Abstract
Men and women aged 50 years and over were recruited for participation in a population-based prevalence survey of vertebral osteoporosis from 36 centres in 19 European countries. All subjects were invited to attend by letter of invitation for a “lifestyle” interview and lateral spinal radiograph. The aim of this analysis was to investigate how far those who agreed to attend were representative of the target population and thus whether any important level of non-response bias existed. To address this a second invitation was sent to all non-responders and, in 20 centres, a sample of ultimate non-responders was contacted by mail, telephone or home visit and given a shortened version of the lifestyle questionnaire. Compared with the sample of non-responders, responders might be considered less at risk from osteoporosis in that as a group they took more exercise and were less likely to be current smokers. Other factors suggested the contrary in that they consumed less calcium and were more likely to have suffered a previous fracture. Amongst responders, these factors appeared also to be related to the timing of response. Thus compared with delayed responders, those who participated after a first letter of invitation took more exercise, were less likely to be smokers and more likely to have suffered a previous fracture. However, in contrast to the results suggested by the non-response survey early responders consumed more calcium than late responders. The magnitude of the differences between responders and non-responders was small (less than 10% for most of the categorical variables) and the differences were not consistently in the direction of an increased or decreased risk of osteoporosis. Additionally the size or direction of these differences was not consistently influenced by the response rate based on classifying centres into those with a high, medium or low response rate. This suggests that in this multicentre study response bias probably does not have a major influence on the prevalence estimates of vertebral fracture. In epidemiological studies of osteoporosis comparison of the lifestyle differences between early and late responders provides useful information concerning response characteristics.
Similar content being viewed by others
References
Criqui MH. Response bias and risk ratios in epidemiologic studies. Am J Epidemiol 1979;109:394–9.
Sheikh K, Mattingly S. Investigating non-response bias in mail surveys. J Epidemiol Community Health 1981;35:293–6.
Barton J, Bain C, Hennekens CH, Rosner B, Belanger C, Roth A, Speizer FE. Characteristics of respondents and non-respondents to a mailed questionnaire. Am J Pub Health 1980;70:823–5.
Mayer CS, Pratt RW. A note on nonresponse in a mail survey. Public Opin Q 1966;30:637–46.
Torgerson DJ, Donaldson C, Garton MJ, Russell IT, Westland M, Reid DM. Population screening for low bone mineral density: do non-attenders have a lower risk of osteoporosis? Osteoporosis Int 1994;4:149–53.
Heilbrun LK, Ross PD, Wasnich RD, Yano K, Vogel JM. Characteristics of respondents and nonrespondents in a prospective study of osteoporosis. J Clin Epidemiol 1991;44:233–9.
O'Neill TW, Marsden D, Matthis C, Raspe H, Silman AJ, and the European Vertebral Osteoporosis Study Group. Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis. J Epidemiol Community Health 1995;49:87–93.
Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208.
Daniell HW. Osteoporosis of the slender smoker: vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med 1976;136:298–304.
Gutin B, Kasper MJ. Can vigorous exercise play a role in osteoporosis prevention? A review. Osteoporosis Int 1992;2:55–69.
Cummings RG. Calcium intake and bone mass: a quantitative review of the evidence. Calcif Tissue Int 1990;47:194–201.
Gardsell P, Johnell O, Nilsson BE, Nilsson JA. The predictive value of fracture, disease, and falling tendency for fragility fractures in women. Calcif Tissue Int 1989;45:327–30.
Israel Y, Orrego H, Holt S, Macdonald DW, Meema HE. Identification of alcohol abuse: thoracic fractures on routine chest x-rays as indicators of alcoholism. Alcoholism 1980;4:420–2.
Bikle DD, Genant HK, Cann C, Recker RR, Halloran BP, Strewler GJ. Bone disease in alcohol abuse. Ann Intern Med 1985;103:42–8.
Holbrook TL, Barrett-Connor E. A prospective study of alcohol consumption and bone mineral density. BMJ 1993;306:1506–9.
Seeman E, Melton LJ III, O'Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med 1983;75:977–83.
Spector TD, McCloskey EV, Doyle DV, Kanis JA. Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford study. J Bone Miner Res 1993;8:817–22.
Hennekens CH, Buring JE. Epidemiology in medicine. Boston Little, Brown: 1987.
Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK, and The Study of Osteoporotic Fractures Research Group. Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner Res 1992;7:449–56.
Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III. Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 1992;7;221–7.
Cooper C, Melton LJ III. Vertebral fractures: how large is the silent epidemic? BMJ 1992;304:793–4.
Ettinger B, Block JE, Smith R, Cummings SR, Harris ST, Genant HK. An examination of the association between vertebral deformities, physical disabilities and psychosocial problems. Maturitas 1988;10:283–96.
Forthofer RN. Investigation of nonresponse bias in NHANES II. Am J Epidemiol 1983;117:507–15.
Criqui MH, Barrett-Connor E, Austin M. Differences between respondents and non-respondents in a population-based cardiovascular disease study. Am J Epidemiol 1978;108:367–72.
Clark VA, Aneshensel CS, Frerichs RR, Morgan TM. Analysis of non-response in a prospective study of depression in Los Angeles County. Int J Epidemiol 1983;12:193–8.
Comstock GW, Helsing KJ. Characteristics of respondents and nonrespondents to a questionnaire for estimating community mood. Am J Epidemiol 1973;97:233–9.
Janzon L, Hanson BS, Isacsson SO, Lindell SE, Steen B. Factors influencing participation in health surveys: results from prospective population study “Men born in 1914” in Malm ó, Sweden. J Epidemiol Community Health 1986;40:174–7.
Wilhelmsen L, Ljungberg S, Wedel H, Werko L. A comparison between participants and non-participants in a primary preventive trial. J Chronic Dis 1976;29:331–9.
Bergstrand R, Vedin A, Wilhelmsson C, Wilhelmsen L. Bias due to non-participation and heterogeneous sub-groups in population surveys. J Chronic Dis 1983;36:725–8.
Author information
Authors and Affiliations
Consortia
Additional information
The European Vertebral Osteoporosis Study Group is listed in full at the end of this paper.
Rights and permissions
About this article
Cite this article
O'Neill, T.W., Marsden, D., Silman, A.J. et al. Differences in the characteristics of responders and non-responders in a prevalence survey of vertebral osteoporosis. Osteoporosis Int 5, 327–334 (1995). https://doi.org/10.1007/BF01622254
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01622254