The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data.

BACKGROUND Socioeconomic differences in health and in use of health care are well known. Most data on socioeconomic differences in health care utilization are based on retrospective self-report in community surveys, but the evidence on the validity of self-reported utilization of health care across socioeconomic groups is limited. The aim of this study was to assess the validity of self-reported utilization of health care across socioeconomic groups in the general population. METHODS We compared the concordance of self-reported and registered hospitalization (one year, n = 1277), and utilization of physiotherapy (one year, n = 1302) and use of prescription drugs (3 months, n = 899), by socioeconomic group (educational level, income, occupational status). Data came from a face-to-face health interview survey in Amsterdam and a health insurance register, and were limited to native Dutch and lower and middle income groups. RESULTS Concordance between reported and registered utilization was generally good to excellent; kappas (agreement adjusted for chance agreement) and percentage accurately reporting ranged from 0.60 and 80% (drugs) to 0.80 and 96% (hospitalization). They differed little, and without statistical significance, between people of low socioeconomic status and others. Assessment of socioeconomic groups in more detail yields somewhat more variation, but no systematic trend in concordance by higher socioeconomic status. CONCLUSION Self-report offers a reasonably valid estimate of differences in utilization of health care between socioeconomic groups in the general population, at least for lower and middle income groups.

[1]  A. Majeed,et al.  Socioeconomic differences in general practice consultation rates in patients aged 65 and over: prospective cohort study , 1999, BMJ.

[2]  H. Picavet,et al.  Health interview surveys. Towards international harmonization of methods and instruments. , 1996, WHO regional publications. European series.

[3]  Stephen E. Fienberg,et al.  The analysis of cross-classified categorical data , 1980 .

[4]  M. Massagli,et al.  The validity of self‐reported health‐care utilization by AIDS patients , 1996, AIDS.

[5]  A. Jette,et al.  The Validity of Self-reported Physician Utilization Measures , 1984, Medical care.

[6]  Y Ben-Shlomo,et al.  Prediction of general practice workload from census based social deprivation scores. , 1992, Journal of epidemiology and community health.

[7]  J. Mackenbach,et al.  The size of mortality differences associated with educational level in nine industrialized countries. , 1994, American journal of public health.

[8]  J. Neaton,et al.  Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. , 1996, American journal of public health.

[9]  A. Feinstein,et al.  High agreement but low kappa: II. Resolving the paradoxes. , 1990, Journal of clinical epidemiology.

[10]  J. V. D. Meer.  Equal care, equal cure? Socioeconomic differences in the use of health services and the course of health problems , 1998 .

[11]  M M Bergmann,et al.  Validity of self-reported diagnoses leading to hospitalization: a comparison of self-reports with hospital records in a prospective study of American adults. , 1998, American journal of epidemiology.

[12]  D. Maclean,et al.  Socioeconomic differences in the use of physician services in Nova Scotia. , 1998, American journal of public health.

[13]  P. Sorlie,et al.  US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. , 1995, American journal of public health.

[14]  E. Bergstralh,et al.  Comparison of self-reported and medical record health care utilization measures. , 1996, Journal of clinical epidemiology.

[15]  W. Hadden,et al.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. , 1993, The New England journal of medicine.

[16]  S. Reijneveld,et al.  The impact of individual and area characteristics on urban socioeconomic differences in health and smoking. , 1998, International journal of epidemiology.

[17]  J. Mackenbach,et al.  Socioeconomic differences in the utilization of health services in a Dutch population: the contribution of health status. , 1996, Health policy.

[18]  K. Stronks,et al.  UvA-DARE ( Digital Academic Repository ) Immigrants in the Netherlands : equal access for equal needs ? , 2001 .

[19]  D G Cook,et al.  Explaining variation in hospital admission rates between general practices: cross sectional study , 1999, BMJ.

[20]  V. Goel,et al.  Socio-Economic Status and Visits to Physicians by Adults in Ontario, Canada , 1997, Journal of health services research & policy.

[21]  R. Sanderman,et al.  Socioeconomic inequity in health care: a study of services utilization in Curaçao. , 1997, Social science & medicine.

[22]  J. B. Garner,et al.  The standard error of Cohen's Kappa. , 1991, Statistics in medicine.

[23]  M. Roland,et al.  Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices , 1996, BMJ.

[24]  W. Manning,et al.  Physician use in Ontario and the United States: The impact of socioeconomic status and health status. , 1996, American journal of public health.

[25]  K. Stronks,et al.  The impact of response bias on estimates of health care utilization in a metropolitan area: the use of administrative data. , 1999, International journal of epidemiology.

[26]  W. McIsaac,et al.  Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. , 2000, Social science & medicine.

[27]  S. Reijneveld.  Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position? , 1998, Journal of epidemiology and community health.

[28]  A Norrish,et al.  Validity of self-reported hospital admission in a prospective study. , 1994, American journal of epidemiology.

[29]  D. Tancredi,et al.  An analysis of physician utilization by elderly persons: systematic differences between self-report and archival information. , 1992, Journal of gerontology.

[30]  M P Becker,et al.  Log-linear modelling of pairwise interobserver agreement on a categorical scale. , 1992, Statistics in medicine.

[31]  J. Goldthorpe,et al.  Intergenerational Class Mobility in Three Western European Societies: England, France and Sweden , 1979 .

[32]  J. Mackenbach,et al.  Socioeconomic inequalities in mortality among women and among men: an international study. , 1999, American journal of public health.

[33]  Juan de Dios Luna,et al.  Validity of self reported utilisation of primary health care services in an urban population in Spain , 2000, Journal of epidemiology and community health.

[34]  J. Carlin,et al.  Bias, prevalence and kappa. , 1993, Journal of clinical epidemiology.

[35]  J L Kelsey,et al.  The measurement of social class in epidemiology. , 1988, Epidemiologic reviews.

[36]  J. Neaton,et al.  Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: II. Black men. , 1996, American journal of public health.

[37]  D. D. de Bakker,et al.  The impact of area deprivation on differences in health: does the choice of the geographical classification matter? , 2000, Journal of epidemiology and community health.

[38]  J. Mackenbach,et al.  Socio-economic differences in general practitioner and outpatient specialist care in The Netherlands: a matter of health insurance? , 1997, Social science & medicine.

[39]  S. Reijneveld.  The cross-cultural validity of self-reported use of health care: a comparison of survey and registration data. , 2000, Journal of clinical epidemiology.

[40]  D. Vågerö,et al.  Socioeconomic inequalities in morbidity and mortality in western Europe , 1997, The Lancet.