title: Moderate agreement between self-reported stroke and hospital-recorded stroke in two cohorts of Australian women: a validation study.
abstract: BACKGROUND
  Conflicting findings on the validity of self-reported stroke from existing studies creates uncertainty about the appropriateness of using self-reported stroke in epidemiological research. We aimed to compare self-reported stroke against hospital-recorded stroke, and investigate reasons for disagreement.
  
  
  METHODS
  We included participants from the Australian Longitudinal Study on Women's Health born in 1921-26 (n = 1556) and 1946-51 (n = 2119), who were living in New South Wales and who returned all survey questionnaires over a defined period of time. We determined agreement between self-reported and hospitalised stroke by calculating sensitivity, specificity and kappa statistics. We investigated whether characteristics including age, education, area of residence, country of birth, language spoken at home, recent mental health at survey completion and proxy completion of questionnaire were associated with disagreement, using logistic regression analysis to obtain odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Agreement between self-report and hospital-recorded stroke was fair in older women (kappa 0.35, 95% CI 0.25 to 0.46) and moderate in mid-aged women (0.56, 95% CI 0.37 to 0.75). There was a high proportion with unverified self-reported stroke, partly due to: reporting of transient ischaemic attacks; strokes occurring outside the period of interest; and possible reporting of stroke-like conditions. In the older cohort, a large proportion with unverified stroke had hospital records of other cerebrovascular disease. In both cohorts, higher education was associated with agreement, whereas recent poor mental health was associated with disagreement.
  
  
  CONCLUSIONS
  Among women who returned survey questionnaires within the period of interest, validity of self-reported stroke was fair to moderate, but is probably underestimated. Agreement between self-report and hospital-recorded stroke was associated with individual characteristics. Where clinically verified stroke data are unavailable, self-report may be a reasonable alternative method of stroke ascertainment for some epidemiological studies.
authors.affiliation: Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Herston QLD 4006, Australia. caroline.jackson@uq.ed.au.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Jackson
authors.forename: Gita D
authors.initials: GD
authors.lastname: Mishra
authors.forename: Leigh
authors.initials: L
authors.lastname: Tooth
authors.forename: Julie
authors.initials: J
authors.lastname: Byles
authors.forename: Annette
authors.initials: A
authors.lastname: Dobson
mesh_terms: D000368:Aged; D001315:Australia; D004522:Educational Status; D005260:Female; D006753:Hospital Records; D006801:Humans; D008137:Longitudinal Studies; D008603:Mental Health; D015203:Reproducibility of Results; D057566:Self Report; D020521:Stroke / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D016387:Women's Health