International Journal of Epidemiology, Vol 28, 1134-1140, Copyright © 1999 by International Epidemiological Association
SA Reijneveld and K Stronks
BACKGROUND: Surveys among the general population are an important method
for collecting epidemiological data on health and utilization of health
care in that population. Selective non-response may affect the validity of
these data. This study examines the impact of response bias on estimates of
health care utilization and on risk estimates for utilization in relation
to demographic and socioeconomic characteristics, using administrative data
on use of health care. METHODS: Data on registered health care utilization
were extracted from a health insurance register and linked to respondents
(2,934; 62.7%) and non-respondents (1,744) in a personal health interview
survey among adult residents from the lower two-thirds income bracket in
Amsterdam, the Netherlands. RESULTS: Estimates of registered health care
utilization are higher if based on respondents only, than if they are based
on the entire target sample. This goes for prescription drugs, specialist
medical care, paramedical care, dental care and medical aids, but not for
hospital care. Most risk estimates of registered utilization for background
characterisitcs (gender, family composition, marital status, year of
settlement, affluence of neighbourhood and ethnicity) differ only slightly
and without statistical significance. If different, most estimates based on
respondents only are somewhat higher. The largest differences are found for
age (average overestimation of risks for age groups 35-64 and 65+ years
compared to that of 16-34 years: 16% and 17%, respectively). CONCLUSIONS:
In this study, response bias affects estimates of registered health care
utilization but hardly affects risk estimates of utilization by background
characteristics.
The impact of response bias on estimates of health care utilization in a metropolitan area: the use of administrative data
Department of Public Health, Leiden, The Netherlands. SA.Reijneveld@pg.tno.nl
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