The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms
Open accessAbstract
BACKGROUND: Population based studies are important for prevalence, incidence and association studies, but their external validity might be threatened by decreasing participation rates. The 50 807 participants in the third survey of the HUNT Study (HUNT3, 2006-08), represented 54% of the invited, necessitating a nonparticipation study. METHODS: Questionnaire data from HUNT3 were compared with data collected from several sources: a short questionnaire to nonparticipants, anonymous data on specific diagnoses and prescribed medication extracted from randomly selected general practices, registry data from Statistics Norway on socioeconomic factors and mortality, and from the Norwegian Prescription Database on drug consumption. RESULTS: Participation rates for HUNT3 depended on age, sex and type of symptoms and diseases, but only small changes were found in the overall prevalence estimates when including data from 6922 nonparticipants. Among nonparticipants, the prevalences of cardiovascular diseases, diabetes mellitus and psychiatric disorders were higher both in nonparticipant data and data extracted from general practice, compared to that reported by participants, whilst the opposite pattern was found, at least among persons younger than 80 years, for urine incontinence, musculoskeletal pain and headache. Registry data showed that the nonparticipants had lower socioeconomic status and a higher mortality than participants. CONCLUSION: Nonparticipants had lower socioeconomic status, higher mortality and showed higher prevalences of several chronic diseases, whilst opposite patterns were found for common problems like musculoskeletal pain, urine incontinence and headache. The impact on associations should be analyzed for each diagnosis, and data making such analyses possible are provided in the present paper.
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Mental health may have played a role in attrition, with those experiencing anxiety or depression being less likely to participate.
“Mental health may have played a role, with those experiencing anxiety or depression being less likely to participate [110].”
From The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study (2025) · cites this paper as [110]
The Discussion section (‘Influence on incidence and prevalence estimates’; page unavailable) says depression appears to restrict participation more than anxiety. It reports higher anxiety-symptom prevalence among participants than the prevalence of anxiety diagnoses in the background population, while cautioning that these measures cannot be directly compared. Thus it supports a possible role for depression, but not the claim that people experiencing anxiety were also less likely to participate. (LLM, conf=0.88)
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References 38 · Cited by 388
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- Authors
- Langhammer, A., Krokstad, S., Romundstad, P., Heggland, J., & Holmen, J.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Langhammer, Arnulf
- Venue
- BMC Medical Research Methodology
- Published
- 2012-09-14
- Volume
- 12
- Issue
- 1
- Pages
- 143-143
- ISSN
- 1471-2288 (ISSN-L)
- PMC
- PMC3512497
- OpenAlex
- W1971823413
- Cited by
- 388
- References
- 38
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 45 · 2023: 28 · 2022: 28 · 2021: 25 · 2020: 30 · 2019: 30 · 2018: 34 · 2017: 29 · 2016: 38 · 2015: 31 · 2014: 20 · 2013: 17
- FWCI
- 71.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Research Methodology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Norges Teknisk-Naturvitenskapelige Universitet
- Norwegian Institute of Public Health
- 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
- HUNT study, non-participation, study participation rates, generalizability, socioeconomic status, mortality, cardiovascular disease, diabetes mellitus, mental illness, musculoskeletal pain, headache, urinary incontinence, prevalence estimates
- MeSH terms
- Adult, Aged, 80 and over, Anthropometry, Female, Heart Diseases, Humans, Life Style, Male, Middle Aged, Norway, Patient Participation, Quality of Life, Surveys and Questionnaires, Social Class, Prevalence, Survival Analysis, Age Distribution, Sex Distribution
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