title: Selective attrition and bias in a longitudinal health survey among survivors of a disaster.
abstract: BACKGROUND
  Little is known about the response mechanisms among survivors of disasters. We studied the selective attrition and possible bias in a longitudinal study among survivors of a fireworks disaster.
  
  
  METHODS
  Survivors completed a questionnaire three weeks (wave 1), 18 months (wave 2) and four years post-disaster (wave 3). Demographic characteristics, disaster-related factors and health problems at wave 1 were compared between respondents and non-respondents at the follow-up surveys. Possible bias as a result of selective response was examined by comparing prevalence estimates resulting from multiple imputation and from complete case analysis. Analysis were stratified according to ethnic background (native Dutch and immigrant survivors).
  
  
  RESULTS
  Among both native Dutch and immigrant survivors, female survivors and survivors in the age categories 25-44 and 45-64 years old were more likely to respond to the follow-up surveys. In general, disasters exposure did not differ between respondents and non-respondents at follow-up. Response at follow-up differed between native Dutch and non-western immigrant survivors. For example, native Dutch who responded only to wave 1 reported more depressive feelings at wave 1 (59.7%; 95% CI 51.2-68.2) than Dutch survivors who responded to all three waves (45.4%; 95% CI 41.6-49.2, p < 0.05). Immigrants who responded only to wave 1 had fewer health problems three weeks post-disaster such as depressive feelings (M = 69.3%; 95% CI 60.9-77.6) and intrusions and avoidance reactions (82.7%; 95% CI 75.8-89.5) than immigrants who responded to all three waves (respectively 89.9%; 95% CI 83.4-96.9 and 96.3%; 95% CI 92.3-100, p < .01). Among Dutch survivors, the imputed prevalence estimates of wave 3 health problems tended to be higher than the complete case estimates. The imputed prevalence estimates of wave 3 health problems among immigrants were either unaffected or somewhat lower than the complete case estimates.
  
  
  CONCLUSIONS
  Our results indicate that despite selective response, the complete case prevalence estimates were only somewhat biased. Future studies, both among survivors of disasters and among the general population, should not only examine selective response, but should also investigate whether selective response has biased the complete case prevalence estimates of health problems by using statistical techniques such as multiple imputation.
authors.affiliation: National Institute for Public Health and the Environment (RIVM), A. van Leeuwenhoeklaan 6, 3720 BA Bilthoven, The Netherlands. bellis.van.den.berg@rivm.nl
authors.forename: Bellis
authors.initials: B
authors.lastname: van den Berg
authors.forename: Peter
authors.initials: P
authors.lastname: van der Velden
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stellato
authors.forename: Linda
authors.initials: L
authors.lastname: Grievink
mesh_terms: D000328:Adult; D000368:Aged; D015982:Bias; D004190:Disasters; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017741:Survivors