title: Validity of self-report for fractures among a multiethnic cohort of postmenopausal women: results from the Women's Health Initiative observational study and clinical trials.
abstract: OBJECTIVE
  The purpose of this study is to examine the validity of, and factors associated with, the accuracy of self-report (participant-report and proxy-report) for fractures.
  
  
  METHODS
  Study participants were from the Women's Health Initiative Clinical Trial and Observational Study cohorts. All women were postmenopausal; populations included American Indian, Asian/Pacific Islander, black, Hispanic, and non-Hispanic white. The average length of follow-up was 4.3 years. Self-reported fractures were adjudicated by reviewing medical records. The first adjudicated self-report of fractures for each participant was included in the analysis (n = 6,652).
  
  
  RESULTS
  We found substantial variations in validity of self-report by the fracture site. Agreements between self-reports for single-site fractures and medical records were high for hip (78%) and forearm/wrist (81%) but relatively lower for clinical spine fractures (51%). The average confirmation rate for all single-site fractures was 71%. Misidentification of fracture sites by participants or proxy-reporters seemed to be a cause of unconfirmed self-reports. Higher confirmation rates were observed in participant-reports than in proxy-reports. Results of the multivariate analysis indicated that multiple factors, such as ethnicity, a history of osteoporosis or fractures, body mass index, years since menopause, smoking status, and number of falls in the past year were significantly (P < 0.05) related to the validity of self-report.
  
  
  CONCLUSIONS
  The validity of self-reports for fracture varies by fracture sites and many other factors. The assessed validity in this study is likely conservative because some of the unconfirmed self-reports may be due to poor medical record systems. The validity of self-reports for hip and forearm/wrist fractures is high in this study, supporting their use in epidemiological studies among postmenopausal women.
authors.affiliation: University of Arizona, Tucson, AZ, USA. zchen@u.arizona.edu
authors.forename: Zhao
authors.initials: Z
authors.lastname: Chen
authors.forename: Charles
authors.initials: C
authors.lastname: Kooperberg
authors.forename: Mary B
authors.initials: MB
authors.lastname: Pettinger
authors.forename: Tamsen
authors.initials: T
authors.lastname: Bassford
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: Simon
authors.initials: S
authors.lastname: Kipersztok
authors.forename: Carolyn
authors.initials: C
authors.lastname: Borne
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Jackson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D017698:Postmenopause; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D011795:Surveys and Questionnaires / Q000592:standards*; D014481:United States / Q000453:epidemiology