Hoeymans N, Feskens E J, Van Den Bos G A, Kromhout D
Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Age Ageing. 1998 Jan;27(1):35-40. doi: 10.1093/ageing/27.1.35.
To investigate to what extent differences in health status between respondents and drop-outs affected the associations between cardiovascular diseases and functional status and self-rated health in a population-based longitudinal health survey in elderly men.
During the 1993 survey of the Zutphen Elderly Study, a non-response survey was carried out. The prevalence of myocardial infarction and stroke, disabilities in basic activities of daily living (BADL) and mobility, and self-rated health were compared between non-respondents (n = 99) and respondents (n = 381). Associations between myocardial infarction and stroke on the one hand and functional status and self-rated health on the other were calculated for the total population and for the respondents to assess the amount of under- or overestimation of these associations.
The health of non-respondents was worse than that of respondents in terms of stroke, disabilities in BADL and mobility and self-rated health. Due to this selective non-response, the associations between cardiovascular diseases and functional status and self-rated health were biased. Although most of the associations were slightly overestimated, the most important bias was the underestimation by 57% of the association between stroke and disabilities in BADL [total population: odds ratios (OR) = 6.1, 95% confidence interval (CI) = 2.7-13.9; respondents only: OR = 2.6, CI = 0.7-9.9].
Selective non-response might lead to bias in the prevalence of disease, disabilities and self-rated health as well as in the associations between disease and functional status and self-rated health. The direction and magnitude of this bias varies according to type of disease and health outcome and is therefore difficult to predict. The need to minimize non-response and to investigate its implications is recommended in every study.
在一项针对老年男性的基于人群的纵向健康调查中，研究受访者与退出者之间的健康状况差异在多大程度上影响了心血管疾病与功能状态及自评健康之间的关联。
在1993年祖特芬老年研究调查期间，进行了一项无应答调查。比较了无应答者（n = 99）和应答者（n = 381）中心肌梗死和中风的患病率、基本日常生活活动（BADL）及活动能力方面的残疾情况以及自评健康状况。计算了总体人群以及应答者中心肌梗死和中风与功能状态及自评健康之间的关联，以评估这些关联被低估或高估的程度。
在中风、BADL及活动能力方面的残疾情况和自评健康方面，无应答者的健康状况比应答者差。由于这种选择性无应答，心血管疾病与功能状态及自评健康之间的关联存在偏差。尽管大多数关联被略微高估，但最重要的偏差是中风与BADL残疾之间的关联被低估了57%[总体人群：优势比（OR）= 6.1，95%置信区间（CI）= 2.7 - 13.9；仅应答者：OR = 2.6，CI = 0.7 - 9.9]。
选择性无应答可能导致疾病、残疾和自评健康患病率以及疾病与功能状态及自评健康之间的关联出现偏差。这种偏差的方向和程度因疾病类型和健康结果而异，因此难以预测。建议在每项研究中尽量减少无应答情况并调查其影响。
