Validation of self-reported diabetes in a representative sample of São Paulo city

Fontanelli, Mariane de Mello; Teixeira, Juliana Araújo; Sales, Cristiane Hermes; Castro, Michelle Alessandra de; Cesar, Chester Luiz Galvão; Alves, Maria Cecilia Goi Porto; Goldbaum, Moisés; Marchioni, Dirce Maria; Fisberg, Regina Mara

doi:10.1590/S1518-8787.2017051006378

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Original Articles • Rev. Saúde Pública 51 (0) • 2017 • https://doi.org/10.1590/S1518-8787.2017051006378 copy

Validation of self-reported diabetes in a representative sample of São Paulo city

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To validate the self-reported diabetes mellitus in adults and older adults living in the city of São Paulo, Brazil.

METHODS

We have used data of 569 subjects (284 adults and 285 older adults), participants of the population-based cross-sectional study Inquérito de Saúde do Município de São Paulo (Health Survey of São Paulo). Fasting glucose ≥ 7.0 mmol/L (126 mg/dL) and/or use of drugs (oral hypoglycemic and/or insulin) defined the diagnosis of diabetes mellitus. We have validated the self-reported diabetes mellitus by calculating the sensitivity, specificity, positive predictive values, and negative predictive values. We have used Poisson regression with robust variance to verify the factors associated with the sensitivity of the self-reported datum. For all analyses, we have considered the sample design of the study.

RESULTS

The sensitivity of self-reported diabetes mellitus was 63.8% (95%CI 49.2–76.3), specificity was 99.7% (95%CI 99.1–99.9), positive predictive value was 95.5% (95%CI 84.4–98.8), and negative predictive value was 96.9% (95%CI 94.9–98.2). The correct reporting of diabetes mellitus was more prevalent among older adults (PR = 2.0; 95%CI 1.2–3.5) than among adults.

CONCLUSIONS

The use of the datum of self-reported diabetes mellitus is valid, especially among older adults living in the city of São Paulo. The results highlight the need to track diabetes mellitus in asymptomatic subjects who have one or more risk factors for it, mainly in the adult population of this city.

Diabetes Mellitus, epidemiology; Diagnostic Self Evaluation; Health Surveys; Reproducibility of Results; Validation Studies

Characteristics	With DM		Without DM		p^b

	n	%	n	%
Sex (n = 569)
Male	28	6.4	188	93.6	0.128
Female	54	9.5	299	90.5
Age group (n = 569)
Adults	17	5.0	267	95.0	0.000
Older adults	65	20.7	220	79.3
Self-reported race (n = 569)
White	49	7.6	306	92.4	0.623
Non-white	33	8.8	181	91.2
Education of head of household (n = 566)
Up to 5 years	57	15.0	196	85.0	0.001
6 or more years	25	5.5	288	94.5
Family income per capita (n = 569)
Up to 1 MW^a	31	7.3	208	92.7	0.620
More than 1 MW	51	8.5	279	91.5
Marital status (n = 269)
With partner	5	3.3	109	96.7	0.097
Without partner	19	8.4	136	91.6
Smoking status (n = 569)
Non-smoker	44	6.2	276	93.8	0.013
Former smoker	29	15.4	118	84.6
Current smoker	9	6.8	93	93.2
Alcohol abuse (n = 255)
Possibly no	21	3.9	212	96.1	0.111
Possibly yes	4	9.2	18	90.8
Physical activity of leisure (n = 569)
Sufficient	4	4.5	50	95.5	0.229
Insufficient	78	8.5	437	91.5
BMI (n = 545)
Not overweight	33	4.8	239	95.2	0.028
Overweight	44	10.7	229	89.3
Waist circumference (n = 489)
Adequate	18	3.9	192	96.1	0.001
Inadequate	56	13.54	223	86.5
Hypertension (n = 569)
No	22	3.7	283	96.3	0.000
Yes	60	17.4	204	82.6
Health insurance (n = 569)
No	49	7.1	321	92.9	0.342
Yes	33	9.6	166	90.4
Hospitalization in the past year (n = 569)
No	77	8.3	448	91.7	0.160
Yes	5	4.3	39	95.7
Health problem in the past 15 days (n = 569)
No	59	7.5	378	92.5	0.303
Yes	23	10.3	109	89.7

Self-reported diabetes mellitus	Diagnosed diabetes mellitus						Total

	Yes			No

	n	%	95%CI	n	%	95%CI	N	%	95%CI
Yes	63	63.8	49.2–76.3	4	0.3	0.0–0.9	67	5.4	4.0–7.2
No	19	36.2	23.7–50.8	483	99.7	99.1–99.9	502	94.6	92.8–96.0
Total	82	100	-	487	100	-	569	100	-

Validity	%	95%CI
Sensitivity	63.8	49.2–76.3
Specificity	99.7	99.1–99.9
Positive predictive value	95.5	84.4–98.8
Negative predictive value	96.9	94.9–98.2

Characteristics	SENS (%)	95%CI	SPEC (%)	95%CI	PPV (%)	95%CI	NPV (%)	95%CI
Sex (n = 569)
Male	72.2	47.2–88.3	99.7	97.8–100.0	94.0	65.7–99.2	98.1	95.5–99.2
Female	58.9	40.8–74.8	99.8	99.1–100.0	96.6	86.3–99.3	95.9	92.8–97.7
Age group (n = 569)
Adults	42.1	22.4–64.6^b	97.9	95.7–99.0	100.0	-	97.0	94.4–98.4
Older adults	85.8	70.7–93.8^b	98.4	94.6–99.6	93.4	78.4–98.3	96.4	91.8–98.4
Self-reported race (n = 569)
White	74.3	53.2–88.1	99.7	99.0–99.9	94.8	83.3–98.5	97.9	95.6–99.1
Non-white	49.3	31.3–67.5	99.9	98.9–100.0	97.0	79.8–99.6	95.3	90.4–97.8
Education of head of household (n = 566)
Up to 5 years	71.7	51.2–86.0	99.3	98.1–99.8	95.0	84.3–98.5	95.2	88.3–98.1
6 or more years	55.7	34.3–75.2	99.9	99.1–100.0	96.3	75.5–99.5	97.5	95.3–98.7
Family income per capita (n = 569)
Up to 1 MW^a	79.0	57.9–91.2	99.3	97.8–99.8	90.0	68.3–97.4	98.4	96.0–99.4
More than 1 MW	56.0	39.4–71.3	100	-	100	-	96.1	92.9–979
Marital status (n = 269)
With partner	40.6	9.6–81.5	99.6	97.5–100.0	79.5	26.9–97.6	98.0	91.5–99.6
Without partner	49.3	22.7–76.3	99.8	98.5–100.0	95.8	71.7–99.5	95.5	90.1–98.1
Smoking status (n = 569)
Non-smoker	58.1	37.5–76.2	99.6	98.5–99.9	89.7	68.2–97.2	97.3	94.7–98.7
Former smoker	77.6	55.1–90.7	100	-	100	-	96.1	90.7–98.4
Current smoker	51.8	17.5–84.5	100	-	100	-	96.6	89.5–99.0
Alcohol consumption (n = 566)
1st tertile	74.8	49.0–90.2	99.5	97.9–99.9	95.6	82.4–99.0	96.4	90.7–98.7
2nd tertile	43.4	18.7–71.9	99.7	98.2–100.0	93.9	62.7–99.3	94.9	89.2–97.7
3rd tertile	85.8	53.2–97.0	99.9	99.1–100.0	96.8	78.3–99.6	99.3	96.8–99.9
Physical activity of leisure (n = 569)
Sufficient	19.2	3.3–62.6	100	–	100	–	96.4	86.1–99.1
Insufficient	67.0	52.0–79.2	99.7	99.0–99.9	95.4	84.1–98.8	97.0	95.1–98.2
BMI (n = 545)
Not overweight	72.1	48.3–87.8	99.6	98.1–99.9	91.0	65.6–98.2	98.4	95.7–99.4
Overweight	59.9	40.0–76.9	99.9	99.2–100.0	98.3	87.9–99.8	95.7	91.4–97.9
Waist circumference (n = 489)
Adequate	67.3	37.1–87.8	99.7	97.9–100.0	90.0	51.6-98.7	98.7	95.9–99.6
Inadequate	60.8	42.5–76.4	99.9	98.9–100.0	98.5	89.5-99.8	94.2	89.3–96.9
Hypertension (n = 569)
No	75.0	50.5–89.8	100	-	100	-	99.1	97.5–99.6*
Yes	58.7	41.9–73.7	99.1	96.9–99.7	93.1	77.1–98.2	91.9	85.4–95.7*
Health insurance (n = 569)
No	59.9	42.5–75.1	99.7	98.6–99.9	93.4	73.3–98.7	97.0	94.2–98.5
Yes	68.9	46.0–85.2	99.9	98.8–100.0	97.9	85.1–99.8	96.8	93.2–98.5
Hospitalization in the past year (n = 569)
No	62.5	47.3–75.5	99.8	99.3–100.0	97.2	88.2–99.4	96.7	94.5–98.1
Yes	100	-	98.2	92.5–99.6	74.2	34.5–94.0	100	-
Health problem in the past 15 days (n = 569)
No	61.5	44.6–76.0	99.9	99.2–100.0	97.8	84.7–99.7	97.0	94.6–98.3
Yes	71.5	37.8–91.2	99.1	97.0–99.7	89.7	68.8–97.2	96.8	89.8–99.1

Characteristics	Univariate model

	PR	95%CI
Sex (n = 82)
Male	1.00	-
Female	0.81	0.53–1.25
Age group (n = 82)
Adults	1.00	-
Older adults	2.04	1.18–3.52
Education of head of household (n = 82)
Up to 5 years	1.00	-
6 or more years	0.78	0.49–1.23
Family income per capita (n = 82)
Up to 1 MW*	1.00	-
More than 1 MW	0.71	0.50–1.01
Grams of alcohol consumption (tertiles) (n = 81)
1st tertile	1.00	-
2nd tertile	0.58	0.27–1.24
3rd tertile	1.15	0.78–1.68
Physical activity of leisure (n = 82)
Sufficient	1.00	-
Insufficient	0.29	0.06–1.43
BMI (n = 77)
Not overweight	1.00	-
Overweight	0.83	0.53–1.30
Waist circumference (n = 74)
Adequate	1.00	-
Inadequate	0.90	0.54–1.52
Hypertension (n = 82)
No	1.00	-
Yes	0.78	0.53–1.14

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Regina Mara Fisberg. Av. Dr. Arnaldo, 715 Cerqueira Cesar. 01246-904 São Paulo, SP, Brasil. E-mail: rfisberg@usp.br