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Comparative Study
. 2025 Mar 27;25(1):81.
doi: 10.1186/s12874-025-02529-x.

Comparison of health measures between survey self-reports and electronic health records among Millennium Cohort Study participants receiving Veterans Health Administration care

Felicia R Carey  1 , Elaine Y Hu  2 , Nicole Stamas  2 , Amber Seelig  2 , Lynne Liu  2 , Aaron Schneiderman  3 , William Culpepper  3 , Rudolph P Rull  4 , Edward J Boyko  2 ; Millennium Cohort Study Team
Collaborators, Affiliations
Comparative Study

Comparison of health measures between survey self-reports and electronic health records among Millennium Cohort Study participants receiving Veterans Health Administration care

Felicia R Carey et al. BMC Med Res Methodol. .

Abstract

Background: Surveys are a useful tool for eliciting self-reported health information, but the accuracy of such information may vary. We examined the agreement between self-reported health information and medical record data among 116,288 military service members and veterans enrolled in a longitudinal cohort.

Methods: Millennium Cohort Study participants who separated from service and registered for health care in the Veterans Health Administration (VHA) by September 18, 2020, were eligible for inclusion. Baseline and follow-up survey responses (2001-2016) about 39 medical conditions, health behaviors, height, and weight were compared with analogous information from VHA and military medical records. Medical record diagnoses were classified as one qualifying ICD code in any diagnostic position between October 1, 1999, and September 18, 2020. Additional analyses were restricted to medical record diagnoses occurring before survey self-report and using specific diagnostic criteria (two outpatient or one inpatient ICD code). Positive, negative, and overall (Youden's J) agreement was calculated for categorical outcomes; Bland-Altman plots were examined for continuous measures.

Results: Among 116,288 participants, 71.8% self-reported a diagnosed medical condition. Negative agreement between self-reported and VHA medical record diagnoses was > 90% for most (80%) conditions, but positive agreement was lower (6.4% to 56.3%). Mental health conditions were more frequently recorded in medical records, while acute conditions (e.g., bladder infections) were self-reported at a higher frequency. Positive agreement was lower when analyses were restricted to medical record diagnoses occurring prior to survey self-report. Specific diagnostic criteria resulted in higher overall agreement.

Conclusions: While negative agreement between self-reported and medical record diagnoses was high in this population, positive and overall agreement were not strong and varied considerably by health condition. Though the limitations of survey-reported health conditions should be considered, using multiple data sources to examine health outcomes in this population may have utility for research, clinical planning, or public health interventions.

Keywords: Agreement; Diagnosis; Electronic health records; Longitudinal research; Self-report.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable federal regulations governing the protection of human subjects. Research data were derived from approved Naval Health Research Center Institutional Review Board protocol number NHRC.2000.0007. Written or electronic informed consent was obtained for all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Bland–Altman plot comparing heights self-reported on the Millennium Cohort Study (MCS) survey and in Veterans Health Administration (VHA) medical records. SD, standard deviation
Fig. 2
Fig. 2
Bland–Altman plot comparing weights self-reported on the Millennium Cohort Study (MCS) survey and in Veterans Health Administration (VHA) medical records. SD, standard deviation
See this image and copyright information in PMC

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