, education, and degree of urbanization. The survey overestimated cancer prevalence ratios for men versus women, old respondents versus young respondents, and urban residents versus rural residents. The prevalence ratios for respondents with a low educational level versus those with a high level were underestimated using survey data. These patterns remained essentially the same after exclusion of nonmelanoma skin cancer from the cancer registry records. This study shows that both overall cancer prevalence and differences in cancer prevalence between subgroups of the population may be biased when health interview survey data are used. If explicit attention is paid to nonmelanoma skin cancer in survey questions, this might improve the validity of overall cancer prevalence estimates, but not that of comparisons between subgroups of the population.
1991年在荷兰东南部通过邮政问卷开展了一项健康访谈调查（n = 17,940），该调查中自我报告的癌症数据与基于人群的癌症登记记录进行了验证。问卷的灵敏度为0.552（95%置信区间（CI）0.507 - 0.597），特异度为0.995（95% CI 0.994 - 0.996）。该调查低估了人群中的癌症患病率25%。在212例假阴性病例中，46%为非黑色素瘤皮肤癌登记病例。从癌症登记记录中排除非黑色素瘤皮肤癌后，该调查高估癌症患病率2%，可忽略不计。邮政调查对癌症的错误分类因年龄、性别、教育程度和城市化程度而异。该调查高估了男性与女性、老年受访者与年轻受访者、城市居民与农村居民之间的癌症患病率比。使用调查数据时，低教育水平受访者与高教育水平受访者的患病率比被低估。从癌症登记记录中排除非黑色素瘤皮肤癌后，这些模式基本保持不变。本研究表明，当使用健康访谈调查数据时，总体癌症患病率以及人群亚组之间癌症患病率的差异可能存在偏差。如果在调查问题中明确关注非黑色素瘤皮肤癌，这可能会提高总体癌症患病率估计的有效性，但不会提高人群亚组之间比较的有效性。
