Am J Epidemiol 2002; 156:774-782.
Copyright © 2002 by the
Johns Hopkins Bloomberg School of Public Health
PRACTICE OF EPIDEMIOLOGY |
Use of Multiple Imputation to Correct for Nonresponse Bias in a Survey of Urologic Symptoms among African-American Men
1 Department of Biostatistics, University of Michigan, Ann Arbor, MI.
2 Department of Urology, University of Michigan, Ann Arbor, MI.
3 Institute for Social Research, University of Michigan, Ann Arbor, MI.
The Flint Men’s Health Study is an ongoing population-based study of African-American men designed to address questions related to prostate cancer and urologic symptoms. The initial phase of the study was conducted in 1996–1997 in two stages: an interviewer-administered survey followed by a clinical examination. The response rate in the clinical examination phase was 52%. Thus, some data were missing for clinical examination variables, diminishing the generalizability of the results to the general population. This paper is a case study demonstrating the application of multiple imputation to address important questions related to prostate cancer and urologic symptoms in a data set with missing values. On the basis of the observed clinical examination data, the American Urological Association Symptoms Score showed a surprising reduction in symptoms in the oldest age group, but after multiple imputation there was a monotonically increasing trend with age. It appeared that multiple imputation corrected for nonresponse bias associated with the observed data. For other outcome measures—namely, the age-adjusted 95th percentile of prostate-specific antigen level and the association between urologic symptoms and prostate volume—results from the observed data and the multiply imputed data were similar.
bias (epidemiology); Blacks; imputation; nonresponse; urology
Abbreviations: Abbreviations: AUABS, American Urological Association Bother Score; AUASS, American Urological Association Symptoms Score; MCAR, missing completely at random; PSA, prostate-specific antigen.
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