Skip to main content
Top
Published in: Journal of Public Health 1/2013

01-02-2013 | Original Article

A low response rate does not necessarily indicate non-response bias in gastroenterology survey research: a population-based study

Authors: Rok Seon Choung, G. Richard Locke III, Cathy D. Schleck, Jeanette Y. Ziegenfuss, Timothy J. Beebe, Alan R. Zinsmeister, Nicholas J. Talley

Published in: Journal of Public Health | Issue 1/2013

Login to get access

Abstract

Aim

To estimate the potential for response bias in standard mailed questionnaires used in surveys of GI symptoms in a community.

Subjects and methods

Validated self-report tools have been developed to measure functional gastrointestinal (GI) disorders but response rates in community surveys have been rapidly declining in many parts of the world. Whether a lower community response rate introduces significant response bias in GI survey research is unknown. A questionnaire was mailed to a total of 5,069 randomly selected subjects. The overall response rate was 52 %. A random sample of 723 of these subjects (428 responders and 295 non-responders, stratified by age and gender) was selected for medical record abstraction (including both inpatient and outpatient history).

Results

The odds for response increased in those with a higher body mass index (odds ratio (OR):1.02 [95 % CI: 1.01, 1.03]), more health care seeking behavior for non-GI problems (OR: 1.97 [95 % CI: 1.43, 2.72]), and for those who had responded to a previous survey (OR: 4.84 [95 % CI: 2.84, 8.26]). Responder status was not significantly associated with any GI symptoms or a diagnosis of GI or non-GI disease (with two exceptions, diverticulosis and skin disease).

Conclusions

Despite a response rate of only 52 %, the results of a community-based GI survey do not appear to be impacted by non-response bias in a major way. A low survey response rate does not necessarily indicate non-response bias.
Literature
go back to reference Atrostic BK, Bates N, Burt G, Silberstein A (2001) Nonresponse in US Government household surveys: consistent measures, recent trends, and new insights. J Off Stat 17(2):209–226 Atrostic BK, Bates N, Burt G, Silberstein A (2001) Nonresponse in US Government household surveys: consistent measures, recent trends, and new insights. J Off Stat 17(2):209–226
go back to reference Bakke P, Gulsvik A, Lilleng P, Overa O, Hanoa R, Eide GE (1990) Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response. J Epidemiol Community Health 44(4):316–320PubMedCrossRef Bakke P, Gulsvik A, Lilleng P, Overa O, Hanoa R, Eide GE (1990) Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response. J Epidemiol Community Health 44(4):316–320PubMedCrossRef
go back to reference Barton J, Bain C, Hennekens CH, Rosner B, Belanger C, Roth A et al (1980) Characteristics of respondents and non-respondents to a mailed questionnaire. Am J Public Health 70(8):823–825PubMedCrossRef Barton J, Bain C, Hennekens CH, Rosner B, Belanger C, Roth A et al (1980) Characteristics of respondents and non-respondents to a mailed questionnaire. Am J Public Health 70(8):823–825PubMedCrossRef
go back to reference Beard CM, Lane AW, O'Fallon WM, Riggs BL, Melton LJ 3rd (1994) Comparison of respondents and nonrespondents in an osteoporosis study. Ann Epidemiol 4(5):398–403PubMedCrossRef Beard CM, Lane AW, O'Fallon WM, Riggs BL, Melton LJ 3rd (1994) Comparison of respondents and nonrespondents in an osteoporosis study. Ann Epidemiol 4(5):398–403PubMedCrossRef
go back to reference Beebe TJ, Talley NJ, Camilleri M, Jenkins SM, Anderson KJ, Locke GR 3rd (2007) The HIPAA authorization form and effects on survey response rates, nonresponse bias, and data quality: a randomized community study. Med Care 45(10):959–965PubMedCrossRef Beebe TJ, Talley NJ, Camilleri M, Jenkins SM, Anderson KJ, Locke GR 3rd (2007) The HIPAA authorization form and effects on survey response rates, nonresponse bias, and data quality: a randomized community study. Med Care 45(10):959–965PubMedCrossRef
go back to reference Brehm JO (1993) The phantom respondents: opinion surveys and political representation. University of Michigan Press, Ann Arbor, MI Brehm JO (1993) The phantom respondents: opinion surveys and political representation. University of Michigan Press, Ann Arbor, MI
go back to reference Castillo EJ, Camilleri M, Locke GR, Burton DD, Stephens DA, Geno DM et al (2004) A community-based, controlled study of the epidemiology and pathophysiology of dyspepsia. Clin Gastroenterol Hepatol 2(11):985–996PubMedCrossRef Castillo EJ, Camilleri M, Locke GR, Burton DD, Stephens DA, Geno DM et al (2004) A community-based, controlled study of the epidemiology and pathophysiology of dyspepsia. Clin Gastroenterol Hepatol 2(11):985–996PubMedCrossRef
go back to reference Chou P, Kuo HS, Chen CH, Lin HC (1997) Characteristics of non-participants and reasons for non-participation in a population survey in Kin-Hu, Kinmen. Eur J Epidemiol 13(2):195–200PubMedCrossRef Chou P, Kuo HS, Chen CH, Lin HC (1997) Characteristics of non-participants and reasons for non-participation in a population survey in Kin-Hu, Kinmen. Eur J Epidemiol 13(2):195–200PubMedCrossRef
go back to reference Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Talley NJ (2007a) Do distinct dyspepsia subgroups exist in the community? A population-based study. Am J Gastroenterol 102(9):1983–1989PubMedCrossRef Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Talley NJ (2007a) Do distinct dyspepsia subgroups exist in the community? A population-based study. Am J Gastroenterol 102(9):1983–1989PubMedCrossRef
go back to reference Choung RS, Locke GR 3rd, Zinsmeister AR, Schleck CD, Talley NJ (2007b) Epidemiology of slow and fast colonic transit using a scale of stool form in a community. Aliment Pharmacol Ther 26(7):1043–1050PubMedCrossRef Choung RS, Locke GR 3rd, Zinsmeister AR, Schleck CD, Talley NJ (2007b) Epidemiology of slow and fast colonic transit using a scale of stool form in a community. Aliment Pharmacol Ther 26(7):1043–1050PubMedCrossRef
go back to reference Criqui MH, Barrett-Connor E, Austin M (1978) Differences between respondents and non-respondents in a population-based cardiovascular disease study. Am J Epidemiol 108(5):367–372PubMed Criqui MH, Barrett-Connor E, Austin M (1978) Differences between respondents and non-respondents in a population-based cardiovascular disease study. Am J Epidemiol 108(5):367–372PubMed
go back to reference Dallosso HM, Matthews RJ, McGrother CW, Clarke M, Perry SI, Shaw C et al (2003) An investigation into nonresponse bias in a postal survey on urinary symptoms. BJU Int 91(7):631–636PubMedCrossRef Dallosso HM, Matthews RJ, McGrother CW, Clarke M, Perry SI, Shaw C et al (2003) An investigation into nonresponse bias in a postal survey on urinary symptoms. BJU Int 91(7):631–636PubMedCrossRef
go back to reference de Leeuw E, de Heer W (2002) Trends in household survey nonresponse: a longitudinal and international comparison. In: Groves RM, Dillman DA, Eltinge JL, Little RJA (eds) survey nonresponse. Wiley, New York, pp 41–54 de Leeuw E, de Heer W (2002) Trends in household survey nonresponse: a longitudinal and international comparison. In: Groves RM, Dillman DA, Eltinge JL, Little RJA (eds) survey nonresponse. Wiley, New York, pp 41–54
go back to reference Dunn JP, Hawkes R (1966) Comparison of respondents and nonrespondents in a periodic health examination program to a mailed questionnaire. Am J Public Health Nations Health 56(2):230–236PubMedCrossRef Dunn JP, Hawkes R (1966) Comparison of respondents and nonrespondents in a periodic health examination program to a mailed questionnaire. Am J Public Health Nations Health 56(2):230–236PubMedCrossRef
go back to reference Eagan TM, Eide GE, Gulsvik A, Bakke PS (2002) Nonresponse in a community cohort study: predictors and consequences for exposure-disease associations. J Clin Epidemiol 55(8):775–781PubMedCrossRef Eagan TM, Eide GE, Gulsvik A, Bakke PS (2002) Nonresponse in a community cohort study: predictors and consequences for exposure-disease associations. J Clin Epidemiol 55(8):775–781PubMedCrossRef
go back to reference Elliott MN, Edwards C, Angeles J, Hambarsoomians K, Hays RD (2005) Patterns of unit and item nonresponse in the CAHPS® Hospital Survey. Health Serv Res 40(6 pt 2):2096–2119PubMedCrossRef Elliott MN, Edwards C, Angeles J, Hambarsoomians K, Hays RD (2005) Patterns of unit and item nonresponse in the CAHPS® Hospital Survey. Health Serv Res 40(6 pt 2):2096–2119PubMedCrossRef
go back to reference Goldberg M, Chastang JF, Leclerc A, Zins M, Bonenfant S, Bugel I et al (2001) Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the French GAZEL cohort and its target population. Am J Epidemiol 154(4):373–384PubMedCrossRef Goldberg M, Chastang JF, Leclerc A, Zins M, Bonenfant S, Bugel I et al (2001) Socioeconomic, demographic, occupational, and health factors associated with participation in a long-term epidemiologic survey: a prospective study of the French GAZEL cohort and its target population. Am J Epidemiol 154(4):373–384PubMedCrossRef
go back to reference Groves RM (2006) Nonresponse rates and nonresponse bias in household surveys. Public Opin Q 70(5):646–675CrossRef Groves RM (2006) Nonresponse rates and nonresponse bias in household surveys. Public Opin Q 70(5):646–675CrossRef
go back to reference Groves RM, Peytcheva E (2008) The impact of nonresponse rates on nonresponse bias: a meta-analysis. Public Opin Q 72(2):167–189CrossRef Groves RM, Peytcheva E (2008) The impact of nonresponse rates on nonresponse bias: a meta-analysis. Public Opin Q 72(2):167–189CrossRef
go back to reference Hara M, Sasaki S, Sobue T, Yamamoto S, Tsugane S (2002) Comparison of cause-specific mortality between respondents and nonrespondents in a population-based prospective study: ten-year follow-up of JPHC Study Cohort I. Japan Public Health Center. J Clin Epidemiol 55(2):150–156PubMedCrossRef Hara M, Sasaki S, Sobue T, Yamamoto S, Tsugane S (2002) Comparison of cause-specific mortality between respondents and nonrespondents in a population-based prospective study: ten-year follow-up of JPHC Study Cohort I. Japan Public Health Center. J Clin Epidemiol 55(2):150–156PubMedCrossRef
go back to reference Harald K, Salomaa V, Jousilahti P, Koskinen S, Vartiainen E (2007) Non-participation and mortality in different socioeconomic groups: the FINRISK population surveys in 1972–92. J Epidemiol Community Health 61(5):449–454PubMedCrossRef Harald K, Salomaa V, Jousilahti P, Koskinen S, Vartiainen E (2007) Non-participation and mortality in different socioeconomic groups: the FINRISK population surveys in 1972–92. J Epidemiol Community Health 61(5):449–454PubMedCrossRef
go back to reference Hardie JA, Bakke PS, Morkve O (2003) Non-response bias in a postal questionnaire survey on respiratory health in the old and very old. Scand J Public Health 31(6):411–417PubMedCrossRef Hardie JA, Bakke PS, Morkve O (2003) Non-response bias in a postal questionnaire survey on respiratory health in the old and very old. Scand J Public Health 31(6):411–417PubMedCrossRef
go back to reference Heilbrun LK, Ross PD, Wasnich RD, Yano K, Vogel JM (1991) Characteristics of respondents and nonrespondents in a prospective study of osteoporosis. J Clin Epidemiol 44(3):233–239PubMedCrossRef Heilbrun LK, Ross PD, Wasnich RD, Yano K, Vogel JM (1991) Characteristics of respondents and nonrespondents in a prospective study of osteoporosis. J Clin Epidemiol 44(3):233–239PubMedCrossRef
go back to reference Hoeymans N, Feskens EJ, Van Den Bos GA, Kromhout D (1998) Non-response bias in a study of cardiovascular diseases, functional status and self-rated health among elderly men. Age Ageing 27(1):35–40PubMedCrossRef Hoeymans N, Feskens EJ, Van Den Bos GA, Kromhout D (1998) Non-response bias in a study of cardiovascular diseases, functional status and self-rated health among elderly men. Age Ageing 27(1):35–40PubMedCrossRef
go back to reference Holle R, Hochadel M, Reitmeir P, Meisinger C, Wichmann HE (2006) Prolonged recruitment efforts in health surveys: effects on response, costs, and potential bias. Epidemiology 17(6):639–643PubMedCrossRef Holle R, Hochadel M, Reitmeir P, Meisinger C, Wichmann HE (2006) Prolonged recruitment efforts in health surveys: effects on response, costs, and potential bias. Epidemiology 17(6):639–643PubMedCrossRef
go back to reference Hox JJ, de Leeuw ED (1994) A comparison of nonresponse in mail, telephone, and face-to-face surveys. Qual Quant 28(4):329–344CrossRef Hox JJ, de Leeuw ED (1994) A comparison of nonresponse in mail, telephone, and face-to-face surveys. Qual Quant 28(4):329–344CrossRef
go back to reference Jacobsen SJ, Xia Z, Campion ME, Darby CH, Plevak MF, Seltman KD et al (1999) Potential effect of authorization bias on medical record research. Mayo Clin Proc 74(4):330–338PubMedCrossRef Jacobsen SJ, Xia Z, Campion ME, Darby CH, Plevak MF, Seltman KD et al (1999) Potential effect of authorization bias on medical record research. Mayo Clin Proc 74(4):330–338PubMedCrossRef
go back to reference Jooste PL, Yach D, Steenkamp HJ, Botha JL, Rossouw JE (1990) Drop-out and newcomer bias in a community cardiovascular follow-up study. Int J Epidemiol 19(2):284–289PubMedCrossRef Jooste PL, Yach D, Steenkamp HJ, Botha JL, Rossouw JE (1990) Drop-out and newcomer bias in a community cardiovascular follow-up study. Int J Epidemiol 19(2):284–289PubMedCrossRef
go back to reference Keeter S, Miller C, Kohut A, Groves RM, Presser S (2000) Consequences of reducing nonresponse in a national telephone survey. Public Opin Q 64(2):125–148PubMedCrossRef Keeter S, Miller C, Kohut A, Groves RM, Presser S (2000) Consequences of reducing nonresponse in a national telephone survey. Public Opin Q 64(2):125–148PubMedCrossRef
go back to reference Kim J, Lonner JH, Nelson CL, Lotke PA (2004) Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty. J Bone Joint Surg Am 86-A(1):15–21PubMed Kim J, Lonner JH, Nelson CL, Lotke PA (2004) Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty. J Bone Joint Surg Am 86-A(1):15–21PubMed
go back to reference Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H et al (2001) Non-response and related factors in a nation-wide health survey. Eur J Epidemiol 17(11):991–999PubMedCrossRef Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H et al (2001) Non-response and related factors in a nation-wide health survey. Eur J Epidemiol 17(11):991–999PubMedCrossRef
go back to reference Launer LJ, Wind AW, Deeg DJ (1994) Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. Am J Epidemiol 139(8):803–812PubMed Launer LJ, Wind AW, Deeg DJ (1994) Nonresponse pattern and bias in a community-based cross-sectional study of cognitive functioning among the elderly. Am J Epidemiol 139(8):803–812PubMed
go back to reference Macera CA, Jackson KL, Davis DR, Kronenfeld JJ, Blair SN (1990) Patterns of non-response to a mail survey. J Clin Epidemiol 43(12):1427–1430PubMedCrossRef Macera CA, Jackson KL, Davis DR, Kronenfeld JJ, Blair SN (1990) Patterns of non-response to a mail survey. J Clin Epidemiol 43(12):1427–1430PubMedCrossRef
go back to reference Melton LJ 3rd, Dyck PJ, Karnes JL, O'Brien PC, Service FJ (1993) Non-response bias in studies of diabetic complications: the Rochester Diabetic Neuropathy Study. J Clin Epidemiol 46(4):341–348PubMedCrossRef Melton LJ 3rd, Dyck PJ, Karnes JL, O'Brien PC, Service FJ (1993) Non-response bias in studies of diabetic complications: the Rochester Diabetic Neuropathy Study. J Clin Epidemiol 46(4):341–348PubMedCrossRef
go back to reference Milne JS, Maule MM, Williamson J (1971) Method of sampling in a study of older people with a comparison of respondents and non-respondents. Br J Prev Soc Med 25(1):37–41PubMed Milne JS, Maule MM, Williamson J (1971) Method of sampling in a study of older people with a comparison of respondents and non-respondents. Br J Prev Soc Med 25(1):37–41PubMed
go back to reference Morton LM, Cahill J, Hartge P (2006) Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol 163(3):197–203PubMedCrossRef Morton LM, Cahill J, Hartge P (2006) Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol 163(3):197–203PubMedCrossRef
go back to reference Nohr EA, Frydenberg M, Henriksen TB, Olsen J (2006) Does low participation in cohort studies induce bias? Epidemiology 17(4):413–418PubMedCrossRef Nohr EA, Frydenberg M, Henriksen TB, Olsen J (2006) Does low participation in cohort studies induce bias? Epidemiology 17(4):413–418PubMedCrossRef
go back to reference Oremus M, Wolfson C (2004) Female specialists were more likely to respond to a postal questionnaire about drug treatments for Alzheimer disease. J Clin Epidemiol 57(6):620–623PubMedCrossRef Oremus M, Wolfson C (2004) Female specialists were more likely to respond to a postal questionnaire about drug treatments for Alzheimer disease. J Clin Epidemiol 57(6):620–623PubMedCrossRef
go back to reference Paganini-Hill A, Hsu G, Chao A, Ross RK (1993) Comparison of early and late respondents to a postal health survey questionnaire. Epidemiology 4(4):375–379PubMedCrossRef Paganini-Hill A, Hsu G, Chao A, Ross RK (1993) Comparison of early and late respondents to a postal health survey questionnaire. Epidemiology 4(4):375–379PubMedCrossRef
go back to reference Richiardi L, Boffetta P, Merletti F (2002) Analysis of nonresponse bias in a population-based case:control study on lung cancer. J Clin Epidemiol 55(10):1033–1040PubMedCrossRef Richiardi L, Boffetta P, Merletti F (2002) Analysis of nonresponse bias in a population-based case:control study on lung cancer. J Clin Epidemiol 55(10):1033–1040PubMedCrossRef
go back to reference Shahar E, Folsom AR, Jackson R (1996) The effect of nonresponse on prevalence estimates for a referent population: insights from a population-based cohort study. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Ann Epidemiol 6(6):498–506PubMedCrossRef Shahar E, Folsom AR, Jackson R (1996) The effect of nonresponse on prevalence estimates for a referent population: insights from a population-based cohort study. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Ann Epidemiol 6(6):498–506PubMedCrossRef
go back to reference Shen M, Cozen W, Huang L, Colt J, De Roos AJ, Severson RK et al (2008) Census and geographic differences between respondents and nonrespondents in a case-control study of non-Hodgkin lymphoma. Am J Epidemiol 167(3):350–361PubMedCrossRef Shen M, Cozen W, Huang L, Colt J, De Roos AJ, Severson RK et al (2008) Census and geographic differences between respondents and nonrespondents in a case-control study of non-Hodgkin lymphoma. Am J Epidemiol 167(3):350–361PubMedCrossRef
go back to reference Sonne-Holm S, Sorensen TI, Jensen G, Schnohr P (1989) Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. J Epidemiol Community Health 43(4):369–374PubMedCrossRef Sonne-Holm S, Sorensen TI, Jensen G, Schnohr P (1989) Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. J Epidemiol Community Health 43(4):369–374PubMedCrossRef
go back to reference Steeh C, Kirgis N, Cannon B, DeWitt J (2001) Are they really as bad as they seem? Nonresponse rates at the end of the twentieth century. J Off Stat 17(2):227–247 Steeh C, Kirgis N, Cannon B, DeWitt J (2001) Are they really as bad as they seem? Nonresponse rates at the end of the twentieth century. J Off Stat 17(2):227–247
go back to reference Talley NJ, Phillips SF, Melton J 3rd, Wiltgen C, Zinsmeister AR (1989) A patient questionnaire to identify bowel disease. Ann Intern Med 111(8):671–674PubMed Talley NJ, Phillips SF, Melton J 3rd, Wiltgen C, Zinsmeister AR (1989) A patient questionnaire to identify bowel disease. Ann Intern Med 111(8):671–674PubMed
go back to reference Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd (1991) Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 101(4):927–934PubMed Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd (1991) Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 101(4):927–934PubMed
go back to reference Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ 3rd (1992) Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 136(2):165–177PubMed Talley NJ, Weaver AL, Zinsmeister AR, Melton LJ 3rd (1992) Onset and disappearance of gastrointestinal symptoms and functional gastrointestinal disorders. Am J Epidemiol 136(2):165–177PubMed
go back to reference Tickle M, Milsom KM, Blinkhorn AS, Worthington HV (2003) Comparing different methods to detect and correct nonresponse bias in postal questionnaire studies. J Public Health Dent 63(2):112–128PubMedCrossRef Tickle M, Milsom KM, Blinkhorn AS, Worthington HV (2003) Comparing different methods to detect and correct nonresponse bias in postal questionnaire studies. J Public Health Dent 63(2):112–128PubMedCrossRef
go back to reference Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13(2):105–110PubMedCrossRef Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J (2003) Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol 13(2):105–110PubMedCrossRef
go back to reference West R, McEwen A, Bolling K, Owen L (2001) Smoking cessation and smoking patterns in the general population: a 1-year follow-up. Addiction 96(6):891–902PubMedCrossRef West R, McEwen A, Bolling K, Owen L (2001) Smoking cessation and smoking patterns in the general population: a 1-year follow-up. Addiction 96(6):891–902PubMedCrossRef
Metadata
Title
A low response rate does not necessarily indicate non-response bias in gastroenterology survey research: a population-based study
Authors
Rok Seon Choung
G. Richard Locke III
Cathy D. Schleck
Jeanette Y. Ziegenfuss
Timothy J. Beebe
Alan R. Zinsmeister
Nicholas J. Talley
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Journal of Public Health / Issue 1/2013
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI
https://doi.org/10.1007/s10389-012-0513-z

Other articles of this Issue 1/2013

Journal of Public Health 1/2013 Go to the issue