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Dolar V, Chatterton ML, Le LKD, Mihalopoulos C, Thomas N, Engel L. Health Service Utilisation of People Living with Psychosis: Validity of Self-report Compared with Administrative Data in a Randomised Controlled Trial. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:255-264. [PMID: 37985649 DOI: 10.1007/s40258-023-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Self-reported service use informs resource utilisation and cost estimates, though its validity for use within economic evaluations is uncertain. OBJECTIVE The aim of this study is to assess agreement in health resource-use measurement between self-reported and administrative data across different resource categories, over time and between different recall periods by subgroups among Australians living with psychosis. METHODS Data were obtained for 104 participants with psychotic disorders from a randomised controlled trial. Agreement between self-reported resource-use questionnaires and administrative data on community-based services and medication use was assessed through estimating differences of group mean number of visits and medications used and intraclass correlation coefficients (ICC) over multiple time periods. RESULTS ICC showed moderate agreement across most time periods for general practitioners, psychiatrists and mental health medications. No clear trends were discernible over time, between varying lengths of recall periods nor across participant subgroups. CONCLUSION Despite poor agreement, when measuring visits to psychologists and other health professionals, small overall differences in group mean number of visits indicate that self-reported data may still be valid for use in economic evaluations in people living with psychosis.
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Affiliation(s)
- Vergil Dolar
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Neil Thomas
- Department of Psychological Sciences, School of Health Sciences, Centre for Mental Health, Swinburne University, Melbourne, Australia
| | - Lidia Engel
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
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Janssen LMM, Drost RMWA, Paulus ATG, Garfield K, Hollingworth W, Noble S, Thorn JC, Pokhilenko I, Evers SMAA. Aspects and Challenges of Resource Use Measurement in Health Economics: Towards a Comprehensive Measurement Framework. PHARMACOECONOMICS 2021; 39:983-993. [PMID: 34169466 PMCID: PMC8352823 DOI: 10.1007/s40273-021-01048-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND While the methods for conducting health economics research in general are improving, current guidelines provide limited guidance regarding resource use measurement (RUM). Consequently, a variety of methods exists, yet there is no overview of aspects to consider when deciding on the most appropriate RUM methodology. Therefore, this study aims to (1) identify and categorize existing knowledge regarding aspects of RUM, and (2) develop a framework that provides a comprehensive overview of methodological aspects regarding RUM. METHODS Relevant articles were identified by enrolling a search string in six databases and handsearching the DIRUM database. Included articles were descriptively reviewed and served as input for a comprehensive framework. Health economics experts were involved during the process to establish the framework's face validity. RESULTS Forty articles were included in the scoping review. The RUM framework consists of four methodological RUM domains: 'Whom to measure', addressing whom to ask and whom to measure; 'How to measure', addressing the different approaches of measurement; 'How often to measure', addressing recall period and measurement patterns; and 'Additional considerations', which covers additional aspects that are essential for further refining the methodologies for measurement. Evidence retrieved from the scoping review was categorized according to these domains. CONCLUSION This study clustered the aspects of RUM methodology in health economics into a comprehensive framework. The results may guide health economists in their decision making regarding the selection of appropriate RUM methods and developing instruments for RUM. Furthermore, policy makers may use these findings to review study results from an evidence-based perspective.
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Affiliation(s)
- Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands.
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Kirsty Garfield
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sian Noble
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation and Machine Learning, Utrecht, The Netherlands
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Harris MG, Bharat C, Glantz MD, Sampson NA, Al‐Hamzawi A, Alonso J, Bruffaerts R, Caldas de Almeida JM, Cia AH, Girolamo G, Florescu S, Gureje O, Haro JM, Hinkov H, Karam EG, Karam G, Lee S, Lépine J, Levinson D, Makanjuola V, McGrath J, Mneimneh Z, Navarro‐Mateu F, Piazza M, Posada‐Villa J, Rapsey C, Tachimori H, Have M, Torres Y, Viana MC, Chatterji S, Zaslavsky AM, Kessler RC, Degenhardt L. Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys. Addiction 2019; 114:1446-1459. [PMID: 30835879 PMCID: PMC7408310 DOI: 10.1111/add.14599] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/03/2018] [Accepted: 02/22/2019] [Indexed: 01/29/2023]
Abstract
AIMS To examine cross-national patterns of 12-month substance use disorder (SUD) treatment and minimally adequate treatment (MAT), and associations with mental disorder comorbidity. DESIGN Cross-sectional, representative household surveys. SETTING Twenty-seven surveys from 25 countries of the WHO World Mental Health Survey Initiative. PARTICIPANTS A total of 2446 people with past-year DSM-IV SUD diagnoses (alcohol or illicit drug abuse and dependence). MEASUREMENTS Outcomes were SUD treatment, defined as having either received professional treatment or attended a self-help group for substance-related problems in the past 12 months, and MAT, defined as having either four or more SUD treatment visits to a health-care professional, six or more visits to a non-health-care professional or being in ongoing treatment at the time of interview. Covariates were mental disorder comorbidity and several socio-economic characteristics. Pooled estimates reflect country sample sizes rather than population sizes. FINDINGS Of respondents with past-year SUD, 11.0% [standard error (SE) = 0.8] received past 12-month SUD treatment. SUD treatment was more common among people with comorbid mental disorders than with pure SUDs (18.1%, SE = 1.6 versus 6.8%, SE = 0.7), as was MAT (84.0%, SE = 2.5 versus 68.3%, SE = 3.8) and treatment by health-care professionals (88.9%, SE = 1.9 versus 78.8%, SE = 3.0) among treated SUD cases. Adjusting for socio-economic characteristics, mental disorder comorbidity doubled the odds of SUD treatment [odds ratio (OR) = 2.34; 95% confidence interval (CI) = 1.71-3.20], MAT among SUD cases (OR = 2.75; 95% CI = 1.90-3.97) and MAT among treated cases (OR = 2.48; 95% CI = 1.23-5.02). Patterns were similar within country income groups, although the proportions receiving SUD treatment and MAT were higher in high- than low-/middle-income countries. CONCLUSIONS Few people with past-year substance use disorders receive adequate 12-month substance use disorder treatment, even when comorbid with a mental disorder. This is largely due to the low proportion of people receiving any substance use disorder treatment, as the proportion of patients whose treatment is at least minimally adequate is high.
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Affiliation(s)
- Meredith G. Harris
- School of Public HealthThe University of Queensland Herston QLD Australia
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health QLD Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney Australia
| | - Meyer D. Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR)National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) Bethesda MD USA
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ali Al‐Hamzawi
- College of Medicine, Al‐Qadisiya University, Diwaniya Governorate Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM‐Hospital del Mar Medical Research Institute Barcelona Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF) Barcelona Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit Leuven (UPC‐KUL), Campus Gasthuisberg Leuven Belgium
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa Lisbon Portugal
| | | | | | - Silvia Florescu
- National School of Public Health, Management and Development Bucharest Romania
| | - Oye Gureje
- Department of PsychiatryUniversity College Hospital Ibadan Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat Barcelona Spain
| | - Hristo Hinkov
- National Center of Public Health and Analyses Sofia Bulgaria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand University Beirut Lebanon
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center Beirut Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center, Balamand University, Faculty of Medicine Beirut Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | - Sing Lee
- Department of PsychiatryChinese University of Hong Kong Tai Po Hong Kong
| | - Jean‐Pierre Lépine
- Hôpital Lariboisière‐Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes‐Paris Diderot;INSERM UMR‐S 1144 Paris France
| | | | - Victor Makanjuola
- Department of Psychiatry, College of MedicineUniversity of Ibadan; University College Hospital Ibadan Nigeria
| | - John McGrath
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health Wacol QLD Australia
- Queensland Brain Institute, University of Queensland St Lucia QLD Australia
- National Centre for Register‐Based ResearchAarhus University Aarhus Denmark
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social ResearchUniversity of Michigan Ann Arbor MI USA
| | - Fernando Navarro‐Mateu
- UDIF‐SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB‐Arrixaca, CIBERESP‐ Murcia Murcia Spain
| | | | - José Posada‐Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences Bogota Colombia
| | - Charlene Rapsey
- Department of Psychological MedicineUniversity of Otago, Dunedin School of Medicine Otago New Zealand
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry Kodaira Tokyo Japan
| | - Margreet Have
- Trimbos‐Instituutthe Netherlands Institute of Mental Health and Addiction Utrecht the Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES University Medellin Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public HealthFederal University of Espírito Santo Vitoria Brazil
| | - Somnath Chatterji
- Department of Information, Evidence and ResearchWorld Health Organization Geneva Switzerland
| | - Alan M. Zaslavsky
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical School Boston MA USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUniversity of New South Wales Sydney NSW Australia
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Van der Heyden J, Charafeddine R, De Bacquer D, Tafforeau J, Van Herck K. Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias. BMC Med Res Methodol 2016; 16:98. [PMID: 27528010 PMCID: PMC4986374 DOI: 10.1186/s12874-016-0198-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS), and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS. Methods To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI). The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses. Results Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 %) and a day patient hospitalisation (7.8 % versus 13.9 %). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33–1.72) for self-report and 1.08 (95 % CI 1.05–1.15) for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51–0.70) and 0.41 (95 % CI 0.39–0.42) respectively] in Brussels compared to Flanders. Conclusion Cautiousness is needed to interpret self-reported use of health care, especially for ambulatory care. Regional differences in self-reported health care use may be influenced by regional differences in the validity of the self-reported information. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0198-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Van der Heyden
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium.
| | - R Charafeddine
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - D De Bacquer
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
| | - J Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - K Van Herck
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
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Sevilla-Dedieu C, Kovess-Masfety V, Angermeyer M, Bruffaerts R, Fernandez A, De Girolamo G, De Graaf R, Haro JM, König HH. Measuring use of services for mental health problems in epidemiological surveys. Int J Methods Psychiatr Res 2011; 20:182-91. [PMID: 21823191 PMCID: PMC6878290 DOI: 10.1002/mpr.346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 01/31/2011] [Accepted: 02/16/2011] [Indexed: 11/10/2022] Open
Abstract
The use of services for mental problems is generally reported as being relatively low. However, the methods used for data collection in surveys may have influenced the quality of self-reported service use. This study compares the information on recourse to physicians for mental problems reported in different sections of a survey conducted in six European countries. Thus, 5545 respondents were asked questions on contacts with physicians at least twice: (1) after the symptoms checklist in any completed diagnostic section, and (2) in a section devoted to use of care for mental problems. Of these 39.3% reported contacts with physicians about mental problems in the diagnostic sections, whereas 29.5% did so in the use-of-care section. Inconsistencies concerned 20.1% of participants, among whom those reporting consultations in diagnostic sections without reporting them in the use-of-care section represented the majority (74.4%). Multiple logistic regression analysis revealed that age, marital status, educational level and country were associated with under-reporting in the use-of-care section, as well as having mood or sleep problems. In conclusion, services used for mental health reasons when measured through a question referring to use of care due to the presence of a mental problem may underestimate the care people received for their problems.
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Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records. Psychiatry Res 2011; 185:261-8. [PMID: 20537717 DOI: 10.1016/j.psychres.2010.04.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/04/2010] [Accepted: 04/30/2010] [Indexed: 11/20/2022]
Abstract
Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.
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Chung S, Domino ME, Morrissey JP. Changes in treatment content of services during trauma-informed integrated services for women with co-occurring disorders. Community Ment Health J 2009; 45:375-84. [PMID: 19308729 PMCID: PMC2758206 DOI: 10.1007/s10597-009-9192-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/10/2009] [Indexed: 11/29/2022]
Abstract
The experience of trauma is highly prevalent in the lives of women with mental health and substance abuse problems. We examined how an intervention targeted to provide trauma-informed integrated services in the treatment of co-occurring disorders has changed the content of services reported by clients. We found that the intervention led to an increased provision of integrated services as well as services addressing each content area: trauma, mental health and substance abuse. There was no increase in service quantity from the intervention. Incorporation of trauma-specific element in the treatment of mental health and substance abuse may have been successfully implemented at the service level thereby better serve women with complex behavioral health histories.
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Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301 USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1104G McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC 27599-7411 USA
| | - Joseph P. Morrissey
- Cecil G. Sheps Center for Health Services Research and Department of Health Policy and Management, University of North Carolina at Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599-7590 USA
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Do Healthy People Worry? Modern Health Worries, Subjective Health Complaints, Perceived Health, and Health Care Utilization. Int J Behav Med 2009; 17:182-8. [DOI: 10.1007/s12529-009-9058-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hvidtjørn D, Grove J, Schendel D, Schieve LA, Ernst E, Olsen J, Thorsen P. Validation of self-reported data on assisted conception in The Danish National Birth Cohort. Hum Reprod 2009; 24:2332-40. [PMID: 19454590 DOI: 10.1093/humrep/dep179] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND An increasing number of children are born after assisted conception and in surveillance programmes information on mode of conception is often achieved via maternal self-report. We assessed the validity of self-reported assisted conception in The Danish National Birth Cohort (DNBC), a prospective pregnancy cohort. Here, the term assisted conception refers to IVF, ICSI, ovulation induction and insemination. METHODS We compared self-reported assisted conception in the DNBC to corresponding data from Danish national registers; the IVF Register and Danish Drug Prescription Register, providing method of conception in the entire population. In the DNBC, 101,042 women accepted the invitation in early pregnancy from 1996 to 2002. Our final study population comprised 88,151 DNBC women aged 20 years and older who participated in the first DNBC interview with a pregnancy resulting in a live born child. RESULTS In the DNBC, assisted conception was reported with a sensitivity of 83% and positive predictive value of 88%. Misclassification was largely explained by ambiguous phrasing of the DNBC interview question and interview skip patterns. Women with false negative reporting were more often multipara (P < 0.001) and older (P = 0.027 for IVF/ICSI and P = 0.002 for ovulation induction). The risk ratio (RR) for being born preterm in IVF/ICSI children was lower for children identified via the DNBC, RR 3.61 (95% confidence interval (CI) 3.31-3.94), than the IVF Register, RR 4.36 (95% CI 4.02-4.74). CONCLUSIONS There was a high positive predictive value of self-reported assisted conception in the DNBC, but the structure of the DNBC interview represented a problem and misclassification could introduce bias.
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Affiliation(s)
- D Hvidtjørn
- Department of Epidemiology, Institute of Public Health, NANEA, University of Aarhus, 8000 Arhus, Denmark.
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