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Respiratory Symptom Reporting Error in Occupational Surveillance of Older Farmers

Johnson, Nancy E. DrPH, MSPH; Browning, Steven R. PhD, MSPH; Westneat, Susan M. MS; Prince, T Scott MD, MPH; Dignan, Mark B. PhD, MPH

Journal of Occupational and Environmental Medicine: April 2009 - Volume 51 - Issue 4 - p 472-479
doi: 10.1097/JOM.0b013e3181973de5
Original Articles

Objective: Agricultural health studies often use respiratory symptom report as a surrogate measure of disease and exposure; little data exists on the accuracy of symptom report in a work-motivated population.

Methods: Screening spirometry and telephone survey data for Kentucky male farmers >55 year (n = 134) in the NIOSH Farm Family Health and Hazard Surveillance Project were compared to investigate the accuracy of symptom report as a measure of respiratory disease risk in older farmers.

Results: The prevalence of reported obstructive respiratory symptoms was 0.24 (95% CI = 0.17 to 0.31); objective measures increased prevalence to 0.35 (95% CI = 0.27 to 0.43). Customary symptom questions did not reliably reflect objective indicators of respiratory impairment.

Conclusions: Older farmers may not accurately report respiratory symptoms. Whether by intention or misinterpretation of physical cues, self-reporting errors in this population may introduce misclassification bias.

From the College of Medicine (Dr Johnson, Dr Dignan); College of Public Health (Drs Browning, Prince); and College of Nursing (Ms Westneat), University of Kentucky, Lexington, Ky.

Address correspondence to: Nancy E. Johnson, DrPH, MSPH, CIH, Department of Internal Medicine, Prevention Research Center, Markey Cancer Center, University of Kentucky, CC441, 800 Rose Street, Lexington, KY 40536; E-mail:

©2009The American College of Occupational and Environmental Medicine