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Epidemiological disaster research: the necessity to include representative samples of the involved disaster workers. Experience from the epidemiological study air disaster Amsterdam-ESADA

¹ Institute for Research in Extramural Medicine and Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, Netherlands
² Erasmus Medical Centre, Department of Child and Adolescent Psychiatry, Rotterdam, Netherlands
³ KLM Health Services, Schiphol Airport, Netherlands

Correspondence to:
Correspondence to:
Dr A C Huizink
Erasmus Medical Centre, Department of Child and Adolescent Psychiatry, WK219, PO Box 2060, 3000 CB Rotterdam, Netherlands; a.c.huizink{at}erasmusmc.nl

Objective: To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study.

Design and Setting: In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor.

Participants: Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination.

Main results: Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks.

Conclusions: The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.

Keywords: selection bias; disaster research

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