title: Comparisons of self-reported and chart-identified chronic diseases in inner-city seniors.
abstract: OBJECTIVE
  To examine agreement between self-report of chronic disease and medical record data for inner-city seniors, their sensitivity and specificity, and the association between patient characteristics and accuracy of self-reports.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Two hospital-based primary care practices serving a low-income inner-city population.
  
  
  METHODS
  Adults aged 65 and older (n=323).
  
  
  METHODS
  Data on self-reported asthma, depression, diabetes mellitus, and hypertension were collected through interviewer-administered surveys (in English and Spanish) and chart abstraction. Chart-based disease was defined in two ways: physician documentation and physician documentation plus use of a medication to treat that condition. Sensitivity, specificity, and agreement were calculated. Univariate and multivariable regression analyses were used to determine the associations between patient characteristics and patient-chart agreement.
  
  
  RESULTS
  Agreement between self-report and chart data was high for diabetes mellitus (kappa=0.94) intermediate for asthma (kappa=0.66), and hypertension (kappa=0.54) and low for depression (kappa=0.4). Sensitivity and specificity were high for diabetes mellitus (0.99 and 0.96, respectively) and low for depression (0.74 and 0.72, respectively). Specificity for hypertension was lowest (0.67). Age, education, health literacy, and other patient characteristics did not have clear associations across conditions.
  
  
  CONCLUSIONS
  Self-reports may be most reliable for diabetes mellitus and least reliable for depression for surveys involving older, inner-city adults. Survey research with older adults should include confirmatory data when assessing presence of depression, hypertension, and asthma.
authors.affiliation: Mount Sinai School of Medicine, New York, New York 10029, USA.
authors.forename: John
authors.initials: J
authors.lastname: Leikauf
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
mesh_terms: D000368:Aged; D001249:Asthma / Q000453:epidemiology; D016009:Chi-Square Distribution; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011204:Poverty Areas; D012650:Self Disclosure; D012680:Sensitivity and Specificity; D014504:Urban Health; D014505:Urban Population