Non-response in a Survey of Cardiovascular Risk Factors in the Dutch Population: Determinants and Resulting Biases

Background: The aim of the research was to study the determinants of participation in a health examination survey (HES) which was carried out in a population that previously participated in a health interview survey (HIS) of Statistics Netherlands, and to estimate the effect of non-participation on both the prevalence of the main HES outcomes (risk factors for cardiovascular disease) and on relationships between variables.

Methods: Logistic regression was used to study the determinants of participation in the HES (n=3699) by those who had previously participated in the HIS (n=12,786). Linear models were used to predict the main outcomes in non-participants of the HES. Item non-response was handled by multiple imputation.

Results: HES participants had a higher socio-economic status and comprised more 'worried well', while the rural population were less likely to participate in the HES. Most predicted values of outcomes in HES non-participants differed from those in HES participants, but much of this was due to differences in the age and gender composition of both groups. Taking age and gender differences into account, most predicted values of outcomes in the entire HIS population were within the 95% confidence intervals of the HES values, with the exception of body height in men and high-density lipoprotein cholesterol, fasting glucose and body weight in women. These differences are most likely to be due to the higher socio-economic status of HES participants. Relationships between HIS variables did not change significantly when using HES participants alone compared with all HIS participants.

Conclusions: Despite a high rate of non-participation, some bias, mostly small, was seen in the prevalence rates of the main outcome variables. Bias in the relationships between variables was negligible.