Skip to main content
Top
Published in: BMC Medical Research Methodology 1/2013

Open Access 01-12-2013 | Research article

The impact of deployment experience and prior healthcare utilization on enrollment in a large military cohort study

Authors: Jaime L Horton, Isabel G Jacobson, Alyson J Littman, John E Alcaraz, Besa Smith, Nancy F Crum-Cianflone

Published in: BMC Medical Research Methodology | Issue 1/2013

Login to get access

Abstract

Background

Longitudinal cohort studies are highly valued in epidemiologic research for their ability to establish exposure-disease associations through known temporal sequences. A major challenge in cohort studies is recruiting individuals representative of the targeted sample population to ensure the generalizability of the study’s findings.

Methods

We evaluated nearly 350,000 invited subjects (from 2004-2008) of the Millennium Cohort Study, a prospective cohort study of the health of US military personnel, for factors prior to invitation associated with study enrollment. Multivariable logistic regression was utilized, adjusting for demographic and other confounders, to determine the associations between both deployment experience and prior healthcare utilization with enrollment into the study.

Results

Study enrollment was significantly greater among those who deployed prior to and/or during the enrollment cycles or had at least one outpatient visit in the 12 months prior to invitation. Mental disorders and hospitalization for more than two days within the past year were associated with reduced odds of enrollment.

Conclusions

These findings suggest differential enrollment by deployment experience and health status, and may help guide recruitment efforts in future studies.
Literature
2.
go back to reference Grimes DA, Schulz KF: Cohort studies: marching towards outcomes. Lancet. 2002, 359 (9303): 341-345. 10.1016/S0140-6736(02)07500-1.CrossRefPubMed Grimes DA, Schulz KF: Cohort studies: marching towards outcomes. Lancet. 2002, 359 (9303): 341-345. 10.1016/S0140-6736(02)07500-1.CrossRefPubMed
3.
go back to reference Sever LE: Epidemiologic approaches to the study of diseases of complex etiology. Birth Defects Orig Artic Ser. 1984, 20 (6): 96-119.PubMed Sever LE: Epidemiologic approaches to the study of diseases of complex etiology. Birth Defects Orig Artic Ser. 1984, 20 (6): 96-119.PubMed
4.
go back to reference White E, Hunt JR, Casso D: Exposure measurement in cohort studies: the challenges of prospective data collection. Epidemiol Rev. 1998, 20 (1): 43-56. 10.1093/oxfordjournals.epirev.a017971.CrossRefPubMed White E, Hunt JR, Casso D: Exposure measurement in cohort studies: the challenges of prospective data collection. Epidemiol Rev. 1998, 20 (1): 43-56. 10.1093/oxfordjournals.epirev.a017971.CrossRefPubMed
5.
go back to reference Couper MP, Singer E, Conrad FG, Groves RM: Risk of disclosure, perceptions of risk, and concerns about privacy and confidentiality as factors in survey participation. J Off Stat. 2008, 24 (2): 255-275.PubMedPubMedCentral Couper MP, Singer E, Conrad FG, Groves RM: Risk of disclosure, perceptions of risk, and concerns about privacy and confidentiality as factors in survey participation. J Off Stat. 2008, 24 (2): 255-275.PubMedPubMedCentral
6.
go back to reference Boshuizen HC, Viet AL, Picavet HSJ, Botterweck A, van Loon AJM: Non-response in a survey of cardiovascular risk factors in the Dutch population: Determinants and resulting biases. Public Health. 2006, 120 (4): 297-308. 10.1016/j.puhe.2005.09.008.CrossRefPubMed Boshuizen HC, Viet AL, Picavet HSJ, Botterweck A, van Loon AJM: Non-response in a survey of cardiovascular risk factors in the Dutch population: Determinants and resulting biases. Public Health. 2006, 120 (4): 297-308. 10.1016/j.puhe.2005.09.008.CrossRefPubMed
7.
go back to reference Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H, Koskenvuo M: Non-response and related factors in a nation-wide health survey. Eur J Epidemiol. 2001, 17 (11): 991-999. 10.1023/A:1020016922473.CrossRefPubMed Korkeila K, Suominen S, Ahvenainen J, Ojanlatva A, Rautava P, Helenius H, Koskenvuo M: Non-response and related factors in a nation-wide health survey. Eur J Epidemiol. 2001, 17 (11): 991-999. 10.1023/A:1020016922473.CrossRefPubMed
8.
go back to reference Young AF, Powers JR, Bell SL: Attrition in longitudinal studies: who do you lose?. Aust Nz J Publ Heal. 2006, 30 (4): 353-361. 10.1111/j.1467-842X.2006.tb00849.x.CrossRef Young AF, Powers JR, Bell SL: Attrition in longitudinal studies: who do you lose?. Aust Nz J Publ Heal. 2006, 30 (4): 353-361. 10.1111/j.1467-842X.2006.tb00849.x.CrossRef
9.
go back to reference Littman AJ, Boyko EJ, Jacobson IG, Horton J, Gackstetter GD, Smith B, Hooper T, Wells TS, Amoroso PJ, Smith TC, et al: Assessing nonresponse bias at follow-up in a large prospective cohort of relatively young and mobile military service members. BMC Med Res Methodol. 2010, 10: 99-10.1186/1471-2288-10-99.CrossRefPubMedPubMedCentral Littman AJ, Boyko EJ, Jacobson IG, Horton J, Gackstetter GD, Smith B, Hooper T, Wells TS, Amoroso PJ, Smith TC, et al: Assessing nonresponse bias at follow-up in a large prospective cohort of relatively young and mobile military service members. BMC Med Res Methodol. 2010, 10: 99-10.1186/1471-2288-10-99.CrossRefPubMedPubMedCentral
10.
go back to reference Van Loon AJM, Tijhuis M, Picavet HSJ, Surtees PG, Ormel J: Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol. 2003, 13 (2): 105-110. 10.1016/S1047-2797(02)00257-0.CrossRefPubMed Van Loon AJM, Tijhuis M, Picavet HSJ, Surtees PG, Ormel J: Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol. 2003, 13 (2): 105-110. 10.1016/S1047-2797(02)00257-0.CrossRefPubMed
11.
go back to reference Shahar E, Folsom AR, Jackson R: The effect of nonresponse on prevalence estimates for a referent population: Insights from a population-based cohort study. Ann Epidemiol. 1996, 6 (6): 498-506. 10.1016/S1047-2797(96)00104-4.CrossRefPubMed Shahar E, Folsom AR, Jackson R: The effect of nonresponse on prevalence estimates for a referent population: Insights from a population-based cohort study. Ann Epidemiol. 1996, 6 (6): 498-506. 10.1016/S1047-2797(96)00104-4.CrossRefPubMed
12.
go back to reference Little R, Rubin DB: Statistical analysis with missing data. 2002, New York: Wiley, 2 Little R, Rubin DB: Statistical analysis with missing data. 2002, New York: Wiley, 2
13.
go back to reference Greenland S: Response and follow-up bias in cohort studies. Am J Epidemiol. 1977, 106 (3): 184-187.PubMed Greenland S: Response and follow-up bias in cohort studies. Am J Epidemiol. 1977, 106 (3): 184-187.PubMed
14.
go back to reference Kleinbaum DG, Morgenstern H, Kupper LL: Selection bias in epidemiologic studies. Am J Epidemiol. 1981, 113 (4): 452-463.PubMed Kleinbaum DG, Morgenstern H, Kupper LL: Selection bias in epidemiologic studies. Am J Epidemiol. 1981, 113 (4): 452-463.PubMed
15.
go back to reference Lohr SL: Brooks/Cole CENGAGE Learning. Sampling: design and analysis. 2009, Second edn Lohr SL: Brooks/Cole CENGAGE Learning. Sampling: design and analysis. 2009, Second edn
16.
go back to reference Demissie S, LaValley MP, Horton NJ, Glynn RJ, Cupples LA: Bias due to missing exposure data using complete-case analysis in the proportional hazards regression model. Stat Med. 2003, 22 (4): 545-557. 10.1002/sim.1340.CrossRefPubMed Demissie S, LaValley MP, Horton NJ, Glynn RJ, Cupples LA: Bias due to missing exposure data using complete-case analysis in the proportional hazards regression model. Stat Med. 2003, 22 (4): 545-557. 10.1002/sim.1340.CrossRefPubMed
17.
go back to reference Hoge CW, Messer SC, Castro CA: Combat duty in Iraq and Afghanistan and mental health problems - reply. New Engl J Med. 2004, 351 (17): 1799-1800. Hoge CW, Messer SC, Castro CA: Combat duty in Iraq and Afghanistan and mental health problems - reply. New Engl J Med. 2004, 351 (17): 1799-1800.
18.
go back to reference Hoge CW, Auchterlonie JL, Milliken CS: Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Jama-J Am Med Assoc. 2006, 295 (9): 1023-1032. 10.1001/jama.295.9.1023.CrossRef Hoge CW, Auchterlonie JL, Milliken CS: Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Jama-J Am Med Assoc. 2006, 295 (9): 1023-1032. 10.1001/jama.295.9.1023.CrossRef
19.
go back to reference Gray GC, Kaiser KS, Hawksworth AW, Hall FW, Barrett-Connor E: Increased postwar symptoms and psychological morbidity among US Navy Gulf War veterans. AmJTrop Med Hyg. 1999, 60 (5): 758-766. Gray GC, Kaiser KS, Hawksworth AW, Hall FW, Barrett-Connor E: Increased postwar symptoms and psychological morbidity among US Navy Gulf War veterans. AmJTrop Med Hyg. 1999, 60 (5): 758-766.
20.
go back to reference Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D, Team MCS: New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. Brit Med J. 2008, 336 (7640): 366-371. 10.1136/bmj.39430.638241.AE.CrossRefPubMedPubMedCentral Smith TC, Ryan MAK, Wingard DL, Slymen DJ, Sallis JF, Kritz-Silverstein D, Team MCS: New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. Brit Med J. 2008, 336 (7640): 366-371. 10.1136/bmj.39430.638241.AE.CrossRefPubMedPubMedCentral
21.
go back to reference Wells TS, LeardMann CA, Fortuna SO, Smith B, Smith TC, Ryan MAK, Boyko EJ, Blazer D, Team MCS: A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. Am J Public Health. 2010, 100 (1): 90-99. 10.2105/AJPH.2008.155432.CrossRefPubMedPubMedCentral Wells TS, LeardMann CA, Fortuna SO, Smith B, Smith TC, Ryan MAK, Boyko EJ, Blazer D, Team MCS: A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. Am J Public Health. 2010, 100 (1): 90-99. 10.2105/AJPH.2008.155432.CrossRefPubMedPubMedCentral
22.
go back to reference Welch KE, LeardMann CA, Jacobson IG, Speigle SJ, Smith B, Smith TC, Ryan MA: Postcards encourage participant updates. Epidemiology. 2009, 20 (2): 313-314. 10.1097/EDE.0b013e3181931558.CrossRefPubMed Welch KE, LeardMann CA, Jacobson IG, Speigle SJ, Smith B, Smith TC, Ryan MA: Postcards encourage participant updates. Epidemiology. 2009, 20 (2): 313-314. 10.1097/EDE.0b013e3181931558.CrossRefPubMed
23.
go back to reference Tate AR, Jones M, Hull L, Fear NT, Rona R, Wessely S, Hotopf M: How many mailouts? Could attempts to increase the response rate in the Iraq war cohort study be counterproductive?. BMC Med Res Methodol. 2007, 7: 51-10.1186/1471-2288-7-51.CrossRefPubMedPubMedCentral Tate AR, Jones M, Hull L, Fear NT, Rona R, Wessely S, Hotopf M: How many mailouts? Could attempts to increase the response rate in the Iraq war cohort study be counterproductive?. BMC Med Res Methodol. 2007, 7: 51-10.1186/1471-2288-7-51.CrossRefPubMedPubMedCentral
24.
go back to reference Wells TS, Jacobson IG, Smith TC, Spooner CN, Smith B, Reed RJ, Amoroso PJ, Ryan MAK, Team MCS: Prior health care utilization as a potential determinant of enrollment in a 21-year prospective study, the millennium cohort study. Eur J Epidemiol. 2008, 23 (2): 79-87. 10.1007/s10654-007-9216-0.CrossRefPubMed Wells TS, Jacobson IG, Smith TC, Spooner CN, Smith B, Reed RJ, Amoroso PJ, Ryan MAK, Team MCS: Prior health care utilization as a potential determinant of enrollment in a 21-year prospective study, the millennium cohort study. Eur J Epidemiol. 2008, 23 (2): 79-87. 10.1007/s10654-007-9216-0.CrossRefPubMed
25.
go back to reference Rupp I, Triemstra M, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos GAM: Selection bias due to non-response in a health survey among patients with rheumatoid arthritis. Eur J Public Health. 2002, 12 (2): 131-135. 10.1093/eurpub/12.2.131.CrossRefPubMed Rupp I, Triemstra M, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos GAM: Selection bias due to non-response in a health survey among patients with rheumatoid arthritis. Eur J Public Health. 2002, 12 (2): 131-135. 10.1093/eurpub/12.2.131.CrossRefPubMed
26.
go back to reference Etter JF, Perneger TV: Analysis of non-response bias in a mailed health survey. J Clin Epidemiol. 1997, 50 (10): 1123-1128. 10.1016/S0895-4356(97)00166-2.CrossRefPubMed Etter JF, Perneger TV: Analysis of non-response bias in a mailed health survey. J Clin Epidemiol. 1997, 50 (10): 1123-1128. 10.1016/S0895-4356(97)00166-2.CrossRefPubMed
27.
go back to reference Freudenstein U, Arthur AJ, Matthews RJ, Jagger C: Community surveys of late-life depression: who are the non-responders?. Age Ageing. 2001, 30 (6): 517-521. 10.1093/ageing/30.6.517.CrossRefPubMed Freudenstein U, Arthur AJ, Matthews RJ, Jagger C: Community surveys of late-life depression: who are the non-responders?. Age Ageing. 2001, 30 (6): 517-521. 10.1093/ageing/30.6.517.CrossRefPubMed
28.
go back to reference Gray GC, Chesbrough KB, Ryan MA, Amoroso P, Boyko EJ, Gackstetter GD, Hooper TI, Riddle JR: The millennium cohort study: a 21-year prospective cohort study of 140,000 military personnel. Mil Med. 2002, 167 (6): 483-488.PubMed Gray GC, Chesbrough KB, Ryan MA, Amoroso P, Boyko EJ, Gackstetter GD, Hooper TI, Riddle JR: The millennium cohort study: a 21-year prospective cohort study of 140,000 military personnel. Mil Med. 2002, 167 (6): 483-488.PubMed
29.
go back to reference Ryan MA, Smith TC, Smith B, Amoroso P, Boyko EJ, Gray GC, Gackstetter GD, Riddle JR, Wells TS, Gumbs G, et al: Millennium cohort: enrollment begins a 21-year contribution to understanding the impact of military service. J Clin Epidemiol. 2007, 60 (2): 181-191. 10.1016/j.jclinepi.2006.05.009.CrossRefPubMed Ryan MA, Smith TC, Smith B, Amoroso P, Boyko EJ, Gray GC, Gackstetter GD, Riddle JR, Wells TS, Gumbs G, et al: Millennium cohort: enrollment begins a 21-year contribution to understanding the impact of military service. J Clin Epidemiol. 2007, 60 (2): 181-191. 10.1016/j.jclinepi.2006.05.009.CrossRefPubMed
30.
go back to reference Dillman DA, Phelps G, Tortora R, Swift K, Kohrell J, Berck J, Messer BL: Response rate and measurement differences in mixed-mode surveys using mail, telephone, interactive voice response (IVR) and the Internet. Soc Sci Res. 2009, 38 (1): 3-20.CrossRef Dillman DA, Phelps G, Tortora R, Swift K, Kohrell J, Berck J, Messer BL: Response rate and measurement differences in mixed-mode surveys using mail, telephone, interactive voice response (IVR) and the Internet. Soc Sci Res. 2009, 38 (1): 3-20.CrossRef
31.
go back to reference Dillman DA, Lesser V, Mason R, Carlson J, Willits F, Robertson R, Burke B: Personalization of mail surveys for general public and populations with a group identity: results from nine studies. Rural Sociol. 2007, 72 (4): 632-646. 10.1526/003601107782638693.CrossRef Dillman DA, Lesser V, Mason R, Carlson J, Willits F, Robertson R, Burke B: Personalization of mail surveys for general public and populations with a group identity: results from nine studies. Rural Sociol. 2007, 72 (4): 632-646. 10.1526/003601107782638693.CrossRef
32.
go back to reference Dillman DA: Mail and internet surveys: the tailored design method. 2000, New York: Wiley Dillman DA: Mail and internet surveys: the tailored design method. 2000, New York: Wiley
33.
go back to reference Chretien JP, Chu LK, Smith TC, Smith B, Ryan MAK: Demographic and occupational predictors of early response to a mailed invitation to enroll in a longitudinal health study. BMC Med Res Methodol. 2007, 7: 6-10.1186/1471-2288-7-6.CrossRefPubMedPubMedCentral Chretien JP, Chu LK, Smith TC, Smith B, Ryan MAK: Demographic and occupational predictors of early response to a mailed invitation to enroll in a longitudinal health study. BMC Med Res Methodol. 2007, 7: 6-10.1186/1471-2288-7-6.CrossRefPubMedPubMedCentral
34.
go back to reference Glantz S, Slinker B: Primer of applied Regression and analysis of variance. 1990, New York, NY: McGraw-Hill Glantz S, Slinker B: Primer of applied Regression and analysis of variance. 1990, New York, NY: McGraw-Hill
35.
go back to reference Heberlein TA, Baumgartner R: Factors affecting response rates to mailed questionnaires - quantitative-analysis of published literature. Am Sociol Rev. 1978, 43 (4): 447-462. 10.2307/2094771.CrossRef Heberlein TA, Baumgartner R: Factors affecting response rates to mailed questionnaires - quantitative-analysis of published literature. Am Sociol Rev. 1978, 43 (4): 447-462. 10.2307/2094771.CrossRef
36.
go back to reference Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JBW, Degruy FV, Brody D, Davies M: Health-related quality-of-life in primary-care patients with mental-disorders - results from the prime-md 1000 study. Jama-J Am Med Assoc. 1995, 274 (19): 1511-1517. 10.1001/jama.1995.03530190025030.CrossRef Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JBW, Degruy FV, Brody D, Davies M: Health-related quality-of-life in primary-care patients with mental-disorders - results from the prime-md 1000 study. Jama-J Am Med Assoc. 1995, 274 (19): 1511-1517. 10.1001/jama.1995.03530190025030.CrossRef
37.
go back to reference Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J: The functioning and well-being of depressed-patients - results from the medical outcomes study. Jama-J Am Med Assoc. 1989, 262 (7): 914-919. 10.1001/jama.1989.03430070062031.CrossRef Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M, Berry S, Greenfield S, Ware J: The functioning and well-being of depressed-patients - results from the medical outcomes study. Jama-J Am Med Assoc. 1989, 262 (7): 914-919. 10.1001/jama.1989.03430070062031.CrossRef
38.
go back to reference Lundberg I, Thakker KD, Hallstrom T, Forsell Y: Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the part study on mental disorders. Soc Psych Psych Epid. 2005, 40 (6): 475-483. 10.1007/s00127-005-0911-4.CrossRef Lundberg I, Thakker KD, Hallstrom T, Forsell Y: Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the part study on mental disorders. Soc Psych Psych Epid. 2005, 40 (6): 475-483. 10.1007/s00127-005-0911-4.CrossRef
39.
go back to reference de Winter AF, Oldehinkel AJ, Veenstra R, Brunnekreef JA, Verhulst FC, Ormel J: Evaluation of non-response bias in mental health determinants and outcomes in a large sample of pre-adolescents. Eur J Epidemiol. 2005, 20 (2): 173-181. 10.1007/s10654-004-4948-6.CrossRefPubMed de Winter AF, Oldehinkel AJ, Veenstra R, Brunnekreef JA, Verhulst FC, Ormel J: Evaluation of non-response bias in mental health determinants and outcomes in a large sample of pre-adolescents. Eur J Epidemiol. 2005, 20 (2): 173-181. 10.1007/s10654-004-4948-6.CrossRefPubMed
Metadata
Title
The impact of deployment experience and prior healthcare utilization on enrollment in a large military cohort study
Authors
Jaime L Horton
Isabel G Jacobson
Alyson J Littman
John E Alcaraz
Besa Smith
Nancy F Crum-Cianflone
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2013
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/1471-2288-13-90

Other articles of this Issue 1/2013

BMC Medical Research Methodology 1/2013 Go to the issue