Validity of Self-reported Stroke and Myocardial Infarction in Korea: The Health Examinees (HEXA) Study

  • Choe, Sunho (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Lee, Joonki (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Lee, Jeeyoo (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Kang, Daehee (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Lee, Jong-Koo (JW LEE Center for Global Medicine, Seoul National University College of Medicine) ;
  • Shin, Aesun (Department of Preventive Medicine, Seoul National University College of Medicine)
  • Received : 2019.04.26
  • Accepted : 2019.10.14
  • Published : 2019.11.29


Objectives: Self-reported disease history is often used in epidemiological studies. In this study, we acquired the hospital records of subjects who self-reported stroke or myocardial infarction (MI) and evaluated the validity of the participants' self-reported disease history. We also determined the level of agreement between specialists and non-specialists. Methods: Among the participants in the Health Examinees study, 1488 subjects self-reported stroke or MI during 2012-2017, and medical records were acquired for the 429 subjects (28.8%) who agreed to share their medical information. Each record was independently assigned to 2 medical doctors for review. The records were classified as 'definite,' 'possible,' or 'not' stroke or MI. If the doctors did not agree, a third doctor made the final decision. The positive predictive value (PPV) of self-reporting was calculated with the doctors' review as the gold standard. Kappa statistics were used to compare the results between general doctors and neurologists or cardiologists. Results: Medical records from 208 patients with self-reported stroke and 221 patients with self-reported MI were reviewed. The PPV of self-reported disease history was 51.4% for stroke and 32.6% for MI. If cases classified as 'possible' were counted as positive diagnoses, the PPV was 59.1% for stroke and 33.5% for MI. Kappa statistics showed moderate levels of agreement between specialists and nonspecialists for both stroke and MI. Conclusions: The validity of self-reported disease was lower than expected, especially in those who reported having been diagnosed with MI. Proper consideration is needed when using these self-reported data in further studies.


Supported by : Centers for Disease Control and Prevention


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