Participation bias in a population-based echocardiography study

Ann Epidemiol. 2004 Sep;14(8):579-84. doi: 10.1016/j.annepidem.2003.11.001.


Purpose: To compare the characteristics of participants and non-participants in a population-based study of cardiac ventricular function.

Methods: Subjects aged 45 years and older on January 1, 1997 were recruited from a sampling frame of Olmsted County residents from the Rochester Epidemiology Project. Subjects were asked to complete a 17-page questionnaire and participate in a 4-hour clinical examination that included a brief physical examination, echocardiography, spirometry, and an electrocardiogram. With specific IRB approval, the community medical records of participants and non-participants from the first wave of recruitment were examined by trained nurse abstractors to elicit details of past medical history.

Results: Of the first 963 persons invited to participate in the study, 488 (51%) completed all phases of the examination. Participation rates were similar among men and women (53% vs. 49%, respectively). By age, participation rates were lowest among persons aged 75 years and older (44.7% and 34.9%) and 45 to 54 years (45.4% and 44.3%) for men and women. Participation rates were not different according to past history of coronary heart disease, congestive heart failure, or other cardiovascular disease. Persons with a history of chronic obstructive pulmonary disease were less likely to participate (19.4% vs. 51%; odds ratio, 0.36; 95% confidence interval, 0.18, 0.76) after adjustment for age, sex, and comorbid conditions.

Conclusions: These results provide some reassurance that participation bias in this study may have little influence on its overall findings, although this cannot be conclusive.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Bias
  • Community Health Planning / methods
  • Community Health Planning / statistics & numerical data
  • Community Participation / statistics & numerical data*
  • Echocardiography
  • Electrocardiography
  • Female
  • Heart Diseases / diagnosis*
  • Heart Diseases / epidemiology
  • Heart Function Tests / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Surveys and Questionnaires