Kriegsman D M, Penninx B W, van Eijk J T, Boeke A J, Deeg D J
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
J Clin Epidemiol. 1996 Dec;49(12):1407-17. doi: 10.1016/s0895-4356(96)00274-0.
The object of the study is to investigate the (in)accuracy of patients' self-reports, as compared with general practitioners' information, regarding the presence of specific chronic diseases, and the influence of patient characteristics.
Questionnaire data of 2380 community-dwelling elderly patients, aged 55-85 years, on the presence of chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, stroke, diabetes, malignancies, and osteoarthritis/rheumatoid arthritis were compared with data from the general practitioners, using the kappa-statistic. Associations between the accuracy of self-reports and patient characteristics were studied by multiple logistic regression analyses.
Kappa's ranged from 0.30 to 0.40 for osteoarthritis/rheumatoid arthritis and atherosclerosis, to 0.85 for diabetes mellitus. In the multivariate analyses, educational level, level of urbanization, deviations in cognitive function, and depressive symptomatology had no influence on the level of accuracy. An influence of gender, age, mobility limitations, and recent contact with the general practitioner was shown for specific diseases. For chronic non-specific lung disease, both "underreporting" and "overreporting" are more prevalent in males, compared to females. Furthermore, males tend to overreport stroke and underreport malignancies and arthritis, whereas females tend to overreport malignancies and arthritis. Both overreporting and underreporting of cardiac disease are more prevalent as people are older. Also, older age is associated with overreporting of stroke, and with underreporting of arthritis. The self-reported presence of mobility limitations is associated with overreporting of all specific diseases studied, except for diabetes mellitus, and its absence is associated with underreporting, except for diabetes mellitus and atherosclerosis. Recent contact with the general practitioner is associated with overreporting of cardiac disease, atherosclerosis, malignancies and arthritis, and with less frequent underreporting of diabetes and arthritis.
Results suggest that patients' self-reports on selected chronic diseases are fairly accurate, with the exceptions of atherosclerosis and arthritis. The associations found with certain patient characteristics may be explained by the tendency of patients to label symptoms, denial by the patient, or inaccuracy of medical records.
本研究的目的是调查患者自我报告与全科医生信息相比，关于特定慢性疾病存在情况的（不）准确性，以及患者特征的影响。
使用kappa统计量，将2380名年龄在55 - 85岁的社区居住老年患者关于慢性非特异性肺病、心脏病、外周动脉粥样硬化、中风、糖尿病、恶性肿瘤以及骨关节炎/类风湿关节炎存在情况的问卷数据与全科医生的数据进行比较。通过多元逻辑回归分析研究自我报告准确性与患者特征之间的关联。
骨关节炎/类风湿关节炎和动脉粥样硬化的kappa值范围为0.30至0.40，糖尿病为0.85。在多变量分析中，教育水平、城市化程度、认知功能偏差和抑郁症状对准确性水平没有影响。特定疾病显示出性别、年龄、行动受限以及近期与全科医生接触情况的影响。对于慢性非特异性肺病，与女性相比，男性“漏报”和“错报”更为普遍。此外，男性倾向于错报中风，漏报恶性肿瘤和关节炎，而女性倾向于错报恶性肿瘤和关节炎。心脏病的错报和漏报随着年龄增长更为普遍。同样，年龄较大与中风的错报以及关节炎的漏报相关。自我报告的行动受限与除糖尿病外所有研究的特定疾病的错报相关，而没有行动受限则与除糖尿病和动脉粥样硬化外的漏报相关。近期与全科医生接触与心脏病、动脉粥样硬化、恶性肿瘤和关节炎的错报相关，与糖尿病和关节炎较少的漏报相关。
结果表明，除动脉粥样硬化和关节炎外，患者对所选慢性疾病的自我报告相当准确。与某些患者特征的关联可能由患者标记症状的倾向、患者的否认或病历的不准确来解释。
