Discrepancies between patient recall and the medical record. Potential impact on diagnosis and clinical assessment of chronic disease.

BACKGROUND: During a case-control study, data necessary for fulfilling diagnostic and classification criteria for spondyloarthropathy were collected from 121 patients. OBJECTIVE: To study the potential impact of differences between patient recall and the medical record on diagnosis and clinical characterization of spondyloarthropathy as a model of chronic disease. METHODS: The study was conducted among four Alaskan Eskimo populations served by the Alaska Native Health Service. Two sets of historical data were compiled for each subject, one acquired during the interview and the other derived from the medical record. Paired items from the interview and the medical record were analyzed to determine discrepancies and consequent effects on diagnosis, classification, and disease characterization. RESULTS: Significant differences were observed in the reporting of genitourinary or diarrheal illnesses preceding or associated with arthritis, the occurrence of eye inflammation in association with joint pain, the occurrence of joint pain and back pain together, and the age at onset of back pain all of which are important to the diagnosis and classification of spondyloarthropathy. In contrast, for information needed to establish the probable inflammatory nature of back pain, patient interview was more helpful than the medical records, which did not provide adequate details to differentiate inflammatory from mechanical back pain. CONCLUSIONS: Patient recall bias can substantially affect diagnosis and clinical assessment of chronic disease, as exemplified by spondyloarthropathy. Reliance on records alone, however, may lead to underestimation of features that require subjective appraisal by the patient.

The risk of nursing home admission in three communities.

Beginning in 1982, the 3-year incidence of nursing home admission was determined for community-dwelling residents aged 65 and over in East Boston, Massachusetts (4%); New Haven, Connecticut (9%); and Iowa and Washington Counties, Iowa (12%). A common methodology was used to collect baseline risk factor and follow-up data on nursing home admissions among persons in each community as part of the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly. A multivariate logistic regression model of baseline risk factors that included the participant's age, race, sex, history of prior admission, ADL limitations, cognitive function, living arrangements, and level of income predicted 80% of the users in each community.

Co-morbidity analysis: a strategy for understanding mortality, disability and use of health care facilities of older people.

Older people often have several co-existing health problems. The type, number, duration and severity of these problems may have an impact on longevity and maintenance of independence. Analyses of co-morbidity can assess the additive or multiplicative effect of more than one chronic condition or impairment on the risks of mortality, loss of functioning and use of health services. Three major surveys of the elderly, initiated in the past ten years, provide data for studying the added burden of multiple morbidities. These surveys are: The National Health Interview Survey-Supplement on Aging; The National Health and Nutrition Examination Survey I-Epidemiologic Follow-up Study; and The Established Populations for Epidemiologic Studies of the Elderly. Results of analyses of co-morbidity using data from these three surveys are presented. Although each analysis used a different definitional approach to estimate the co-morbidity effect, each demonstrated an associated or increased risk on the outcome.

Frequency of church attendance and blood pressure elevation.

Blood pressure levels were examined with regard to church attendance patterns in a group of white male heads of households who appeared in the 1967-1969 follow-up examination of the Evans County Cardiovascular Epidemiologic Study. A consistent pattern of lower systolic and diastolic blood pressures among frequent church attenders was found compared to that of infrequent attenders which was not due to the effects of age, obesity, cigarette smoking, or socioeconomic status.