Elsevier

Annals of Epidemiology

Volume 13, Issue 2, February 2003, Pages 105-110
Annals of Epidemiology

Original report
Survey Non-response in the Netherlands: Effects on Prevalence Estimates and Associations

https://doi.org/10.1016/S1047-2797(02)00257-0Get rights and content

Abstract

PURPOSE: Differences in respondent characteristics may lead to bias in prevalence estimates and bias in associations. Both forms of non-response bias are investigated in a study on psychosocial factors and cancer risk, which is a sub-study of a large-scale monitoring survey in the Netherlands.

METHODS: Respondents of a cross-sectional monitoring project (MORGEN; N = 22,769) were also asked to participate in a prospective study on psychosocial factors and cancer risk (HLEQ; N = 12,097). To investigate diverse aspects of non-response in the HLEQ on prevalence estimates and associations are studied, based on information gathered in the MORGEN-project.

RESULTS: A response percentage of 45% was obtained in the MORGEN-project. Response rates were found to be lower among men and younger people. The HLEQ showed a response percentage of 56%, and respondents reported higher socioeconomic status, better subjective health and healthier lifestyle behaviors than non-respondents. However, associations between smoking status and either socioeconomic status or subjective health based on respondents only were not statistically different from those based on the entire MORGEN-population.

CONCLUSION: Non-response leads to bias in prevalence estimates of current smoking, current alcohol intake, and low physical activity or poor subjective health. However, non-response did not cause bias in the examined associations.

Section snippets

Selected Abbreviations and Acronyms

HLEQ = Health and Life Experiences Questionnaire

Study Population

Between 1993 and 1997, in the MORGEN-project, data on health status and the prevalence of risk factors were collected in a random sample of the general population, aged 20–59 years, drawn from three towns in the Netherlands. In Amsterdam and Maastricht each year a new sample was examined and in Doetinchem, participants of an earlier study (1987 to 1991) were re-examined. A total of 50,766 persons received an invitation to participate in the MORGEN-project. Those who returned a reply card had

Results

In total, 50,766 people were approached for participation in the MORGEN-project. Finally, 22,769 persons (45%) completed the total survey including questionnaires and a medical examination (Fig. 1). Overall, response percentages were higher among women (49%) than men (41%) and were higher among older persons (30% among people aged 20–29 and 54% among people aged 50–65). Response percentages were highest in Doetinchem (68%), intermediate in Maastricht (45%) and lowest in Amsterdam (34%). A

Discussion

The response rate of 45% in the MORGEN-project was only slightly lower than published values for comparable studies in the Netherlands (50–70%) (20). This may be explained by a general increase in non-response over the past 10 years and the length of the questionnaires (21). The mean response rate in the MORGEN-project was elevated by the relatively high response rate in Doetinchem (68%), which consisted largely of a selected sub-population (participants in the previous monitoring project).

Acknowledgements

The MORGEN project was financially supported by the Ministry of Public Health, Welfare and Sports of The Netherlands and the National Institute of Public Health and the Environment. The authors thank the epidemiologists and field workers of the Municipal Health Services in Amsterdam, Doetinchem and Maastricht for their important contribution to the data collection. The project steering committee consisted of Dr. H.B. Bueno de Mesquita, Dr. H.A. Smit, Dr. W.M.M. Verschuren and J.C. Seidell

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