title: Self-report versus ultrasound measurement of uterine fibroid status.
abstract: BACKGROUND
  Much of the epidemiologic research on risk factors for fibroids, the leading indication for hysterectomy, relies on self-reported outcome. Self-report is subject to misclassification because many women with fibroids are undiagnosed. The purpose of this analysis was to quantify the extent of misclassification and identify associated factors.
  
  
  METHODS
  Self-reported fibroid status was compared to ultrasound screening from 2046 women in Right From The Start (RFTS) and 869 women in the Uterine Fibroid Study (UFS). Log-binomial regression was used to estimate sensitivity (Se) and specificity (Sp) and examine differences by ethnicity, age, education, body mass index, parity, and miscarriage history.
  
  
  RESULTS
  Overall sensitivity was ≤0.50. Sensitivity was higher in blacks than whites (RFTS: 0.34 vs. 0.23; UFS: 0.58 vs. 0.32) and increased with age. Parous women had higher sensitivity than nulliparae, especially in RFTS whites (Se ratio=2.90; 95% confidence interval [CI]: 1.51, 5.60). Specificity was 0.98 in RFTS and 0.86 in UFS. Modest ethnic differences were seen in UFS (Sp ratio, black vs. white=0.90; 95% CI: 0.81, 0.99). Parity was inversely associated with specificity, especially among UFS black women (Sp ratio=0.84; 95% CI: 0.73, 0.97). Among women who reported a previous diagnosis, a shorter time interval between diagnosis and ultrasound was associated with increased agreement between the two measures.
  
  
  CONCLUSIONS
  Misclassification of fibroid status can differ by factors of etiologic interest. These findings are useful for assessing (and correcting) bias in studies using self-reported clinical diagnosis as the outcome measure.
authors: Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA. slmyers@ucdavis.edu
authors: Sharon L
authors: SL
authors: Myers
authors: Donna Day
authors: DD
authors: Baird
authors: Andrew F
authors: AF
authors: Olshan
authors: Amy H
authors: AH
authors: Herring
authors: Jane C
authors: JC
authors: Schroeder
authors: Leena A
authors: LA
authors: Nylander-French
authors: Katherine E
authors: KE
authors: Hartmann
mesh_terms: D000022:Abortion, Spontaneous / Q000208:ethnology; D000328:Adult; D001741:Black or African American; D044383:Black People / Q000523:psychology; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D012044:Regression Analysis; D057566:Self Report; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D018084:Ultrasonography, Interventional; D044465:White People / Q000523:psychology; D016387:Women's Health / Q000208:ethnology