Parental reporting of childrens' coughing is biased

Assessment of cough in the clinical setting as well as in community-based studies of respiratory epidemiology has relied on self-reports. To examine the accuracy and potential for systematic bias in reported cough during a field study, questionnaires administered to parents about their childrens' coughing were compared to overnight cough recordings performed in 145 homes in the community of Wallaceburg, Canada. Percentage agreement between reported and recorded coughing was low, with kappa statistics ranging from 0.02-0.10. Compared to non-smoking parents, smokers under-reported their childrens' coughing (p = 0.01). The association found between parental smoking and recorded coughing was biased towards the null when reported coughing was substituted for recorded coughing: the odds ratio between parental smoking and recorded coughing was 3.1 (95% CI: 1.1-8.8) whereas for reported coughing it was 0.6 (95% CI: 0.2-1.7), the difference in the odds ratios being significant at p = 0.03. When carrying out field surveys, consideration should be given to measuring cough in a subsample of the population in order to estimate the degree of bias inherent in the questionnaire-based results.