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American Journal of Epidemiology Vol. 143, No. 3: 283-292
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Use of Proxies to Measure Health and Functional Status in Epidemiologic Studies of Community-dwelling Women Aged 65 Years and Older

Jay Magaziner1,, Susan Spear Bassett2, J. Richard Hebel1 and Ann Gruber-Baldini1

1Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland Baltimore, MD
2Department of Psychiatry, School of Medicine, The Johns Hopkins University Baltimore, MD

Reprint requests to Dr. Jay Magaziner, Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, 660 W. Redwood Street, Room 142, Baltimore, MD 21201.

Proxy and subject responses to survey questions about chronic conditions, health symptoms, and physical and instrumental functioning were compared to determine the extent of disagreement, the direction of nonrandom discrepancies (i.e., bias), and how disagreement and bias vary by proxy and subject characteristics. Subjects included 538 community-dwelling women aged 65 years and older who participated in the third home interview of a health survey in Baltimore, Maryland, 1986, and a self-designated proxy for each. The authors observed kappa values of >0.6 (i.e., substantial to almost perfect agreement) for five of nine chronic conditions, no health symptoms, six of seven physical tasks of daily living, and seven of seven instrumental tasks of daily living. With few exceptions, proxies were more likely than subjects to report the presence of a condition, symptom, or functional problem. Variations in agreement and bias were noted by subject and proxy characteristics, with different patterns observed for different measurement areas. When using proxy reports in place of self-reports, it is important to evaluate the impact that using proxies has on study results.

activities of daily living; aged; bias; chronic disease; epidemiologic methods; interviews


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