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Missing Data: A Systematic Review of How They Are Reported and Handled

Eekhout, Irisa,b,c; de Boer, R. Michielc,d; Twisk, Jos W. R.a,b,c; de Vet, Henrica C. W.a,b; Heymans, Martijn W.a,b,c

doi: 10.1097/EDE.0b013e3182576cdb

Background: The objectives of this systematic review are to examine how researchers report missing data in questionnaires and to provide an overview of current methods for dealing with missing data.

Methods: We included 262 studies published in 2010 in 3 leading epidemiologic journals. Information was extracted on how missing data were reported, types of missing, and methods for dealing with missing data.

Results: Seventy-eight percent of the studies lacked clear information about the measurement instruments. Missing data in multi-item instruments were not handled differently from other missing data. Complete-case analysis was most frequently reported (81% of the studies), and the selectivity of missing data was seldom examined.

Conclusions: Although there are specific methods for handling missing data in item scores and in total scores of multi-item instruments, these are seldom applied. Researchers mainly use complete-case analysis for both types of missing, which may seriously bias the study results.

Supplemental Digital Content is available in the text.

From the aDepartment of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; bEMGO Institute for Health and Care Research, Amsterdam, The Netherlands; cDepartment of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, Institute for Health Sciences, VU University, Amsterdam, The Netherlands; and dDepartment of Public Health, University Medical Center Groningen, Groningen, The Netherlands.

Submitted 12 October 2011; accepted 24 February 2012; posted 11 May 2012.

Supported by EMGO Institute of Health and Care Research. The authors reported no other financial interests related to this research.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Iris Eekhout, Department of Epidemiology and Biostatistics, VU University Medical Center (room MF D439), Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.