Cited by 324Survey Methodology and NonresponseStatistical Methods in EpidemiologyHealth disparities and outcomes

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The Health Status of Nonparticipants in a Population-based Health Study: The Hordaland Health Study

Knudsen, A. K., Hotopf, M., Skogen, J. C., Overland, S., Mykletun, A.·2010·American Journal of Epidemiology

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Abstract

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.

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Skogen, J. C., Hjetland, G. J., Bøe, T., Hella, R. T., & Knudsen, A. K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063319 · Cited by 73
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Prevalence of the American Heart Association's “Ideal Cardiovascular Health” Metrics in a Rural, Cross‐sectional, Community‐Based Study: The Heart of New Ulm Project
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Grasdalsmoen, M., Engdahl, B., Fjeld, M. K., Steingrímsdóttir, Ó. A., Nielsen, C. S., Eriksen, H. R., Lønning, K. J., & Sivertsen, B. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235419 · Cited by 61
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Yan, H., Guo, J., Zhou, W., Dong, C., & Liu, J. L. (2021) · Psychology Health & Medicine · doi:10.1080/13548506.2021.1971725 · Cited by 53
“Smaller sample sizes may represent convenience sampling methods, which may be representative of a healthier population (Knudsen et al., 2010).”
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Comparing the sociodemographic characteristics of participants and non-participants in the population-based Tromsø Study
Vo, C. Q., Samuelsen, P., Sommerseth, H. L., Wisløff, T. F., Wilsgaard, T., & Eggen, A. E. (2023) · BMC Public Health · doi:10.1186/s12889-023-15928-w · Cited by 55
Cancer survivors who fully participate in the PROFILES registry have better health-related quality of life than those who drop out
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“However, associations are less vulnerable to bias caused by low participation rates than prevalence [103], and the associations between class membership and covariates may be considered valid despite a relatively low participation rate.”
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Changes in mental health problems and suicidal behaviour in students and their associations with COVID-19-related restrictions in Norway: a national repeated cross-sectional analysis
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“Results from very similar surveys conducted in Norway indicate that those who did not participate had higher level of some chronic health problems, higher mortality and prevalence of disability pension and lower socioeconomic status than participants did.(26) 28 Selective attrition may introduce bias in the longitudin…”
Result
Widespread pain and medically certified disability pension in the H ordaland H ealth S tudy
Øverland, S. N., Harvey, S. B., Knudsen, A. K., Mykletun, A., & Hotopf, M. H. (2011) · European Journal of Pain · doi:10.1016/j.ejpain.2011.08.005 · Cited by 46
“Common mental disorders like anxiety, depression and insomnia also predict disability pensions (Knudsen et al., 2010b; Mykletun et al., 2006; Overland et al., 2008; Sivertsen et al., 2009).”
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Seasonal Variations in Sleep Problems at Latitude 63 -65 in Norway: The Nord-Trondelag Health Study, 1995-1997
Sivertsen, B., Øverland, S. N., Krokstad, S., & Mykletun, A. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwr052 · Cited by 44
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Health problems account for a small part of the association between socioeconomic status and disability pension award. Results from the Hordaland Health Study
Østby, K. A., Ørstavik, R., Knudsen, A. K., Reichborn‐Kjennerud, T., & Mykletun, A. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-12 · Cited by 45
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ADHD, comorbid disorders and psychosocial functioning: How representative is a child cohort study? Findings from a national patient registry
Oerbeck, B., Øvergaard, K. R., Aspenes, S. T., Pripp, A. H., Mørdre, M., Aase, H., Reichborn‐Kjennerud, T., & Zeiner, P. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1204-7 · Cited by 45
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Prevalence of mental disorders among Norwegian college and university students: a population-based cross-sectional analysis
Sivertsen, B., Knudsen, A. K., Kirkøen, B., Skogen, J. C., Lagerstrøm, B. O., Lønning, K.-J., Kessler, R. C., & Reneflot, A. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100732 · Cited by 49
“While it has been shown that non-participants of health surveys generally have worse health than participants, 48 people may also be more prone to participate in a survey if the topic seems relevant to them personally.”
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Young people's overestimation of peer substance use: an exaggerated phenomenon?
Pape, H. (2012) · Addiction · doi:10.1111/j.1360-0443.2011.03680.x · Cited by 44
Trends in cardiovascular risk factors across levels of education in a general population: is the educational gap increasing? The Tromsø study 1994–2008
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Adult ADHD Symptoms and Satisfaction With Life: Does Age and Sex Matter?
Oerbeck, B., Øvergaard, K. R., Pripp, A. H., Aase, H., Reichborn‐Kjennerud, T., & Zeiner, P. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715612257 · Cited by 43
Depression in Persons with Diabetes by Age and Antidiabetic Treatment: A Cross-Sectional Analysis with Data from the Hordaland Health Study
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Lower Subjective Socioeconomic Status Is Associated With Increased Risk of Reporting Negative Experiences on Social Media. Findings From the “LifeOnSoMe”-Study
Skogen, J. C., Bøe, T., Finserås, T. R., Sivertsen, B., Hella, R. T., & Hjetland, G. J. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.873463 · Cited by 50
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“A previous study of the HUSK population showed higher risk of being awarded disability pension for neurotic, stressrelated or somatoform disorders as well as for diseases in the circulatory system among nonparticipants.(27) In general, non-participation represents a greater threat to the validity of results from studi…”
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Excess Mortality in Patients With Type 1 Diabetes Without Albuminuria—Separating the Contribution of Early and Late Risks
Groop, P., Thomas, M. C., Feodoroff, M., Forsblom, C. M., & Harjutsalo, V. (2018) · Diabetes Care · doi:10.2337/dc17-1618 · Cited by 40
Delayed sleep–wake phase disorder in young adults: prevalence and correlates from a national survey of Norwegian university students
Sivertsen, B., Harvey, A. G., Gradisar, M., Pallesen, S., & Hysing, M. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.09.028 · Cited by 43

Authors: Knudsen, A. K., Hotopf, M., Skogen, J. C., Overland, S., & Mykletun, A.
Affiliations: University of Bergen (NO)
Corresponding author: Knudsen, A. K.
ORCID: Knudsen, A. K.
Hotopf, M.
Skogen, J. C.
Mykletun, A.
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2010-09-15
Volume: 172
Issue: 11
Pages: 1306-1314
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/aje/kwq257
OpenAlex: W2163894459
Cited by: 322
References: 40
Citations by year: 2026: 6 · 2025: 19 · 2024: 13 · 2023: 19 · 2022: 26 · 2021: 23 · 2020: 21 · 2019: 24 · 2018: 11 · 2017: 15 · 2016: 20 · 2015: 26 · 2014: 28 · 2013: 29 · 2012: 27
FWCI: 73.33
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
Research Portal (King's College London) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Funders: National Institute for Health and Care Research (NF-SI-0507-10088)
Topics: Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Social Sciences › Health › Health disparities and outcomes
Keywords: non-participation, participation bias, Hordaland Health Study, disability pension, common mental disorders, substance abuse, psychosis, personality disorders, health status, prevalence studies, exposure-outcome association, research validity
MeSH terms: Adult, Mental Disorders, Community Participation, Diagnosis-Related Groups, Female, Health Status, Health Status Indicators, Humans, Male, Middle Aged, Musculoskeletal Diseases, Norway, Population Surveillance, Surveys and Questionnaires, Selection Bias, Prevalence, Sex Distribution, Insurance, Disability

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The Health Status of Nonparticipants in a Population-based Health Study: The Hordaland Health Study

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