Assessment of occupational exposure in a population based case-control study: Comparing postal questionnaires with personal interviews

Background--In case-control studies, data collection on occupational exposures by means of personal interviews is usually costly and time consuming. As detailed semiquantitative information on exposure from these interviews often has to be dichotomised in the analyses due to the small numbers of exposed subjects, the question is raised whether simple postal questionnaires yield the same results for occupational exposure in epidemiological studies as job specific personal interviews. Methods--Data on occupational exposures during pregnancy were compared from 121 women who both completed a checklist with 17 occupational exposure categories in a postal questionnaire and were personally interviewed with specific questions on exposure with details of job and task. kappa Coefficients were calculated as measures of agreement corrected for chance, and sensitivity and positive predictive values as measures of validity and usefulness, with the exposure assessment based on information from the interview as the gold standard. Results--Values of kappa varied from 0.09 for domestic cleaning agents to 0.70 for pesticides, indicating only low to moderate agreement between the questionnaire and the interview. Sensitivity ranged from 38% to 100%, with the highest values for agents used by healthcare workers. Positive predictive values were lower, between 9% and 63%, which indicates that overreporting was more common than underreporting in the questionnaire. Conclusions--These results underline the high potential for misclassification of occupational exposure in studies based on questionnaires. Therefore, postal questionnaires are not considered an alternative to job and task specific personal interviews in epidemiological studies.