Comparison of self-reports and biomedical measurements on hypertension and diabetes among older adults in China

Abstract

Background Researchers interested in the effects of health on various life outcomes often use self-reported health and disease as an indicator of true, underlying health status. However, the validity of reporting is questionable as it relies on the awareness, recall bias and social desirability. Accordingly, biomedical test is generally regarded as a more precise indication of the disease. Methods Using data from the third wave of China Health and Retirement Longitudinal Study (CHARLS), we selected individuals aged 40–85 years old who participated in both health interview survey and biomedical test. Sensitivity, specificity, false negative reporting and false positive reporting were used as measurements of (dis) agreement or (in) validity, and binary and multinomial logistic regression were used to estimate under-report or over-report of hypertension and diabetes. Results Self-reported hypertension and diabetes showed low sensitivity (73.24 and 49.21%, respectively) but high specificity (93.61 and 98.05%, respectively). False positive reporting of hypertension and diabetes were 3.97 and 1.67%, while false negative reports were extremely high at 10.14 and 7.38%. Educational attainment, hukou, age and gender affected both group-specific error and overall error with some differences in their magnitude and directions. Conclusion Self-reported conditions underestimate the disease burden of hypertension and diabetes in China. Adding objective measurements into social survey could improve data accuracy and allow better understanding of socioeconomic inequalities in health. Furthermore, there is an urgent need to provide basic health education and physical examination to citizens, and promote the use of healthcare to lower the incidence and unawareness of disease in China.

Inconsistency in prevalence of hypertension based on self-reports and use of standard tests: Implications for large scale surveys

“…This may reflect issues of recall bias or actual unawareness of the condition owing to the failure to undertake testing. Similar results have been reported in a number of studies in China ( Ning et al, 2016 ; Xie & Wang, 2020 ) and India ( Bhatia et al, 2021 ; Onur & Velamuri, 2018 ; Puri et al, 2020 ; Shivashankar et al, 2021 ; Tenkorang et al, 2015 ).…”

“…Hypertension is a well-known risk factor for cardiovascular disease. It is the leading cause of death worldwide, with 17.8 million deaths reported in 2017 ( Xie & Wang, 2020 ). High-quality estimates of prevalence based on biomedical measurements are needed to monitor cardiovascular disease risks and plan public health prevention and interventions.…”

Validity of self‐reported hypertension in India: Evidence from nationally representative survey of adult population over 45 years

“…Previous studies examining the validity of self‐reported hypertension have found the sensitivity of self‐reported hypertension to range from 34.5% to 83.9% and the specificity from 92.0% to 98.7% 8,9,35–37,11,12,29–34 . Literature suggests that self‐reported hypertension generally exerts high sensitivity and specificity and a moderate level of agreement 38 …”

Effect of Hypertension, Waist-to-Height Ratio, and Their Transitions on the Risk of Type 2 Diabetes Mellitus: Analysis from the China Health and Retirement Longitudinal Study

“…Hypertensive participants were defined as (1) self-reported hypertension diagnosis, and/or (2) a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, and/or (3) were under antihypertensive medication [ 32 ]. Blood pressure was measured three times by trained medical personnel using an Omron HEN-7200 monitor.…”