The Health Status of Nonparticipants in a Population-based Health Study The Hordaland Health Study
The Health Status of Nonparticipants in a Population-based Health Study The Hordaland Health Study
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DOI：
10.1093/aje/kwq257
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发表时间：
2010-12-11
影响因子：
5
通讯作者：
Mykletun, Arnstein
中科院分区：
文献类型：
--
作者：
Knudsen, Ann Kristin;Hotopf, Matthew;Mykletun, Arnstein
作者旨在研究不参加基于人群的健康研究是否与较差的健康状况有关；确定非参与者中特定的健康问题是否过多；并探讨参与偏差对暴露与结果之间关联的潜在影响。他们使用了 1997-1999 年在挪威西部进行的霍达兰健康研究 (HUSK) 的数据。在受邀的 29,400 人中，63.1% 的人参与了这项研究。来自 HUSK 的信息与挪威国家残疾养老金 (DP) 登记处相关联，包括有关 DP 诊断的信息。非参与者获得 DP 的风险几乎是参与者的两倍（相对风险 = 1.88，95% 置信区间：1.81、1.95）。对于因精神障碍而接受的 DP，这种关联最为强烈，不参与的风险增加了 3 倍。在非参与者中，药物滥用、精神障碍和人格障碍的比例尤其过高。作者通过排除具有较高常见精神障碍症状（暴露）的 HUSK 参与者并检查对 DP（结果）的影响，模拟了不参与对暴露和结果之间关联的影响。这种选择性排除适度减少了常见精神障碍和 DP 之间的关联。作者得出的结论是，非参与者的健康状况较差，但这取决于疾病。与暴露与结果之间关联的研究相比，参与偏差对患病率研究有效性的威胁可能更大。
The authors aimed to examine whether nonparticipation in a population-based health study was associated with poorer health status; to determine whether specific health problems were overrepresented among nonparticipants; and to explore potential consequences of participation bias on associations between exposures and outcomes. They used data from the Hordaland Health Study (HUSK), conducted in western Norway in 1997-1999. Of 29,400 persons invited, 63.1% participated in the study. Information from HUSK was linked with the Norwegian national registry of disability pensions (DPs), including information about DP diagnosis. The risk of DP receipt was almost twice as high among nonparticipants as participants (relative risk = 1.88, 95% confidence interval: 1.81, 1.95). The association was strongest for DPs received for mental disorders, with a 3-fold increased risk for nonparticipation. Substance abuse, psychotic disorders, and personality disorders were especially overrepresented among nonparticipants. The authors simulated the impact of nonparticipation on associations between exposures and outcomes by excluding HUSK participants with higher symptoms of common mental disorders (exposure) and examining the impact on DP (outcome). This selective exclusion modestly reduced associations between common mental disorders and DP. The authors conclude that nonparticipants have poorer health, but this is disorder-dependent. Participation bias is probably a greater threat to the validity of prevalence studies than to studies of associations between exposures and outcomes.