title: Investigation of selection bias in the association of race with prevalent atrial fibrillation in a national cohort study: REasons for Geographic And Racial Differences in Stroke (REGARDS).
abstract: Atrial fibrillation (AF) is diagnosed more commonly in whites than blacks in the United States. In epidemiologic studies, selection bias could induce a noncausal positive association of white race with prevalent AF if voluntary enrollment was influenced by both race and AF status. We investigated whether nonrandom enrollment biased the association of race with prevalent self-reported AF in the US-based REasons for Geographic And Racial Differences in Stroke Study (REGARDS).
  
  
  
  REGARDS had a two-stage enrollment process, allowing us to compare 30,183 fully enrolled REGARDS participants with 12,828 people who completed the first-stage telephone survey but did not complete the second-stage in-home visit to finalize their REGARDS enrollment (telephone-only participants).
  
  
  
  REGARDS enrollment was higher among whites (77.1%) than among blacks (62.3%) but did not differ by self-reported AF status. The prevalence of AF was 8.45% in whites and 5.86% in blacks adjusted for age, sex, income, education, and perceived general health. The adjusted white/black prevalence ratio of self-reported AF was 1.43 (95% CI, 1.32-1.56) among REGARDS participants and 1.38 (1.22-1.55) among telephone-only participants.
  
  
  
  These findings suggest that selection bias is not a viable explanation for the higher prevalence of self-reported AF among whites in population studies such as REGARDS.
authors.affiliation: Department of Health Science, Brigham Young University, Provo, UT; Department of Epidemiology, University of Alabama at Birmingham, Birmingham. Electronic address: elt@byu.edu.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Thacker
authors.affiliation: Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC; Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock.
authors.forename: LeaVonne
authors.initials: L
authors.lastname: Pulley
authors.affiliation: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham.
authors.forename: George
authors.initials: G
authors.lastname: Howard
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, Birmingham.
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D015983:Selection Bias; D057566:Self Report; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
keywords: Atrial fibrillation; Cohort study; Race; Selection bias