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VALIDATION OF QUESTIONNAIRE INFORMATION ON RISK FACTORS AND DISEASE OUTCOMES IN A PROSPECTIVE COHORT STUDY OF WOMEN
Abstract
To assess the validity of self-reported illnesses, medical records were reviewed for participants reporting major illnesses on the biennial follow-up questionnaires used in a prospective cohort study which began in 1976. In over 90% of cases of cancer of the breast, skin, large bowel, and thyroid, histopathology reports confirmed the subjects' self-report. Lower levels of confirmation were obtained for cancers of the lung, ovary, and uterus. Application of strict diagnostic criteria also gave lower levels of confirmation for myocardial infarction (68%) and stroke (66%). Among random samples of women reporting fractures and hypertension all records obtained confirmed self-reports. For self-reported elevated cholesterol levels 85.7% of self-reports were confirmed. Self-report is a valuable epidemiologic tool but may require additional documentation when the disease is diagnostically complex.
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“The moderately increased lung and colorectal cancer mortality among women with ≥15 years of night shift work is consistent with previous reports on the risk of developing incident lung and colorectal among night shift–working women in the same cohort.58,59”
From Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts (2015) · cites this paper as [59]
In the citing paper
“Of 85 women we sampled from NHS who had reported high blood pressure and responded to a validation questionnaire, only one denied elevated blood pressure (reporting that she in fact had hypotension).(21) Self reported hypertension was found to have high vaildity compared to the medical records. Of 51 women who reported hypertension for whom we were able to obtain medical records, hypertension (bl”
From Infertility, fertility treatment, and risk of hypertension (2015) · cites this paper as [21]
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Vitamin E Consumption and the Risk of Coronary Disease in Women
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Self-citationPostmenopausal Estrogen Therapy and Cardiovascular Disease
Stampfer, M. J., Colditz, G. A., Willett, W. C., Manson, J. E., ROSNER, B. A., Speizer, F. E., & Hennekens, C. H. (1991) · New England Journal of Medicine · doi:10.1056/nejm199109123251102 · Cited by 2,000
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Self-citationImpact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period
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BackgroundSelf-citationAdherence to a DASH-Style Diet and Risk of Coronary Heart Disease and Stroke in Women
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Self-citationRotating night shifts and risk of breast cancer in women participating in the nurses׳ health study
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“To address this potential limitation, we performed a separate study in which an 86% validation rate for selfreported hypertension was observed, consistent with other studies.(36,37) For example, in a comparable population in the Nurses’ Health Study, 99% of women who reported high BP confirmed their diagnosis based on…”
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Self-citationPlasma 25-Hydroxyvitamin D Levels and Risk of Incident Hypertension
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Self-citationNight-Shift Work and Risk of Colorectal Cancer in the Nurses' Health Study
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Self-citationA prospective study of nutritional factors and hypertension among US men.
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Self-citationAlcohol Consumption and Mortality among Women
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Self-citationBody Weight, Weight Change, and Risk for Hypertension in Women
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“The validity of self-reported diagnosis of hypertension was assessed in a random sample of 100 nurses who had reported a diagnosis of high blood pressure on the 1982 questionnaire (14).”
BackgroundSelf-citationBirth Weight and Adult Hypertension and Obesity in Women
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Self-citationAssociation between obesity and kidney disease: A systematic review and meta-analysis
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BackgroundIndependent Impact of Gout on Mortality and Risk for Coronary Heart Disease
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Self-citationRelative and Absolute Excess Risks of Coronary Heart Disease among Women Who Smoke Cigarettes
Willett, W. C., Green, A. C., Stampfer, M. J., Speizer, F. E., Colditz, G. A., ROSNER, B. A., Monson, R. R., Stason, W. B., & Hennekens, C. H. (1987) · New England Journal of Medicine · doi:10.1056/nejm198711193172102 · Cited by 608
Self-citationSweetened beverage consumption and risk of coronary heart disease in women
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“The validity of self-reported hypertension has been documented [27].”
BackgroundSelf-citationOrigin, Methods, and Evolution of the Three Nurses’ Health Studies
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Self-citationThe Impact of Diabetes Mellitus on Mortality From All Causes and Coronary Heart Disease in Women
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“The confirmation of self-reported MI through medical record review according to strict diagnostic criteria was approximately 68% before 1984.(7) This increased to 82% between 1990 and 1996 (unpublished data).”
MethodSelf-citationBody mass index and the risk of stroke in men
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Self-citationAssociation Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women
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“34,35 The exposure assessments lacked information on intensity of night shift work and physiological measures that may be affected by shift work.”
BackgroundSelf-citationMenstrual cycle irregularity and risk for future cardiovascular disease
Solomon, C. G., Hu, F. B., Dunaif, A., Rich-Edwards, J. E., Stampfer, M. J., Willett, W. C., Speizer, F. E., & Manson, J. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.5.8471 · Cited by 528
“Prior validation studies in the cohort have confirmed a high accuracy of self-report for such variables as body weight (13), diabetes mellitus (14), and hypertension and hypercholesterolemia (15).”
MethodSelf-citationHabitual intake of flavonoid subclasses and incident hypertension in adults
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“The limitations of the current study include that the blood pressures of participants were not directly measured, and the diagnosis of hypertension was self-reported; however, all participants were health professionals, and hypertension reporting by participants of these cohorts was highly sensitive (19).”
BackgroundSelf-citationWalking and Leisure-Time Activity and Risk of Hip Fracture in Postmenopausal Women
Feskanich, D. (2002) · JAMA · doi:10.1001/jama.288.18.2300 · Cited by 501
“Specificity was demonstrated in a small validation study in which all 30 reported hip fractures were confirmed by medical records.(19)”
BackgroundDietary Patterns, Meat Intake, and the Risk of Type 2 Diabetes in Women
Fung, T. T., Schulze, M. B., Manson, J. E., Willett, W. C., & Hu, F. B. (2004) · Archives of Internal Medicine · doi:10.1001/archinte.164.20.2235 · Cited by 492
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Self-citationNight work and risk of breast cancer
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“Indeed, in a small validation study of 30 reported hip fractures, medical records confirmed all reports.(14)”
BackgroundAssociation between body mass index and CKD in apparently healthy men.
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“We inquired about physician-diagnosed hypertension and high cholesterol every 2 years; these self-reports were highly accurate compared with medical records in a validation study (25).”
MethodSelf-citationModerate Alcohol Consumption and the Risk of Breast Cancer
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Self-citationMethods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study
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Self-citationValidation of diagnostic codes within medical services claims
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BackgroundC-reactive protein and the risk of developing hypertension
Sesso, H. D., Buring, J. E., Rifai, N., Blake, G., Gaziano, J. M., & Ridker, R. M. (2004) · ACC Current Journal Review · doi:10.1016/j.accreview.2004.02.025 · Cited by 430
Prospective Study of Adult Onset Diabetes Mellitus (Type 2) and Risk of Colorectal Cancer in Women
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Self-citationProspective Study of Nutritional Factors, Blood Pressure, and Hypertension Among US Women
Ascherio, A., Hennekens, C. H., Willett, W. C., Sacks, F. M., ROSNER, B. A., Manson, J. E., Witteman, J. C. M., & Stampfer, M. J. (1996) · Hypertension · doi:10.1161/01.hyp.27.5.1065 · Cited by 403
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“In a similar population of the Nurses’ Health Study, these self-reported covariates were found to be reasonable valid in a validation study of this cohort [20].”
Migraine, headache, and the risk of stroke in women
Kurth, T., Slomke, M. A., Kase, C. S., Cook, N. R., Lee, I.-M. M., Gaziano, J. M., Diener, H., & Buring, J. E. (2005) · Neurology · doi:10.1212/01.wnl.0000154528.21485.3a · Cited by 380
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Self-citationRisk of symptomatic gallstones in women with severe obesity
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Self-citationDASH-Style Diet Associates with Reduced Risk for Kidney Stones
Taylor, E. N., Fung, T. T., & Curhan, G. C. (2009) · Journal of the American Society of Nephrology · doi:10.1681/asn.2009030276 · Cited by 366
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Excess mortality after hip fracture in elderly persons from Europe and the USA : the CHANCES project
Katsoulis, M., Benetou, V., Karapetyan, T., Feskanich, D., Grodstein, F., Pettersson, U., Eriksson, S., Wilsgaard, T., Jørgensen, L., Ahmed, L. A., et al. (2017) · Journal of Internal Medicine · doi:10.1111/joim.12586 · Cited by 360
Measures of Obesity and Cardiovascular Risk Among Men and Women
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“In a small validation study, all 30 reported hip fractures were confirmed by medical records (39).”
BackgroundSelf-citationBergmann, M., Byers, T., Freedman, D. S., & Mokdad, A. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009387 · Cited by 372
“Earlier studies (5, 7) have shown that when cancer sites are closely related (e.”
BackgroundResultInfluentialLow-Carbohydrate Diets and All-Cause and Cause-Specific Mortality
Fung, T. T., van Dam, R. M., Hankinson, S. E., Stampfer, M. J., Willett, W. C., & Hu, F. B. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-153-5-201009070-00003 · Cited by 364
“Questionnaires are sent biennially to collect medical, lifestyle, and other healthrelated information (19).”
BackgroundSelf-citationDyslipidemia and the Risk of Incident Hypertension in Men
Halperin, R. O., Sesso, H. D., Ma, J., Buring, J. E., Stampfer, M. J., & Gaziano, J. M. (2005) · Hypertension · doi:10.1161/01.hyp.0000196306.42418.0e · Cited by 347
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“Although the use of self-reported risk factors is not ideal in research settings, they have been shown to provide a valid assessment of study participants’ overall risk profiles (40), particularly in well-educated populations (41).”
BackgroundIntervening on risk factors for coronary heart disease: an application of the parametric g-formula.
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Prospective Study of Diabetes and Risk of Hip Fracture
Janghorbani, M., Feskanich, D., Willett, W. C., & Hu, F. B. (2006) · Diabetes Care · doi:10.2337/dc06-0440 · Cited by 342
“Hip fracture was based on self-report, although the validity has been shown to be high (26).”
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Prospective Study of Oral Contraceptives and Hypertension Among Women in the United States
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Self-rated health and survival: a 7-year follow-up study of Australian elderly.
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Body Size and 24-Hour Urine Composition
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A Prospective Study of Cigarette Smoking and Risk of Incident Hypertension in Women
Bowman, T. S., Gaziano, J. M., Buring, J. E., & Sesso, H. D. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.08.017 · Cited by 330
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Self-citationA Prospective Study of Cigarette Smoking and the Risk of Pancreatic Cancer
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“Validation against medical records has also shown that hypertension is accurately self-reported by HPFS participants,(22) and although the soundness of self-reported hypercholesterolemia has not been assessed in the HPFS, it has been successfully validated in a cohort of nurses using the same biennial questionnaire.(2…”
Low glycaemic diets alter lipid metabolism to influence tumour growth
Lien, E. C., Westermark, A. M., Zhang, Y., Yuan, C., Li, Z., Lau, A. N., Sapp, K. M., Wolpin, B. M., & Heiden, M. G. V. (2021) · Nature · doi:10.1038/s41586-021-04049-2 · Cited by 323
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Cigarette Smoking and Risk of Stroke in Middle-Aged Women
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Self-citationThe Effect of Parental History of Myopia on Children's Eye Size
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“Sources of measurement error pertinent to the patient and patient survey methods include: (1) recall bias with respect to time period (ie, telescoping, or recalling an event as happening more recently than it did);(11,29) (2) response bias due to sensitive items (eg, weight);(5) (3) patient definitions or perceptions…”
MethodHealthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women
Chomistek, A. K., Chiuve, S. E., Eliassen, A. H., Mukamal, K. J., Willett, W. C., & Rimm, E. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.024 · Cited by 283
“However, reporting of hypertension and hypercholesterolemia has previously been found to be fairly reliable in this and a similar population (35,36), with 94% of self-reported cases of hypertension and 86% of self-reported cases of hypercholesterolemia confirmed by medical records.”
Self-citationProtein Consumption and Bone Fractures in Women
Feskanich, D., Willett, W. C., Stampfer, M. J., & Colditz, G. A. (1996) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a008767 · Cited by 280
Self-citation
Metadata
- Authors
- COLDITZ, G. A., MARTIN, P., STAMPFER, M. J., WILLETT, W. C., SAMPSON, L., ROSNER, B., HENNEKENS, C. H., & SPEIZER, F. E.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- COLDITZ, GRAHAM A.
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1986-05
- Volume
- 123
- Issue
- 5
- Pages
- 894-900
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W1958805324
- Cited by
- 992
- References
- 0
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 19 · 2023: 25 · 2022: 23 · 2021: 17 · 2020: 27 · 2019: 22 · 2018: 32 · 2017: 40 · 2016: 49 · 2015: 48 · 2014: 40 · 2013: 36 · 2012: 45
- FWCI
- 35.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL24074, HL34594)
- National Cancer Institute (CA-16686)
- Topics
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- questionnaire validation, self-reported illness, breast cancer, skin cancer, thyroid cancer, lung cancer, ovarian cancer, uterine cancer, myocardial infarction, stroke, fracture, hypertension, cholesterol levels, women, risk factors, disease outcome
- MeSH terms
- Adult, Blood Pressure, Cardiovascular Diseases, Cholesterol, Epidemiologic Methods, Female, Follow-Up Studies, Humans, Hypertension, Medical Records, Middle Aged, Morbidity, Neoplasms, Surveys and Questionnaires, United States, Fractures, Bone
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