Validity of self-reported myocardial infarction and stroke in regions with Sami and Norwegian populations: the SAMINOR 1 Survey and the CVDNOR project

Abstract

ObjectiveUpdated knowledge on the validity of self-reported myocardial infarction (SMI) and self-reported stroke (SRS) is needed in Norway. Our objective was to compare questionnaire data and hospital discharge data from regions with Sami and Norwegian populations to assess the validity of these outcomes by ethnicity, sex, age and education.DesignValidation study using cross-sectional questionnaire data and hospital discharge data from all Norwegian somatic hospitals.Participants and setting16 865 men and women aged 30 and 36–79 years participated in the Population-based Study on Health and Living Conditions in Sami and Norwegian Populations (SAMINOR) 1 Survey in 2003–2004. Information on SMI and SRS was available from self-administered questionnaires for 15 005 and 15 088 of these participants, respectively. We compared this information with hospital discharge data from 1994 until SAMINOR 1 Survey attendance.Primary and secondary outcomesSensitivity, specificity, positive predictive value (PPV), negative predictive value and κ.ResultsThe sensitivity and PPV of SMI were 90.1% and 78.9%, respectively; the PPV increased to 93.1% when all ischaemic heart disease (IHD) diagnoses were included. The SMI prevalence estimate was 2.3% and hospital-based 2.0%. The sensitivity and PPV of SRS were 81.1% and 64.3%, respectively. The SRS prevalence estimate was 1.5% and hospitalisation-based 1.2%. Moderate to no variation was observed in validity according to ethnicity, sex, age and education.ConclusionsThe sensitivity and PPV of SMI were high and moderate, respectively; for SRS, both of these measures were moderate. Our results show that SMI from the SAMINOR 1 Survey may be used in aetiological/analytical studies in this population due to a high IHD-specific PPV. The SAMINOR 1 questionnaire may also be used to estimate the prevalence of acute myocardial infarction and acute stroke.

Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

“…However, as discussed above, self-reports were verified against medical or hospital records in 455 reported events, with a confirmation rate of 89%, and available data from other studies of stroke and myocardial infarction support the accuracy of self-reports. 41 , 42 , 43 , 44 Third, our data are cross-sectional and we cannot determine whether participants are prescribed and commenced on secondary prevention and then cease using the medication, or whether they are never prescribed the medication; nor can we tell whether they are using the medication as prescribed (eg, daily vs weekly). For example, one study using registry data from India found that about half of all patients suffering a myocardial infarction were discharged on secondary prevention but adherence declined rapidly.…”

Pharmacological management of modifiable cardiovascular risk factors (blood pressure and lipids) following diagnosis of myocardial infarction, stroke and diabetes: comparison between population-based studies in Russia and Norway

“…Here we examined the impact of different definitions of medication use and found the substantive findings remained the same. Literature on the validity of self-reported CVD morbidities, including validation of self-reported stroke in a previous wave of the Tromsø Study [17] suggests that these are specific but not sensitive, with Excluding those with missing data on education or visiting a doctor in the past 12 months lower sensitivity for stroke and diabetes than MI [17][18][19][20][21]. While lower sensitivity of self-report means we may have missed some participants eligible for inclusion this is unlikely to have affected the results unless the people excluded differed substantially in terms of medication use and control from those included in the two studies and under-reporting of disease status differed by study.…”

Risk of Incident Cardiovascular Disease and Cardiovascular Risk Factors in First and Second-Generation Indians: The Singapore Indian Eye Study

“…However, we believe that that the impact of such biases would likely be similar in first and second-generation Indians. In addition, previous studies have shown self-reported outcomes for CVD to be valid in the estimation of actual outcome 51 – 53 . Combined with our reliability results of ~75%, we consider that the self-reported CVD outcomes captured in our study remains an appropriate indicator of actual CVD events.…”