Research Article| Volume 56, ISSUE 9, P867-873, September 2003

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The impact of survey nonresponse bias on conclusions drawn from a mammography intervention trial


      Background and objective

      This study demonstrates the impact of survey nonresponse bias on conclusions from a mammography trial targeting a disadvantaged population.


      The trial randomized 1558 women to three interventions designed to promote repeat mammography: mailed reminder (minimum group); mailed thank-you card, patient newsletters, and reminder (maximum group); and no mailings (control group). The primary outcome, repeat mammogram within 15 months, was assessed from administrative and phone survey data.


      Administrative estimates revealed a statistically significant difference of 7% between the maximum and control groups on the primary outcome. Survey estimates (response rate 80%) revealed no significant differences. The differences by data source were traced to a survey nonresponse bias. There was a statistically significant difference of 16% between the maximum and control groups among survey nonrespondents for the primary outcome, but there were no differences among survey respondents.


      The findings reiterate that even a low survey nonresponse rate can bias study conclusions and suggest studies targeting disadvantaged populations should avoid relying solely on survey data for outcome analyses.


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