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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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Self-citationCohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma
Kang, J. H., VoPham, T., Laden, F., et al. (2020) · Journal of Glaucoma · doi:10.1097/ijg.0000000000001496 · Cited by 13
Self-citationTen-year changes in plasma L-carnitine levels and risk of coronary heart disease
Heianza, Y., Ma, W., DiDonato, J. A., Sun, Q., Rimm, E. B., Hu, F. B., Rexrode, K. M., Manson, J. E., & Qi, L. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02713-x · Cited by 13
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ResultHeart Trouble and Racial Group Identity: Exploring Ethnic Heterogeneity Among Black Americans
Dagadu, H. E., & Christie‐Mizell, C. A. (2013) · Race and Social Problems · doi:10.1007/s12552-013-9109-7 · Cited by 14
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ResultBaron, M., Schieir, O., Hudson, M., et al. (2009) · Lara D. Veeken · doi:10.1093/rheumatology/ken504 · Cited by 13
Personal history of gallstones and risk of incident psoriasis and psoriatic arthritis in U.S. women
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Assessing discomfort after anaesthesia: should you ask the patient or read the record?
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MethodPredicting work disability among people with chronic conditions: a prospective cohort study
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Nash, S. H., Day, G. M., Hiratsuka, V. Y., Zimpelman, G. L., & Koller, K. R. (2019) · International Journal of Circumpolar Health · doi:10.1080/22423982.2019.1571383 · Cited by 12
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BackgroundPancreatic cancer is associated with medication changes prior to clinical diagnosis
Zhang, Y., Wang, Q.-L., Yuan, C., Lee, A. A., Babić, A., Ng, K., Perez, K. J., Nowak, J. A., Lagergren, J., Stampfer, M. J., et al. (2023) · Nature Communications · doi:10.1038/s41467-023-38088-2 · Cited by 12
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Self-citationDietary Carbohydrate Intake, Carbohydrate Quality, and Healthy Aging in Women
Korat, A. V. A., Duscova, E., Shea, M. K., Jacques, P. F., Sebastiani, P., Wang, M., Mahdavi, S. M., Eliassen, A. H., Willett, W. C., & Sun, Q. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.11056 · Cited by 11
Self-citationLiao, X., Zhou, X., Wang, M., Hart, J. E., Laden, F., & Spiegelman, D. L. (2017) · Journal of the Royal Statistical Society Series C (Applied Statistics) · doi:10.1111/rssc.12229 · Cited by 11
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Paik, J. M., Rosen, H. N., Gordon, C. M., et al. (2018) · Calcified Tissue International · doi:10.1007/s00223-018-0432-2 · Cited by 11
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Role of chronic health disorders in perimenopausal fractures
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“Details regarding the ascertainment and validation of lifestyle factors in this cohort have been described.[18,21] Briefly, height, body weight, smoking, and physical activity were self-reported on validated biennial questionnaires at baseline and updated every 2 years, with high validity and reproducibility that have…”
MethodSelf-citationWu, Y., Kim, H., Wang, K., et al. (2023) · European Journal of Epidemiology · doi:10.1007/s10654-023-01018-z · Cited by 10
“The NHS was established in 1976 when 121,701 female nurses aged 30–55 years returned the initial questionnaire [13].”
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“The results are as follows: Consumption in the Netherlands is expected to rise by 61% by 2090, according to demographic and gender projections (Colditz et al., 1986).”
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“Hypertension and hypercholesterolemia were self-reported, with the validity of these reports confirmed on random sampling of medical records (22).”
BackgroundAssociation of smoking with risk of stroke in middle-aged and older Chinese
Gan, Y., Wu, J., Li, L., Zhang, S., Yang, T., Tan, S., Mkandawire, N., Zhong, Y., Jiang, J., Wang, Z., et al. (2018) · Medicine · doi:10.1097/md.0000000000013260 · Cited by 11
“In several validation studies, however, self-report of smoking([29]) and other cardiovascular risk factors were reliable.([30]) Thirdly, the studywas carried out inmiddle-aged and older Chinese adults; therefore, our results may not be generalized to the populations of all ages, other poor regions, or other ethnicitie…”
ResultMilk Consumption for the Prevention of Fragility Fractures
Byberg, L., & Lemming, E. W. (2020) · Nutrients · doi:10.3390/nu12092720 · Cited by 11
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Huang, T., Redline, S. S., Gordon, C. M., Schernhammer, E. S., Curhan, G. C., & Paik, J. M. (2022) · Sleep Health · doi:10.1016/j.sleh.2021.11.011 · Cited by 10
History of Diverticulitis and Risk of Incident Cardiovascular Disease in Men: A Cohort Study
Tam, I., Liu, P., Ma, W., Cao, Y., Jovani, M., Wu, K., Rimm, E. B., Strate, L. L., Giovannucci, E. L., & Chan, A. T. (2021) · Digestive Diseases and Sciences · doi:10.1007/s10620-021-06949-9 · Cited by 9
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“The Nurses’ Health Study reported that although 32% of participant-reported myocardial infarctions could not be confirmed using strict World Health Organization criteria (symptoms and either typical electrocardiogram changes or elevations of serum cardiac enzyme levels), most were nevertheless hospitalizations for car…”
BackgroundIncreased Odds of Melanoma: Parkinson's Disease, Essential Tremor, Dystonia versus Controls
Shalaby, S. Y., & Louis, E. D. (2016) · Neuroepidemiology · doi:10.1159/000443794 · Cited by 10
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“However, as the participants in this study were registered nurses, the validity of their reports is expected to be high, as shown in previous validation studies [24,25].”
ResultSelf-citationLe lien entre le lieu de naissance et certaines caractéristiques de santé en Ontario
Pomerleau, J., & Østbye, T. (1997) · Canadian Journal of Public Health · doi:10.1007/bf03403902 · Cited by 10
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“58 The second limitation is the risk of bias in many of the studies.”
Gentry‐Maharaj, A., Fourkala, E., Burnell, M., Ryan, A., Apostolidou, S., Habib, M., Sharma, A., Parmar, M., Jacobs, I. J., & Menon, U. (2013) · British Journal of Cancer · doi:10.1038/bjc.2013.626 · Cited by 9
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BackgroundInfluentialPolygenic risk score of shorter telomere length and risk of depression and anxiety in women
Chang, S., Prescott, J., Vivo, I. D., Kraft, P. L., & Okereke, O. I. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.05.021 · Cited by 10
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Concordance between Sources of Morbidity Reports: Self-Reports and Medical Records
Jones, M. P., Bartrop, R. W., Dickson, H. G., et al. (2011) · Frontiers in Pharmacology · doi:10.3389/fphar.2011.00016 · Cited by 9
“Our results stand in some contrast to some other work which showed much higher rates of subject–record concordance, including that of Colditz et al. (1986) which found rates between 68 and 90% and Barr et al. (2009) who found 68% agreement for cardiovascular disease events.”
BackgroundResultMultivitamin use and the risk of hypertension in a prospective cohort study of women
Rautiainen, S., Wang, L., Lee, I.-M. M., Manson, J. E., Gaziano, J. M., Buring, J. E., & Sesso, H. D. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000973 · Cited by 9
“60) and hypertension that was confirmed with medical record review in a subsample of women and men [28,29] among health professionals has been estimated to be moderately high [29,30].”
BackgroundHeight, height-related SNPs, and risk of non-melanoma skin cancer
Li, X., Liang, L., Feng, Y. A., Vivo, I. D., Giovannucci, E. L., Tang, J. Y., & Han, J. (2016) · British Journal of Cancer · doi:10.1038/bjc.2016.366 · Cited by 9
“However, the high validity of self-reported BCC in these medically sophisticated populations has been confirmed in previous studies (Colditz et al, 1986).”
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Jiménez, M. C., Sun, Q., Schürks, M., Hu, F. B., Manson, J. E., & Rexrode, K. M. (2013) · Clinical Chemistry · doi:10.1373/clinchem.2013.212597 · Cited by 9
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Rheumatoid arthritis: A commonly misused diagnosis by the general population
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Incident Hypercholesterolemia in Relation to Changes in Vigorous Physical Activity
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“The analyses are based on selfreported running distances and physician diagnosis of hypercholesterolemia, which, despite their validation and use in other epidemiological studies (1), could bias the results.”
Understanding self-perceived health in the elderly
Ongaro, F., & Salvini, S. (1995) · European Journal of Population / Revue européenne de Démographie · doi:10.1007/bf01264908 · Cited by 9
Liu, B., Wang, Y., Hu, Y., Wan, Y., Zhang, C., Rimm, E. B., Hu, F. B., & Sun, Q. (2025) · Diabetes Care · doi:10.2337/dc25-1401 · Cited by 8
Longitudinal Study of Analgesic Use and Risk of Incident Persistent Tinnitus
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Blarigan, E. L. V., Ma, C., Ou, F., Bainter, T. M., Venook, A. P., Ng, K., Niedzwiecki, D., Giovannucci, E. L., Lenz, H., Polite, B. N., et al. (2022) · International Journal of Cancer · doi:10.1002/ijc.34230 · Cited by 9
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BackgroundSelf-citationJo, G., Kwak, S., Kim, J. Y., Lim, H., & Shin, M. (2018) · Nutrients · doi:10.3390/nu10111595 · Cited by 9
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BackgroundValidit�t und Reliabilit�t von Probandenangaben zu Frakturen
Meisinger, C., Wildner, M., D�ring, A., et al. (2000) · Sozial- und Präventivmedizin · doi:10.1007/bf01306014 · Cited by 8
A comparison of information on motor vehicle crashes as reported by written or telephone interviews
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“%) when compared with medical records [18].”
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Tran, M. M., George-Washburn, E. A., Rhee, J., Li, W., Qureshi, A. A., & Cho, E. (2024) · Archives of Dermatological Research · doi:10.1007/s00403-024-03132-8 · Cited by 10
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“Our previous validation study showed 90% pathology confirmation rate of self-reports of a single BCC diagnosis in a subset of our cohort [15, 16].”
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Sakaki, J. R., Melough, M. M., Roberts, M. B., et al. (2021) · Cancers · doi:10.3390/cancers13092173 · Cited by 7
“However, self-reported skin cancer data has been previously validated in other populations with high validity [39,40].”
BackgroundUnrestrained eating behavior and risk of mortality: A prospective cohort study
Zhang, Y., Song, M., Yuan, C., Chan, A. T., Schernhammer, E. S., Wolpin, B. M., Stampfer, M. J., Meyerhardt, J. A., Fuchs, C. S., Roberts, S. B., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.014 · Cited by 9
Self-citationPrediction of 24‐Hour Urinary Sodium Excretion Using Machine‐Learning Algorithms
Hamaya, R., Wang, M., Juraschek, S. P., Mukamal, K. J., Manson, J. E., Tobias, D. K., Sun, Q., Curhan, G. C., Willett, W. C., Rimm, E. B., et al. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.034310 · Cited by 7
“36 29 This error is likely mostly random with respect to our predicted sodium intake, and thus our risk estimates may be underestimated with respect to predicted incidence of hypertension.”
Self-citationPhobic anxiety and plasma levels of global oxidative stress in women
Hagan, K. A., Wu, T., Rimm, E. B., Eliassen, A. H., & Okereke, O. I. (2015) · The European Journal of Psychiatry · doi:10.4321/s0213-61632015000100001 · Cited by 7
Renin‐Angiotensin System Polymorphisms and Risk of Hypertension: Influence of Environmental Factors
Forman, J. P., Fisher, N. D. L., Pollak, M. R., Cox, D. G., Tonna, S., & Curhan, G. C. (2008) · Journal of Clinical Hypertension · doi:10.1111/j.1751-7176.2008.08007.x · Cited by 7
Personal history of non‐melanoma skin cancer diagnosis and death from melanoma in women
Chen, S. T., Li, X., & Han, J. (2017) · International Journal of Cancer · doi:10.1002/ijc.31176 · Cited by 6
“Self-reported basal cell carcinomas were not verified by medical records given prior studies demonstrating >90% validity.(11) Given the way data are collected, these are treated as “first NMSC.”
Rotating Nightshift Work and Hematopoietic Cancer Risk in US Female Nurses
Zhang, Y., Birmann, B. M., Papantoniou, K., Zhou, E. S., Erber, A. C., & Schernhammer, E. S. (2020) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkz106 · Cited by 7
Goemaere, S., Liberman, U. A., Adachi, J. D., Hawkins, F., Lane, N., Saag, K. G., Schnitzer, T., Kaufman, J. M., Malice, M. P., Carofano, W., et al. (2003) · JCR Journal of Clinical Rheumatology · doi:10.1097/01.rhu.0000073586.28977.31 · Cited by 7
“The reliability of fracture history has been shown.(11) However, a shortcoming of the data is that a possible recall bias may overestimate or underestimate the real fracture prevalence and incidence in the present study.”
Fhärm, E., Rolandsson, O., & Weinehall, L. (2008) · Scandinavian Journal of Public Health · doi:10.1177/1403494807085374 · Cited by 7
“On the other hand, it has previously been demonstrated that a self-report of physician-diagnosed diabetes is accurate and valid, and that recall of drug usage history in well-defined chronic conditions is accurate [23,24].”
BackgroundDimitrov, B. D. (2000) · PubMed · Cited by 7
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“The validity and reproducibility of information on lifestyles, diet, menopausal status, disease outcomes, and anthropometrics in our cohorts have previously been reported [35–41].”
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Pathway analysis of expression-related SNPs on genome-wide association study of basal cell carcinoma
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“Colditz et al. [39] evaluated the validity of self-reported illnesses including skin cancer in the NHS.”
Birth Weight and Adult-Onset Hearing Loss
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COX‐2 inhibitors show no preventive effect in the development of skin cancer
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La distribución geográfica de la razón varón/mujer de la mortalidad cardiovascular en España
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Adherence to Healthy Lifestyle and Risk of Cardiometabolic Diseases in Individuals With Hypertension
Qiu, Z., Liu, G., Hu, Y., Wang, S., Liu, B., Rimm, E. B., Wang, M., Manson, J. E., Hu, F. B., & Sun, Q. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.0937 · Cited by 6
Validity of Self-Reported Comorbidities in Systemic Sclerosis: Table 1.
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Aspirin, Non-Aspirin Analgesics and the Risk of Hypertension in the SUN Cohort
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Type 2 diabetes mellitus and risk of cutaneous squamous cell carcinoma
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Hemochromatosis risk genotype is not associated with colorectal cancer or age at its diagnosis
Jarvik, G. P., Wang, X., Fontanillas, P., Kim, E., Chanprasert, S., GORDON, A. S., Bastarache, L. A., Kowdley, K. V., Harrison, T. A., Rosenthal, E. A., et al. (2020) · Human Genetics and Genomics Advances · doi:10.1016/j.xhgg.2020.100010 · Cited by 5
“’’ Self-report of colon cancer has been reported to be reasonably accurate in prior studies.(29,30) Similarly, HH diagnosis phenotype was assessed by self-report (‘‘Have you ever been diagnosed with, or treated for, hemochromatosis?’’) and contrasted with HFE genotype and self-report of phlebotomy (‘‘Did your doctor e…”
Analysis of Co-Aggregation of Cancer Based on Registry Data
Matthews, A. G., Betensky, R. A., Anton‐Culver, H., et al. (2006) · Public Health Genomics · doi:10.1159/000091485 · Cited by 5
“We note that reporting errors can occur both because many deep organ cancers are not accurately recalled by the proband, and also metastatic sites are sometimes reported as primary cancer sites [24,25].”
BackgroundBokhof, B., Eisele, L., Erbel, R. M., & Moebus, S. (2014) · Cancer Epidemiology · doi:10.1016/j.canep.2014.01.002 · Cited by 5
“Missing expert knowledge may result in mistaken information or improperly applied terminology [4–6].”
BackgroundGordon, J. H., LaMonte, M. J., Zhao, J., Genco, R. J., Cimato, T. R., Hovey, K. M., Andrews, C., & Wactawski‐Wende, J. (2020) · Journal of Human Hypertension · doi:10.1038/s41371-020-00422-2 · Cited by 5
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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