Concordance between self-reports and archival records of physician visits: a case-control study comparing individuals with and without alcohol use disorders in the community.
OBJECTIVE
The accuracy of self-reported healthcare use among individuals with alcohol use disorders (AUD) has been questioned. The present study attempts to compare the accuracy of self-reported physician visits for individuals who differ with respect to their history of AUDs.


METHODS
Our data source was a 14-year follow-up of individuals interviewed at the St. Louis site of the 1981-1983 Epidemiologic Catchment Area Study (ECA). We used a case-control design (n=237) to compare the accuracy of self-reports among ECA participants with stably diagnosed AUDs (cases; n=75) to two comparison groups: those with problem/very heavy drinking (n=81) and those unaffected by alcohol (n=81). Intraclass correlation coefficients (ICC) described the concordance between self-reports and archival records of physician visits in the prior six months. We used multinomial logistic regression to identify characteristics associated with under-reporting and over-reporting, and zero-truncated Poisson regression to identify characteristics associated with discordance severity.


RESULTS
Self-reports of cases had substantial concordance with physician records (ICC=0.74, CI=0.61-0.83). As compared to cases, those with problem/very heavy drinking had a significantly higher ICC, and those who were unaffected by alcohol had a significantly lower ICC. However, differences in concordance disappeared when using regression models that adjusted for factors known to affect the accuracy of self-reported healthcare use. Utilization frequency was a strong predictor of inaccurate reporting.


CONCLUSIONS
These findings suggest AUD status may not independently affect the accuracy of self-reports. Counts of physician visits for those with AUD may be considered accurate when utilization frequency is low.
George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA. jeglass@wustl.edu
Joseph E
JE
Glass
Kathleen K
KK
Bucholz
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000378:metabolism*; D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000378:metabolism; D000437:Alcoholism / Q000453:epidemiology / Q000378:metabolism; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000139:chemically induced / Q000378:metabolism; D003153:Community Health Services / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010820:Physicians; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D057566:Self Report; D013997:Time Factors
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