Does self-report data on HIV primary care utilization agree with medical record data for socially marginalized populations in the United States?
To test whether self-report data agree with medical record data in marginalized, HIV-infected populations, we collected information about HIV primary care visits over a 6-month period from both sources. Patients were drawn from a large study of engagement and retention in care conducted between 2003 and 2005. Self-report data were collected in face-to-face interviews and medical records were extracted using a rigorous, standardized protocol with multiple quality checks. We found poor overall agreement (weighted kappa = 0.36, 95% confidence interval = 0.28, 0.43). Factors associated with disagreement included younger age (adjusted odds ratio for 20 versus 40 years = 1.25, 95% confidence interval = 0.98, 1.60), non-Hispanic black race/ethnicity (adjusted odds ratio for non-Hispanic blacks versus non-Hispanic whites = 1.48, 95% confidence interval = 1.03, 2.13), lower education (adjusted odds ratio for high school education, GED, or less versus some college or college graduate = 1.43, 95% confidence interval = 0.96, 2.13), and substance use (adjusted odds ratio for any illicit drug/heavy alcohol use in the past 6 months versus no use = 1.39, 95% confidence interval = 1.02, 1.90). These findings do not support a conclusion that unconfirmed self-report data of HIV primary care visits are a sufficient substitute for rigorously collected medical record data in studies focusing on marginalized populations. Use of other data sources (e.g., administrative data), use of other self-reported outcome measures that have better concordance with medical records/administrative data (e.g., CD4 counts), or incorporation of rigorous measures to increase reliability of self-report data may be needed. Limitations of this study include the lack of a true gold standard with which to compare self-report data.
Sophie Davis School of Biomedical Education, City College of New York , New York, NY 10031, USA. nsohler@sci.ccny.cuny.edu
Nancy L
NL
Sohler
Sharon M
SM
Coleman
Howard
H
Cabral
Sylvie
S
Naar-King
Carol
C
Tobias
Chinazo O
CO
Cunningham
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008913:Minority Groups / Q000523:psychology; D015999:Multivariate Analysis; D016017:Odds Ratio; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012650:Self Disclosure; D014481:United States