Accuracy of patients' reports of comorbid disease and their association with mortality in ESRD.
BACKGROUND
Patient awareness of chronic diseases is low. Unawareness may represent poor understanding of chronic illness and may be associated with poor outcomes in patients with end-stage renal disease (ESRD).


METHODS
Concurrent prospective national cohort study.


METHODS
Incident hemodialysis and peritoneal dialysis patients enrolled in the Choices for Healthy Outcomes in Caring for ESRD Study and followed up until 2004.


METHODS
Inaccurate patient self-report of 8 comorbid diseases compared with the medical record.


METHODS
All-cause mortality was the primary outcome. Cox proportional hazard models were used to assess the contribution of demographics and clinical measures in the relation of inaccurate self-report to mortality.


RESULTS
In 965 patients, the proportion of inaccurate self-reporters ranged from 3% for diabetes mellitus to 35% for congestive heart failure. Generally, inaccurate self-reporters were older and had more chronic diseases. Greater risk of death was found for inaccurate self-reporters of ischemic heart disease (hazard ratio [HR], 1.34; 95% confidence interval, 1.12 to 1.59; P = 0.001), coronary intervention (HR, 1.46; 95% confidence interval, 1.08 to 1.97; P = 0.01), and chronic obstructive pulmonary disease (HR, 1.40; 95% confidence interval, 1.14 to 1.70; P = 0.001). The greater risk of death remained significant for chronic obstructive pulmonary disease (HR, 1.36; 95% confidence interval, 1.11 to 1.66; P = 0.003) after adjustment for age, sex, and race. In patients receiving peritoneal dialysis, greater risk of death (HR, 2.06; 95% confidence interval, 1.34 to 3.15; P = 0.001) was found for inaccurate self-reporters of ischemic heart disease.


CONCLUSIONS
Includes potential for residual confounding, medical record error, misclassification of patient accuracy of self-report, and low inaccurate self-report of some chronic diseases, reducing the power to measure associations.


CONCLUSIONS
Accuracy of self-report depends on the specific comorbid disease. Patients with ESRD, especially those receiving peritoneal dialysis, who inaccurately report heart disease may be less aware of their chronic comorbid disease and may be at greater risk of mortality compared with those who accurately report their comorbid disease.
Cavanaugh
Kerri L
KL
Department of Medicine, Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN 37232-2372, USA. cavanaugh@vanderbilt.edu
Merkin
Sharon Stein
SS
Plantinga
Laura C
LC
Fink
Nancy E
NE
Sadler
John H
JH
Powe
Neil R
NR
D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D010358:Patient Participation / Q000379:methods; D010530:Peritoneal Dialysis / Q000379:methods / Q000401:mortality; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality; D018570:Risk Assessment; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016019:Survival Analysis