Open Access Research

Non-response bias and hazardous alcohol use in relation to previous alcohol-related hospitalization: comparing survey responses with population data

Kozma Ahacic12*, Ingemar Kåreholt34, Asgeir R Helgason12 and Peter Allebeck12

Author Affiliations

1 Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Box 1497, Solna, 171 29, Sweden

2 Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, 171 77, Sweden

3 Karolinska Institutet and Stockholm University, Aging Research Centre (ARC), Gävlegatan 16, Stockholm, 113 30, Sweden

4 Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden, Jönköping, Sweden

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Substance Abuse Treatment, Prevention, and Policy 2013, 8:10  doi:10.1186/1747-597X-8-10

Published: 4 March 2013



This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence.


Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect.


Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i.e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized.


Few people receive alcohol-related hospital care and it remains unclear whether this group’s underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems – i.e. a history of alcohol-related hospitalizations – are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

Non-response bias; Missing data; Attrition; Hazardous alcohol use; Abstainers; Abstinence