Abstract
Background and aimsAnalytical approaches to addressing survey non‐participation bias typically use only demographic information to improve estimates. We applied a novel methodology which uses health information from data linkage to adjust for non‐representativeness. We illustrate the method by presenting adjusted alcohol consumption estimates for Scotland.DesignData on consenting respondents to the Scottish Health Surveys (SHeSs) 1995–2010 were linked confidentially to routinely collected hospital admission and mortality records. Synthetic observations representing non‐respondents were created using general population data. Multiple imputation was performed to compute adjusted alcohol estimates given a range of assumptions about the missing data. Adjusted estimates of mean weekly consumption were additionally calibrated to per‐capita alcohol sales data.SettingScotland.Participants13 936 male and 18 021 female respondents to the SHeSs 1995–2010, aged 20–64 years.MeasurementsWeekly alcohol consumption, non‐, binge‐ and problem‐drinking.FindingsInitial adjustment for non‐response resulted in estimates of mean weekly consumption that were elevated by up to 17.8% [26.5 units (18.6–34.4)] compared with corrections based solely on socio‐demographic data [22.5 (17.7–27.3)]; other drinking behaviour estimates were little changed. Under more extreme assumptions the overall difference was up to 53%, and calibrating to sales estimates resulted in up to 88% difference. Increases were especially pronounced among males in deprived areas.ConclusionsThe use of routinely collected health data to reduce bias arising from survey non‐response resulted in higher alcohol consumption estimates among working‐age males in Scotland, with less impact for females. This new method of bias reduction can be generalized to other surveys to improve estimates of alternative harmful behaviours.
Highlights
Accurate data on addictive substance use are necessary to inform policy development, implementation and evaluation [1,2] and for alcohol research
Incidence rates of alcohol-related harm [7,8], as well as all-cause mortality [8,9], have been found to be substantially lower among survey respondents compared with the general population, as we identified from recordlinkage in Scottish Health Surveys (SHeSs) [10]
The aims of this study were threefold: i Exploit linkage of survey records to administrative health data to adjust for health-related nonrepresentativeness in alcohol consumption estimates; ii Conduct sensitivity analysis given a range of assumptions about the unobserved data; and iii Triangulate adjusted survey estimates with alcohol sales data
Summary
Accurate data on addictive substance use are necessary to inform policy development, implementation and evaluation [1,2] and for alcohol research. Providing important additional insights compared to sales data [5], survey-derived estimates face various biases—including those arising from non-participation of invited respondents (unit non-response), social desirability and recall [6]—. Incidence rates of alcohol-related harm [7,8], as well as all-cause mortality [8,9], have been found to be substantially lower among survey respondents compared with the general population, as we identified from recordlinkage in SHeS [10] These features contribute to underestimation of population consumption from surveys [11,12,13,14], evident as a substantial differential between survey- and sales data-based estimates of mean weekly units consumed [15,16,17], hampering alcohol research.
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