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. 2025 Apr;14(7):e038730.
doi: 10.1161/JAHA.124.038730. Epub 2025 Mar 21.

Reliability and Validity of Self-Reported Risk Factors for Stroke and Dementia

Reinier W P Tack  1   2   3   4 , Jasper R Senff  1   2   3   4 , Tamara N Kimball  1   2   3   4   5 , Savvina Prapiadou  1   2   3   4   5 , Benjamin Y Q Tan  1   2   3   4 , Nirupama Yechoor  1   2   3   4 , Jonathan Rosand  1   2   3   4 , Sanjula D Singh  1   2   3   4 , Christopher D Anderson  1   2   3   4   5
Affiliations

Reliability and Validity of Self-Reported Risk Factors for Stroke and Dementia

Reinier W P Tack et al. J Am Heart Assoc. 2025 Apr.

Abstract

Background: Stroke and dementia are leading causes of mortality and can be prevented through risk factor management. Risk factor assessment requires laboratory or physical measurements. We aimed to determine whether self-reported risk factors serve as reliable proxies and predict stroke- and dementia-related mortality.

Methods and results: We used cross-sectional data from the NHANES (National Health and Nutrition Examination Survey) from 1999 to 2018 linked to National Death Index records. We included participants with available data on self-reported and measured hypertension, hypercholesterolemia, diabetes, kidney disease, hearing impairment and overweight. Reliability was assessed using F1 scores, and used survey-weighted Cox-proportional hazards models evaluated associations with stroke- or dementia-related mortality. Reliability of self-reported risk factors was highest in overweight (F1 score 0.81, sensitivity 76%, specificity 77%) and diabetes (F1 score 0.71, sensitivity 77%, specificity 97%) and lowest for kidney disease (F1 score 0.25, sensitivity 16%, specificity 98%). Self-reported hypertension (hazard ratio [HR], 1.49 [95% CI, 1.14-1.94]) and diabetes (HR, 1.58 [95% CI, 1.18-2.12]) were associated with stroke-related mortality, comparable to measured risk factors. For dementia-related mortality, only measured hearing impairment (all dementia cases had hearing impairment at baseline) and both self-reported (HR, 0.50 [95% CI, 0.37-0.68]) and measured overweight (HR, 0.70 [95% CI, 0.52-0.93]) were associated.

Conclusions: In conclusion, the reliability and validity of self-reported risk factors for stroke and dementia differ between risk factors. Although self-reported measures vary in their reliability, they perform equally as well as objective metrics for evaluating the risk of stroke- and dementia-related mortality.

Keywords: HbA1c; blood pressure; cholesterol; dementia; hearing impairment; stroke.

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Conflict of interest statement

Dr Anderson receives sponsored research support from Bayer AG, the National Institutes of Health, the American Heart Association, and Massachusetts General Hospital and has consulted for ApoPharma. Dr Rosand has received sponsored reserach support from Eli Lilly and Company for expert witness services, grants from the American Heart Association and the National Institute of Health, and Elsevier Publishing and serves as a trustee for Columbia University. Dr Tan declares research funding from the National Medical Research Council, Singapore and Abbott Laboratories Singapore. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Risk factor values stratified by answers to common questions.
Objective blood pressure, total cholesterol, HbA1c, GFR, hearing loss, and BMI stratified by answers to common questions. Point estimates represent mean value, and error bars represent 95% CIs. Absence of error bars represents very narrow CIs. The dotted line represents the cutoff for risk factor definitions. BMI indicates body mass index; DBP, diastolic blood pressure; GFR, glomerular filtration rate; HbA1c, glycated hemoglobin a1c; and SBP, systolic blood pressure.
Figure 2
Figure 2. Reliability of self‐reported risk factors to identify objective risk factors.
Classification table depicting performance of common questions in predicting hypertension, hypercholesterolemia, diabetes, kidney disease, hearing impairment, and overweight. LR indicates likelihood ratio; NPV, negative predictive value; and PPV, positive predictive value.
Figure 3
Figure 3. Hazard ratios for stroke and dementia‐related mortality.
Hazard ratios and 95% CIs obtained from Cox proportional hazard regression models corrected for age, sex, race, and education level. Models using hearing impairment are corrected only for age and sex. BMI indicates body mass index; dB, decibel; GFR, glomerular filtration rate; HbA1c, hemoglobin A1c; and TC, total cholesterol
See this image and copyright information in PMC

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