Concordance between self-reports and archival records of physician visits: a case-control study comparing individuals with and without alcohol use disorders in the community

Drug Alcohol Depend. 2011 Jul 1;116(1-3):57-63. doi: 10.1016/j.drugalcdep.2010.11.021. Epub 2011 Jan 14.


Objective: The accuracy of self-reported healthcare use among individuals with alcohol use disorders (AUD) has been questioned. The present study attempts to compare the accuracy of self-reported physician visits for individuals who differ with respect to their history of AUDs.

Methods: Our data source was a 14-year follow-up of individuals interviewed at the St. Louis site of the 1981-1983 Epidemiologic Catchment Area Study (ECA). We used a case-control design (n=237) to compare the accuracy of self-reports among ECA participants with stably diagnosed AUDs (cases; n=75) to two comparison groups: those with problem/very heavy drinking (n=81) and those unaffected by alcohol (n=81). Intraclass correlation coefficients (ICC) described the concordance between self-reports and archival records of physician visits in the prior six months. We used multinomial logistic regression to identify characteristics associated with under-reporting and over-reporting, and zero-truncated Poisson regression to identify characteristics associated with discordance severity.

Results: Self-reports of cases had substantial concordance with physician records (ICC=0.74, CI=0.61-0.83). As compared to cases, those with problem/very heavy drinking had a significantly higher ICC, and those who were unaffected by alcohol had a significantly lower ICC. However, differences in concordance disappeared when using regression models that adjusted for factors known to affect the accuracy of self-reported healthcare use. Utilization frequency was a strong predictor of inaccurate reporting.

Conclusions: These findings suggest AUD status may not independently affect the accuracy of self-reports. Counts of physician visits for those with AUD may be considered accurate when utilization frequency is low.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / metabolism*
  • Alcohol-Related Disorders / epidemiology*
  • Alcohol-Related Disorders / metabolism
  • Alcoholism / epidemiology
  • Alcoholism / metabolism
  • Case-Control Studies
  • Cognition Disorders / chemically induced
  • Cognition Disorders / metabolism
  • Community Health Services / statistics & numerical data*
  • Disease Progression
  • Female
  • Humans
  • Male
  • Medical Records*
  • Middle Aged
  • Office Visits / statistics & numerical data*
  • Physicians
  • Psychiatric Status Rating Scales
  • Residence Characteristics
  • Self Report*
  • Time Factors