Reporting errors in time-to-pregnancy data collected with a short questionnaire. Impact on power and estimation of...

Few tools exist in reproductive epidemiology for studying adverse effects on fertility. Data on time to pregnancy (the number of menstrual cycles required to conceive) can be used to estimate fecundability ratios, a sensitive endpoint for identifying factors associated with reduced fertility. Time-to-pregnancy data can be collected in detailed interviews. The accuracy of data collected on brief, self-administered questionnaires is not known. In a study of occupational exposures to dental assistants conducted in 1987-1988, 523 women provided time-to-pregnancy data both on a short, mailed questionnaire and in a detailed telephone interview. The correlation between the two measures was 0.82. Assuming that the detailed data were accurate, reporting errors in data from the short form were distributed nondifferentially with respect to most covariates of interest in fecundability analyses. Simulation studies were conducted to estimate bias and loss of power from the misclassification. Bias was toward the null. Substantial power was lost in detecting weak exposures. However, exposures that reduce fecundability by 50 percent (equivalent to adding about three cycles to the median time to pregnancy) could still be detected with 80 percent power in samples of about 100 women (half of them exposed to a possible toxin). The authors conclude that time-to-pregnancy data collected with a few self-administered questions can be useful in a variety of epidemiologic studies, including occupational and environmental surveillance programs.