Abstract
BackgroundHealth-related quality of life (HRQoL) measures are increasingly used in the general population. However, little is known about patterns and determinants of unanswered or unusable questionnaires and their consequences on estimates of HRQoL.MethodsThe 2003 Decennial Health Survey collected socio-demographic and health information, including HRQoL, for 30,782 adults representative of the French population. The pattern, determinants and impact on estimate validity of non, incomplete and inconsistent responses to the SF-36 questionnaire were determined. For this, phi coefficients, polytomous logistic regression models and multiple imputation methods were used.ResultsOnly 48% of the subjects eligible for the HRQoL measurement provided a complete and consistent SF-36 questionnaire. Three patterns of non-response and five of partial (incomplete or inconsistent) response were identified, sharing largely similar socio-demographic profiles (higher age, lower educational level and economic status, foreign background, and isolated). The consequences of non and partial responses on HRQoL estimates were large in several groups of subjects although these biases ran in opposite directions and partially neutralized each other.ConclusionsWhen measuring HRQoL in the general population, missing and inconsistent data are frequent, especially in elderly, educationally and socio-economically deprived, foreign and isolated groups. Methods for handling missing data are required to correct for potentially the associated and serious selection and non-differential information biases in studies targeting or investigating these groups.
Highlights
Health-related quality-of-life (HRQoL) measures are increasingly used, complementary to mortality and morbidity indicators, to assess health status in the general population e.g. [1,2,3]
Little is known about patterns and determinants of non response and unusable questionnaires and their effects on estimates of Health-related quality of life (HRQoL) in the population setting
Little attention has been paid to inconsistent responses to HRQoL items and their determinants, in some cases the algorithms for scoring questionnaires take them into account [10]
Summary
Health-related quality-of-life (HRQoL) measures are increasingly used, complementary to mortality and morbidity indicators, to assess health status in the general population e.g. [1,2,3]. Little is known about patterns and determinants of non response and unusable questionnaires and their effects on estimates of HRQoL in the population setting. As with other health status measures, both non responses and incomplete responses reduce the statistical power of studies (by reducing sample size). They may cause biases if non- or partialrespondents differ from respondents as concerns HRQoL or its determinants or confounders. In studies addressing this problem in the general population, non response to self-administered HRQoL measures was not distinguished from non response to other health information. Health-related quality of life (HRQoL) measures are increasingly used in the general population.
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