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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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Coffee Consumption and Risk of Stroke in Women
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Self-Report as an Indicator of Incident Disease
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“Accurate reporting is more likely for diseases with clear and unambiguous criteria, a well-defined diagnosis that is easily communicated to the patient or required hospitalization (1, 4, 6, 8, 26, 33).”
InfluentialValidity of a Self-reported History of Doctor-diagnosed Angina
Lampe, F. C. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00146-2 · Cited by 168
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Long-term Ultraviolet Flux, Other Potential Risk Factors, and Skin Cancer Risk: A Cohort Study
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“However, we previously demonstrated high validity of the BCC self-reports, with more than 90% confirmed by pathology records (29, 30).”
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Sedentary Behaviors and the Risk of Incident Hypertension * The SUN Cohort
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“However, abundant evidence indicates that self-reported information about HTN diagnosis is valid for epidemiologic studies,(30) particularly among highly educated populations.(31) Given the high educational level of our participants and access to universal healthcare in the Spanish population, we can assume the validi…”
BackgroundSmoking and Risk of Hemorrhagic Stroke in Women
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Self-citationNightshift work and fracture risk: the Nurses’ Health Study
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“Validation studies of hypertension confirmed with a medical examination found a reasonable accuracy of self-reported information; a somewhat lower validity was usually found for self-reported hypercholesterolaemia (Colditz et al, 1986; Giles et al, 1995; Vargas et al, 1997; Martin et al, 2000).”
Simon, T. G., King, L. Y., Chong, D. Q., Nguyen, L. H., Ma, Y., VoPham, T., Giovannucci, E. L., Fuchs, C. S., Meyerhardt, J. A., Corey, K. E., et al. (2018) · Hepatology · doi:10.1002/hep.29660 · Cited by 160
“populations((15)) and previous studies have demonstrated that the anthropormophic and lifestyle covariates in these cohorts are comparable to the broader population.((23,24)) Second, this study may be subject to detection bias, if individuals with diabetes are more likely to receive medical attention and come under en…”
BackgroundMethodPOST-MENOPAUSAL HORMONE USE AND TOOTH LOSS: A PROSPECTIVE STUDY
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Long-Term Changes in Gut Microbial Metabolite Trimethylamine N-Oxide and Coronary Heart Disease Risk
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ResultFamily history and risk of breast cancer: nurses’ health study
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Self-citationRisk factors for mortality in the Nurses’ Health Study: a competing risks analysis
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“For example, women, older individuals and those with a higher educational or socio-economic level report more accurate BP values (Colditz et al. 1986; Goldman et al. 2003).”
BackgroundAlonso, Á., Beunza, J. J., Delgado‐Rodríguez, M., Martínez, J. A., & Martínez‐González, M. Á. (2005) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/82.5.972 · Cited by 151
“With regard to the validity of outcome ascertainment, abundant evidence indicates that selfreported information about a hypertension diagnosis is valid for epidemiologic studies (36), particularly in highly educated populations (37).”
BackgroundProspective Study of Snoring and Risk of 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 (20).”
BackgroundResultSelf-citationFurther Insight Into the Cardiovascular Risk Calculator
Cook, N. R., & Ridker, P. M. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5336 · Cited by 149
A prospective study of cardiovascular risk factors and incident hearing loss in men
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“Self-reported hypertension has previously been validated in this cohort.(9,10)”
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Walking Versus Running for Hypertension, Cholesterol, and Diabetes Mellitus Risk Reduction
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“Participants were asked to report physician-diagnosed hypertension, which has been shown to be reliably reported [38, 39].”
BackgroundSelf-citationNonnarcotic Analgesic Use and the Risk of Hypertension in US Women
Dedier, J., Stampfer, M. J., Hankinson, S. E., Willett, W. C., Speizer, F. E., & Curhan, G. C. (2002) · Hypertension · doi:10.1161/01.hyp.0000035856.77718.da · Cited by 145
Self-citationMilk, dietary calcium, and bone fractures in women: a 12-year prospective study.
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“Although self-report items of history of cardiovascular health are limited, prior studies have found high levels of recall accuracy of cardiovascular health history (Colditz et al., 1986; Harlow & Linet, 1989).”
ResultSurvival after squamous cell and basal cell carcinoma of the skin: A retrospective cohort analysis
Rees, J. R., Zens, M. S., Celaya, M. O., et al. (2015) · International Journal of Cancer · doi:10.1002/ijc.29436 · Cited by 142
Nephrolithiasis and risk of hypertension in women
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Self-citationHealth Care System Changes and Reported Musculoskeletal Disorders Among Registered Nurses
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“These include specific fatty acids obtained primarily from dairy fat including the odd-chain saturated fats pentadecanoic acid (15:0) and heptadecanoic acid (17:0)(7,8) and the natural ruminant trans fat trans-palmitoleate (t-16:1n-7).(9) These fatty acids are not endogenously synthesized and are obtained only from di…”
Self-citationRelation of moderate alcohol consumption and risk of systemic hypertension in women
Witteman, J. C. M., Willett, W. C., Stampfer, M. J., Colditz, G. A., Kok, F. J., Sacks, F. M., Speizer, F. E., ROSNER, B. A., & Hennekens, C. H. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)91043-6 · Cited by 139
Self-citationSteffen, M., Kuhle, C., Hensrud, D., Erwin, P. J., & Murad, M. H. (2012) · Journal of Hypertension · doi:10.1097/hjh.0b013e3283588d73 · Cited by 139
“Self-reported HTN and BP measurements were validated in the NHS and Johns Hopkins medical student cohorts [28,29]; however, this may not be translatable to other populations.”
MethodDASH-Style Diet and 24-Hour Urine Composition
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Self-citationKidney Dysfunction, Inflammation, and Coronary Events
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Self-citationAssociation of Sleep Duration and Hypertension Among US Adults Varies by Age and Sex
Fang, J., Wheaton, A. G., Keenan, N. L., Greenlund, K. J., Perry, G., & Croft, J. B. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2011.201 · Cited by 136
Folate Intake and the Risk of Incident Hypertension Among US Women
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“In a subset of women who reported hypertension, medical record review confirmed a documented systolic and diastolic blood pressure higher than 140 and 90 mm Hg, respectively, in 100% and higher than 160 mm Hg and 95 mm Hg in 77%; additionally, self-reported hypertension was predictive of subsequent cardiovascular even…”
BackgroundLewis, J. R., Zhu, K., & Prince, R. L. (2011) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.1484 · Cited by 138
“identified a self-reported false positive rate for MI of 32% in the Women’s Health Initiative, while Colditz et al.((1)) found that 32% of participants in the Nurses Health Study were incorrect in their belief that they had sustained an MI.”
ResultEfficient Replication of over 180 Genetic Associations with Self-Reported Medical Data
Tung, J. Y., Do, C. B., Hinds, D. A., Kiefer, A. K., Macpherson, J. M., Chowdry, A. B., Francke, U., Naughton, B., Mountain, J. L., Wojcicki, A., et al. (2011) · PLoS ONE · doi:10.1371/journal.pone.0023473 · Cited by 132
“First, there tends to be good concordance for well-defined and easily diagnosed diseases and for chronic conditions that require repeated medical follow-up (kappa ranging from 0.71–0.80 for diabetes, hypertension, myocardial infarction, and stroke) [4– 9].”
BackgroundInfluentialDiet-Dependent Net Acid Load and Risk of Incident Hypertension in United States Women
Zhang, L., Curhan, G. C., & Forman, J. P. (2009) · Hypertension · doi:10.1161/hypertensionaha.109.135582 · Cited by 132
A comparison of interview data and medical records for previous medical conditions and surgery
Linet, M. S., Harlow, S. D., McLaughlin, J. K., & McCaffrey, L. (1989) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(89)90119-4 · Cited by 133
Excess Weight and the Risk of Incident Coronary Heart Disease Among Men and Women
Flint, A. J., Hu, F. B., Glynn, R. J., Caspard, H., Manson, J. E., Willett, W. C., & Rimm, E. B. (2010) · Obesity · doi:10.1038/oby.2009.223 · Cited by 134
Self-citationVitamin D Intake and Risk of Incident Hypertension
Forman, J. P., Bischoff-Ferrari, H. A., Willett, W. C., Stampfer, M. J., & Curhan, G. C. (2005) · Hypertension · doi:10.1161/01.hyp.0000182662.82666.37 · Cited by 133
“Self-reported hypertension was shown to be highly reliable in NHS I and HPFS. 21,22 In a subset of women who reported hypertension, medical record review confirmed a documented systolic and diastolic blood pressure (cid”
BackgroundSelf-citationValidity of Pharmacoepidemiologic Drug and Diagnosis Data
West, S. L., Strom, B. L., & Poole, C. (2006) · Pharmacoepidemiology · doi:10.1002/9780470059876.ch45 · Cited by 134
Long-Term Change in Diet Quality Is Associated with Body Weight Change in Men and Women
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Self-citationSimino, J. M., Shi, G., Bis, J. C., Chasman, D. I., Ehret, G., Gu, X., Guo, X., Hwang, S., Sijbrands, E. J. G., Smith, A. V., et al. (2014) · The American Journal of Human Genetics · doi:10.1016/j.ajhg.2014.05.010 · Cited by 133
Smoking and suicide among nurses.
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Self-citationWhole- and refined-grain intakes and the risk of hypertension in women
Wang, L., Gaziano, J. M., Liu, S., Manson, J. E., Buring, J. E., & Sesso, H. D. (2007) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/86.2.472 · Cited by 129
“Yet the validity of self-reported hypertension in health professionals was high in previous studies (40, 41).”
BackgroundBatty, G. D., Deary, I. J., Schoon, I., & Gale, C. R. (2007) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2006.054494 · Cited by 129
A Prospective Study of Hypertension and Risk of Uterine Leiomyomata
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“Self-reported hypertension was found to be reliable in a validation study conducted in 1983 among women in a similar cohort— Nurse’s Health Study I (67).”
MethodAssociation Between Social Integration and Suicide Among Women in the United States
Tsai, A. C., Lucas, M., & Kawachi, I. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.1002 · Cited by 127
“We also adjusted our estimates for the following time-updated covariates: employment status (46), family history of alcoholism, body mass index (47, 48), weekly physical activity (49), alcohol intake (50), caffeine intake (51-53), smoking status (54), and history of hypertension, diabetes mellitus, or hypercholesterol…”
ResultTu, K., Mitiku, T., Lee, D. S., Guo, H., & Tu, J. V. (2010) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(10)70412-8 · Cited by 127
“However, this poor sensitivity may not be a result of the inability of administrative data to identify patients with this disease but, rather, inaccuracies of self-report (10).”
BackgroundHigher Levels of Albuminuria within the Normal Range Predict Incident Hypertension
Forman, J. P., Fisher, N. D. L., Schopick, E. L., & Curhan, G. C. (2008) · Journal of the American Society of Nephrology · doi:10.1681/asn.2008010038 · Cited by 127
Whole grains and incident hypertension in men.
Flint, A. J., Hu, F. B., Glynn, R. J., Jensen, M. K., Franz, M., Sampson, L., & Rimm, E. B. (2009) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.27460 · Cited by 126
“Information on potential confounding factors, including medical history, food, and nutrient intake, and lifestyle behaviors that could influence the relation between whole-grain intake and hypertension were gathered from the 1986 baseline and updated on subsequent follow-up surveys by using validated measures (16).”
BackgroundMethodSelf-citationSildenafil Use and Increased Risk of Incident Melanoma in US Men
Li, W., Qureshi, A. A., Robinson, K. C., & Han, J. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.594 · Cited by 126
Association of Sweetened Beverage Intake with Incident Hypertension
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“Self-reported hypertension has been shown to be highly reliable in the HPFS and NHS I(15): in a subset of HPFS participants who reported hypertension, medical record review confirmed a documented systolic and diastolic BP>140 and 90 mmHg, respectively, in 100 %; among the NHS I women, 100 % of a subset who reported hy…”
ResultVarraso, R., Willett, W. C., & Camargo, C. A. (2010) · American Journal of Epidemiology · doi:10.1093/aje/kwp455 · Cited by 125
Self-citationUric Acid and Insulin Sensitivity and Risk of Incident Hypertension
Forman, J. P., Choi, H. K., & Curhan, G. C. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2008.521 · Cited by 124
“05) Triglycerides Median (range), mg/dL Per 20 mg/dL 48 (12-58) 68 (59-78) 92 (79-109) 143 (110-580) No.”
Racial Discrimination and the Incidence of Hypertension in US Black Women
Cozier, Y. C., Palmer, J. R., Horton, N. J., Fredman, L., Wise, L. A., & Rosenberg, L. A. (2006) · Annals of Epidemiology · doi:10.1016/j.annepidem.2005.11.008 · Cited by 125
Nut consumption and risk of hypertension in US male physicians
Djoussé, L., Rudich, T., & Gaziano, J. M. (2008) · Clinical Nutrition · doi:10.1016/j.clnu.2008.08.005 · Cited by 128
Hypertension in adult survivors of child abuse: observations from the Nurses' Health Study II
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Fruit and Vegetable Intake and the Risk of Hypertension in Middle-Aged and Older Women
Wang, L., Manson, J. E., Gaziano, J. M., Buring, J. E., & Sesso, H. D. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2011.186 · Cited by 127
Agreement Between Patient Reports of Cardiovascular Disease and Patient Medical Records
Sauver, J. L. S., Hagen, P. T., Cha, S. S., Bagniewski, S. M., Mandrekar, J. N., Curoe, A. M., Rodeheffer, R. J., Roger, V. L., & Jacobsen, S. J. (2005) · Mayo Clinic Proceedings · doi:10.4065/80.2.203 · Cited by 124
A prospective study of selenium status and breast cancer risk
Hunter, D. J. (1990) · JAMA · doi:10.1001/jama.264.9.1128 · Cited by 124
Wu, S., Cho, E., Li, W., Weinstock, M. A., Han, J., & Qureshi, A. A. (2016) · American Journal of Epidemiology · doi:10.1093/aje/kwv282 · Cited by 123
“However, a high accuracy of self-reported BCC among subsets of cohort participants has been demonstrated in previous validation studies, with approximately 90% being confirmed by histopathological findings or medical records (23, 24).”
Angiotensin-converting enzyme inhibitors and the risk of cancer
Friis, S., Sørensen, H. T., Mellemkjøer, L., McLaughlin, J. K., Nielsen, G. L., Blot, W. J., & Olsen, J. H. (2001) · Cancer · doi:10.1002/1097-0142(20011101)92:9 · Cited by 156
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“Self-report of angina or myocardial infarction appears to be reasonably valid in men (25) but less accurate in women (26) when comparisons are made against medical records.”
BackgroundA Prospective Study of Plasma Lipid Levels and Hypertension in Women
Sesso, H. D. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.20.2420 · Cited by 126
“potential limitation, we performed a separate study in which an 86% validation rate for self-reported hypertension was observed, consistent with other studies.(42,43) Sensitivity analyses considering various definitions of hypertension also yielded consistent RRs for increasing levels of each lipid variable.”
Resultthe Millennium Cohort Study Team, Smith, B., Chu, L. K., Smith, T. C., Amoroso, P. J., Boyko, E. J., Hooper, T. I., Gackstetter, G. D., & Ryan, M. A. K. (2008) · BMC Medical Research Methodology · doi:10.1186/1471-2288-8-37 · Cited by 121
Coffee consumption and risk of incident gout in women: the Nurses’ Health Study
Choi, H. K., & Curhan, G. C. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2010.29565 · Cited by 122
Physical Activity and Cardiovascular Disease Risk in Middle-aged and Older Women
Sesso, H. D., Paffenbarger, R. S., Ha, T., & Lee, I.-M. M. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010020 · Cited by 121
“We expect that self-reported data on coronary risk factors among this cohort of women were valid and reliable, as demonstrated in several studies of women (31-34).”
ResultLead and hypertension in a sample of middle-aged women.
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Self-citationPrevalence of Osteoporosis by Educational Level in a Cohort of Postmenopausal Women
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“Even thoughself-reportdiagnoseshave been shown to be valid [27], the level of formal educationcould bias the report abouthabitsand health practices.”
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Obesity, Weight Gain, and Ovarian Cancer
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Self-citationInternational food group–based diet quality and risk of coronary heart disease in men and women
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“The NHS cohort began in 1976 and is comprised of women nurses who were 35–55 y old at the time (13).”
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“Second, NMSC outcome was based on particpant self-report, and cases were not adjudicated; however, several studies have found self-reported skin cancer to be highly accurate.(48,49) We lacked information on specific types of NMSC in this study; thus, we cannot determine if there was a differential effect of CaD supple…”
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“The methodological literature also indicates a high degree of accuracy of self-reported physician diagnosed hypertension [68, 69].”
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“The selfreports of the latter two conditions were shown to be highly valid in an earlier study (19).”
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Self-citationAntihypertensive Medications and the Risk of Incident Type 2 Diabetes
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Alcohol Intake and Risk of Incident Psoriasis in US Women
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“Previous validation studies in the NHS for another skin condition, basal cell carcinoma, found self-reports to be greater than 90% accurate.(31,32) Furthermore, in the subset of confirmed psoriasis cases, we found a stronger association between risk of incident psoriasis and overall alcohol intake as well as nonlight…”
Validity of Self-Reports of Fractures in Perimenopausal Women
Honkanen, K., Honkanen, R., Heikkinen, L. B., Kröger, H., & Saarikoski, S. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a010040 · Cited by 109
“Some of these studies also include a review of fractures; these studies indicate both accurate reporting (6-8) and underreporting of fractures (9).”
BackgroundPhysical activity and breast cancer risk in the College Alumni Health Study (United States)
Sesso, H. D., Lee, I.-M. M., & Paffenbarger, R. S. (1998) · Cancer Causes & Control · doi:10.1023/a:1008827903302 · Cited by 107
“In another prospective study of women of similar socioeconomic status and educational background, self-reports of breast cancer were con®rmed in over 90 percent of cases.(40) Deaths were compiled continuously by the University of Pennsylvania alumni of®ce, which maintains a weekly listing of deceased alumnae with less…”
BackgroundProspective Associations between Somatic Illness and Mental Illness from Childhood to Adulthood
Cohen, P. R., Pine, D. S., Must, A., Kasen, S., & Brook, J. S. (1998) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009442 · Cited by 108
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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