Validity and reliability of self-reported arthritis: Georgia Senior Centers, 2000–2001

doi:10.1016/j.amepre.2004.12.004

American Journal of Preventive Medicine

Volume 28, Issue 3, April 2005, Pages 251-258

https://doi.org/10.1016/j.amepre.2004.12.004 Get rights and content

Background

Arthritis and other rheumatic conditions are a common cause of disability among adults in the United States. Telephone interviews of the state-based Behavioral Risk Factor Surveillance System (BRFSS) are used by states and territories to estimate the prevalence of arthritis. The purpose of this study was to assess the validity and reliability of the 1996–2001 BRFSS arthritis case definition in a senior center population.

Methods

A total of 487 respondents at selected senior centers in Georgia were surveyed by telephone, evaluated 3 to 4 weeks later by board-certified rheumatologists, and completed a written survey in 2000 to 2001. Using the rheumatologists’ summary assessment “Does this person have arthritis or a related condition” as the standard, the sensitivity and specificity of the BRFSS arthritis case definitions were calculated. Reliability for the BRFSS arthritis case definition was also calculated by comparing responses to the telephone survey with responses to a written survey.

Results

Sensitivity was 70.8% (95% confidence interval [CI]=65.9–75.6), and the specificity was 70.3% (95% CI=62.9–77.8). The agreement between the telephone and written responses indicating self-reported arthritis was high (κ=0.68). Analyses were conducted in 2002 to 2004.

Conclusions

Self-reported arthritis in the 1996–2001 BRFSS was highly reliable, and moderately sensitive and specific among these senior center participants.

Introduction

Arthritis and other rheumatic conditions are among the most prevalent diseases in the United States.¹ They include a wide range of illnesses and conditions,² the more common of which are osteoarthritis, rheumatoid arthritis, fibromyalgia, and gout,³ and most share the characteristics of pain, aching, stiffness, or swelling in or around the joints.² Arthritis is a leading cause of disability among adults in the United States,⁴ with direct and indirect costs estimated at $86.2 billion in 1997.⁵ Quality of life is also consistently worse for people with arthritis, compared with people without arthritis, because of pain, discomfort, reduced mobility, and the negative impact the disease can have on mental health.6, 7

Although arthritis is clearly a public health burden, it receives less attention than diseases associated with acute mortality.⁸ Arthritis is also a challenging subject of epidemiologic study due to inherent difficulties in defining a case and clearly distinguishing among different disorders.⁹ Estimates of overall arthritis prevalence in the United States have been drawn from the self-reported data of the National Health Interview Survey (NHIS),10, 11 which used an approach that required respondents to answer affirmatively to a short list of conditions, and be subsequently classified as having arthritis or other rheumatic conditions. According to these data, 16% of people classified with arthritis had not seen a doctor for their condition,¹² a finding that demonstrates the inability of healthcare system data to properly estimate arthritis prevalence and supports the use of self-reported data, such as the data collected in the state-based Behavioral Risk Factor Surveillance System (BRFSS), for a more complete population prevalence estimate of arthritis.

Assessments of the accuracy of self-reported data for arthritis are limited to a few studies of small groups.13, 14 Although the validity and reliability of hypertension, diabetes, and other topics included on the BRFSS have been published,¹⁵ to date no studies have published findings on the validity and reliability of the BRFSS arthritis case definition.* The purpose of this study was to assess the validity and reliability of the BRFSS arthritis case definition in a senior center population aged ≥50 years.

Section snippets

Study population

A convenience sample of senior center attendees residing in Georgia was chosen for this study population because of a probable high prevalence of arthritis and ease of providing a rheumatologic assessment. To achieve demographic balance in the sample, participants were recruited from 12 senior centers categorized by race/ethnicity (black, white); socioeconomic status (SES) (low, medium/high); and center location (urban, suburban, rural). A list of Georgia senior centers was compiled using

Description of participants

Compared to BRFSS respondents aged ≥50, study participants were significantly more likely to be older, black, female, poor, widowed, report any physical activity, have had a checkup within the past year, and no unhealthy days (Table 1). More study participants were classified with self-reported arthritis, original compared to the comparable BRFSS population (58.5% vs 52.2%), but this difference was not significant. Study participants were significantly more likely than BRFSS respondents to be

Discussion

Self-reported arthritis was highly reliable and, using a history and physical examination by board-certified rheumatologists as the gold standard, was moderately sensitive and specific.

Misclassification yielded different results for false-negative and false-positive participants. False negatives reported better health than true positives, and may have minimized their symptoms, making them less likely to report symptoms during the telephone interview. Conversely, false positives reported worse

References (22)

L.F. Callahan et al.
Arthritis and women’s healthprevalence, impact, and prevention
Am J Prev Med
(1996)
Factors associated with prevalent self-reported arthritis and other rheumatic conditions—United States, 1989–91
MMWR Morb Mortal Wkly Rep
(1996)
R.C. Lawrence et al.
Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States
Arthritis Rheum
(1998)
Prevalence of disabilities and associated health conditions among adults—United States, 1999
MMWR Morb Mortal Wkly Rep
(2001)
Updatedirect and indirect costs of arthritis and other rheumatic conditions—United States, 1997
MMWR Morb Mortal Wkly Rep
(2004)
F.D. Mili et al.
Health related quality of life among adults reporting arthritisanalysis of data from the Behavioral Risk Factor Surveillance System, US, 1996–99
J Rheumatol
(2003)
A. Praemer et al.
Muskuloskeletal conditions in the United States
(1999)
A.J. Silman et al.
Epidemiology of the rheumatic diseases
(2001)
Prevalence of arthritis, United States, 1997
MMWR Morb Mortal Wkly Rep
(2001)

Arthritis prevalence and activity limitations, United States, 1990

MMWR Morb Mortal Wkly Rep

(1994)

Cited by (88)

Comparing self-reports to national register data in the detection of disabling mental and musculoskeletal disorders among ageing women
2022, Maturitas
Citation Excerpt :
However, simple self-reports have gained less attention in the context of MDs and MSDs. Self-reports of depression [14] and arthritis [14–17] have moderate accuracy. Also, contradictory findings exist [10,15].
Self-reports of diseases are used in research due to time and cost efficiency. Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the leading causes of global disability.
To investigate how self-reports detect physician-diagnosed severe MDs and MSDs in postmenopausal women.
In the population-based OSTPRE cohort, 1466 women (aged 57–66) had received a permanent work disability pension (DP) due to ‘MDs only’ (n = 336), ‘MSDs only’ (n = 926) or ‘MDs + MSDs’ (n = 204) by the end of 1998 and responded to a postal enquiry in 1999. In 2009, 1029 women responded to a follow-up enquiry. Self-reports were cross-checked against register data on DPs.
In 1999, 47 % of the participants in the ‘MDs only’ and 21 % in the ‘MDs + MSDs’ reported DPs due to MDs, whereas 75 % in the ‘MSDs only’ and 67 % in the ‘MDs + MSDs’ reported DPs due to MSDs. By 2009, this discrepancy increased, with the respective figures being 34 % and 19 % for MDs and 75 % for both MSDs groups. In 1999, older age was related to non-reporting in the three groups (each: p ≤ 0.001).
Self-reports grossly underestimate the prevalence of disabling MDs and considerably that of MSDs among ageing women. Thus, additional sources of information are needed.
Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study
2021, Preventive Medicine Reports
Citation Excerpt :
Respondents who answered “yes” were coded as 1, whereas respondents who answered “no” were coded as 0. This item has been found to provide reliable overall arthritis surveillance with adequate sensitivity and specificity (Bombard et al., 2005; Sacks et al., 2005) and has been used in other population-based studies (Barbour et al., 2013, 2017; Fontaine et al., 2007; Guglielmo et al., 2018; Hootman et al., 2016). The main explanatory variables examined in this paper were CPA and CSA and were both measured as binary variables.
The objective of this cross-sectional study was to investigate childhood physical and sexual abuse as factors associated with arthritis among adults from selected states in the United States. Data for this study came from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 75,717 adults 18–75 years old (49.7% female) was analyzed using log-binomial regression. The outcome variable investigated in this study was arthritis, and the main explanatory variables were childhood physical and sexual abuse. Of the 75,717 respondents examined, 20,938 (representing 27.6%) had arthritis. A little over one in four respondents (25.5%) experienced childhood physical abuse and 5.6% experienced childhood sexual abuse by age 18. In the multivariable regression, respondents who experienced childhood physical abuse had 1.36 times the risk of having arthritis when compared to respondents who did not experience childhood physical abuse (ARR = 1.36, p < .001, 95% CI = 1.28–1.46). Respondents who experienced childhood sexual abuse had 1.60 times the risk of having arthritis when compared to respondents who did not experience childhood sexual abuse (ARR = 1.74, p < .001, 95% CI = 1.54–1.97). The findings of this study demonstrate that childhood physical and sexual abuse are associated with arthritis later in adulthood. The associations persisted even after adjusting for demographic, socioeconomic status, body mass index (BMI), current smoking status, and self-perceived physical health. The findings of this study add to the burgeoning number of studies demonstrating the adverse impact of childhood physical and sexual abuse on chronic health outcomes among adults.
Factors associated with the health care cost in older Australian women with arthritis: An application of the Andersen's Behavioural Model of Health Services Use
2016, Public Health
Factors associated with the utilisation of health care have not been rigorously examined in people with arthritis. The objective of this study was to examine the determinants of health care utilisation and costs in older women with arthritis using the Andersen's behavioural model as a framework.
Longitudinal cohort study.
Participants of Surveys 3 to 5 of the Australian Longitudinal Study on Women's Health who reported arthritis were included in the study. Information about health care utilisation and unit prices were based on linked Medicare Australia data, which included prescription medicines and health services. Total health care costs of participants with arthritis were measured for the years 2002 to 2003, 2005 to 2006, and 2008 to 2009, which corresponded to the survey years. Potential explanatory variables of the health care cost and other characteristics of the participants were collected from the health surveys. Explanatory variables were grouped into predisposing characteristics, enabling factors and need variables conforming to the Andersen's Behavioural Model of Health Services Use. Longitudinal data analysis was conducted using generalized estimating equations.
A total of 5834 observations were included for the three periods. Regression analysis results show that higher health care cost in older Australian women with arthritis was significantly associated with residing in an urban area, having supplementary health insurance coverage, more comorbid conditions, using complementary and alternative medicine, and worse physical functioning. It was also found that predisposing characteristics (such as the area of residence) and enabling factors (such as health insurance coverage) accounted for more variance in the health care cost than need variables (such as comorbid conditions).
These results may indicate an inefficient and unfair allocation of subsidised health care among older Australian women with arthritis, where individuals with less enabling resources and more socio-economic disadvantages have a lower level of health care utilisation. Future research may focus on evaluating the effectiveness of policies designed to reduce excessive out-of-pocket costs and to improve equity in health care access in the older population.
Prevalence of rheumatoid arthritis in Greece: results from the national health examination survey EMENO
2023, Rheumatology International
Associations of Arthritis with Functional Disability and Depressive Symptom in general US Adults: NHANES 1988-1994 and 1999-2018
2023, Research Square
Prevalence and risk factors for falls among community-dwelling adults in Riyadh area
2023, PeerJ

View all citing articles on Scopus

View full text

Research articlesValidity and reliability of self-reported arthritis: Georgia Senior Centers, 2000–2001

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study population

Description of participants

Discussion

Am J Prev Med

Factors associated with prevalent self-reported arthritis and other rheumatic conditions—United States, 1989–91

MMWR Morb Mortal Wkly Rep

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

Arthritis Rheum

Prevalence of disabilities and associated health conditions among adults—United States, 1999

MMWR Morb Mortal Wkly Rep

Updatedirect and indirect costs of arthritis and other rheumatic conditions—United States, 1997

MMWR Morb Mortal Wkly Rep

Health related quality of life among adults reporting arthritisanalysis of data from the Behavioral Risk Factor Surveillance System, US, 1996–99

J Rheumatol

Muskuloskeletal conditions in the United States

Epidemiology of the rheumatic diseases

Prevalence of arthritis, United States, 1997

MMWR Morb Mortal Wkly Rep

Arthritis prevalence and activity limitations, United States, 1990

MMWR Morb Mortal Wkly Rep

Research articles
Validity and reliability of self-reported arthritis: Georgia Senior Centers, 2000–2001