Robust estimation of dementia prevalence from two-phase surveys with non-responders via propensity score stratification

• Published in: BMC medical research methodology 2023-05, Vol.23 (1), p.130-130, Article 130
• Main Authors: Shen, Chong, Pei, Minyue, Wang, Xiaoxiao, Zhao, Yiming, Wang, Luning, Tan, Jiping, Deng, Ke, Li, Nan
• Format: Article
• Language: English
• Subjects: Activities of daily living; Alzheimer's disease; Binomial distribution; Confounding (Statistics); Cross-Sectional Studies; Dementia; Dementia - diagnosis; Dementia - epidemiology; Diagnosis; Distribution; Humans; Independent variables; Methods; Missing data; Neuropsychology; Prevalence; Prevalence estimation; Prevalence studies (Epidemiology); Propensity Score; Regression analysis; Response rates; Sociodemographics; Surveys and Questionnaires; Veterans
• ISSN: 1471-2288; 1471-2288
• DOI: 10.1186/s12874-023-01954-0

Missing diagnoses are common in cross-sectional studies of dementia, and this missingness is usually related to whether the respondent has dementia or not. Failure to properly address this issue can lead to underestimation of prevalence. To obtain accurate prevalence estimates, we propose different estimation methods within the framework of propensity score stratification (PSS), which can significantly reduce the negative impact of non-response on prevalence estimates. To obtain accurate estimates of dementia prevalence, we calculated the propensity score (PS) of each participant to be a non-responder using logistic regression with demographic information, cognitive tests and physical function variables as covariates. We then divided all participants into five equal-sized strata based on their PS. The stratum-specific prevalence of dementia was estimated using simple estimation (SE), regression estimation (RE), and regression estimation with multiple imputation (REMI). These stratum-specific estimates were integrated to obtain an overall estimate of dementia prevalence. The estimated prevalence of dementia using SE, RE, and REMI with PSS was 12.24%, 12.28%, and 12.20%, respectively. These estimates showed higher consistency than the estimates obtained without PSS, which were 11.64%, 12.33%, and 11.98%, respectively. Furthermore, considering only the observed diagnoses, the prevalence in the same group was found to be 9.95%, which is significantly lower than the prevalence estimated by our proposed method. This suggested that prevalence estimates obtained without properly accounting for missing data might underestimate the true prevalence. Estimating the prevalence of dementia using the PSS provides a more robust and less biased estimate.