Concordance between self-reports and archival records of physician visits: A case-control study comparing individuals with and without alcohol use disorders in the community

Objective: The accuracy of self-reported healthcare use among individuals with alcohol use disorders (AUD) has been questioned. The present study attempts to compare the accuracy of self-reported physician visits for individuals who differ with respect to their history of AUDs. Methods: Our data source was a 14-year follow-up of individuals interviewed at the St. Louis site of the 1981-1983 Epidemiologic Catchment Area Study (ECA). We used a case-control design (n= 237) to compare the accuracy of self-reports among ECA participants with stably diagnosed AUDs (cases; n= 75) to two comparison groups: those with problem/very heavy drinking (n= 81) and those unaffected by alcohol (n= 81). Intraclass correlation coefficients (ICC) described the concordance between self-reports and archival records of physician visits in the prior six months. We used multinomial logistic regression to identify characteristics associated with under-reporting and over-reporting, and zero-truncated Poisson regression to identify characteristics associated with discordance severity. Results: Self-reports of cases had substantial concordance with physician records (ICC = 0.74, CI = 0.61-0.83). As compared to cases, those with problem/very heavy drinking had a significantly higher ICC, and those who were unaffected by alcohol had a significantly lower ICC. However, differences in concordance disappeared when using regression models that adjusted for factors known to affect the accuracy of self-reported healthcare use. Utilization frequency was a strong predictor of inaccurate reporting. Conclusions: These findings suggest AUD status may not independently affect the accuracy of self-reports. Counts of physician visits for those with AUD may be considered accurate when utilization frequency is low.