Recall bias

Systematic error due to differences in accuracy or completeness of recall to memory of past events or experiences.

Background

Recall bias is a systematic error that occurs when participants do not remember previous events or experiences accurately or omit details: the accuracy and volume of memories may be influenced by subsequent events and experiences. Recall bias is a problem in studies that use self-reporting, such as  case-control studies and retrospective cohort studies.

In case-control studies, researchers must be careful to question each study participant, in the same way, to avoid influencing their responses. Bias in recall can be greater when the study participant has a poorer recall in general, and when events over a longer time interval are being asked about. Other issues that influence recall include age, education, socioeconomic status and how important the condition is to the patient. Furthermore, undesirable habits such as smoking or eating unhealthy foods tend to be underreported, and are therefore subject to recall bias. Pre-existing beliefs may also impact on recall of previous events.

Example

Parents of children diagnosed with cancer may be more likely to recall infections earlier in the child’s life than parents of children without cancer. This may lead to observing an entirely or partially untrue association between childhood infection and cancer. Recall can be particularly problematic when the events of interest happened a long time ago.

Recall bias can increase or decrease the strength of the observed associations. For instance, when individuals recall lower than actual rates of unhealthy food intake, associations will suggest that lower levels of intake increase risk. When people recall higher than actual levels of fruit and vegetable intake (a desirable habit) a protective association will suggest eating more fruit and veg is necessary to reduce disease risk.

In the early 2000s, there was considerable publicity arising from a claim that the measles, mumps and rubella (MMR) vaccine was related to and possibly caused autism in children (the originating claim was subsequently found to be based on fraudulent data and the publication was withdrawn) (Andrews 2002). Researchers found that parents of autistic children diagnosed after the publicity tended to recall the start of autism as being soon after the MMR jab more often than parents of similar children who were diagnosed prior to the publicity.

Impact

A review of studies on emotionally arousing events found that victims of assault or war-exposure tended to amplify their memories of the events, while results from a vivid, enduring memory that was learned about through a surprising or shocking event (flashbulb memory) suggested memory for such emotional events either remained stable or diminishes over time.

A systematic review of bias in imaging studies found that the potential effects of recall bias are poorly researched. Amongst 12 studies that analysed bais in imaging interpretation, none assessed recall bias. 

Preventive steps

Prospective cohort studies aim to avoid problems of recall of data by asking for information at the time that volunteers join the study. However, many such studies also request historical information, which may be at risk of recall bias and researchers should be aware of this.  Strategies that might reduce recall bias include careful selection of the research questions, choosing an appropriate data collection method, studying people to study with new-onset disease or use a prospective design, which is the most appropriate way to avoid recall bias.

Case-control studies are useful in situations where the condition of interest is rare, but are at risk of recall bias. These studies need to ensure that the way questions are asked does not influence participants’ answers.

Sources

Andrews N et al. Recall bias, MMR, and autism. Arch Dis Child. 2002 Dec; 87(6): 493–494. doi:  10.1136/adc.87.6.493 

Auvinen A et al.  Epidemiological risk assessment of mobile phones and cancer: where can we improve? Eur J Cancer Prev. 2006 Dec;15(6):516-23.

Barry D. Differential recall bias and spurious associations in case/control studies. Stat Med. 1996 Dec 15;15(23):2603-16. PMID:8961466

Boone D et al.  Systematic review: bias in imaging studies – the effect of manipulating clinical context, recall bias and reporting intensity. Eur Radiol. 2012 Mar;22(3):495-505. doi: 10.1007/s00330-011-2294-0. Epub 2011 Sep 30.

Chouinard E et al.  Recall bias in case-control studies: an empirical analysis and theoretical framework. J Clin Epidemiol. 1995 Feb;48(2):245-54. 

Coughlin SS. Recall bias in epidemiologic studies..J Clin Epidemiol. 1990;43(1):87-91.

Drews CD et al.  The impact of differential recall on the results of case-control studies. Int J Epidemiol. 1990 Dec;19(4):1107-12. 

Hatziandreu EJ et al.  The reliability of self-reported cigarette consumption in the United States. Am J Public Health. 1989 Aug;79(8):1020-3

Porta M, et al. A dictionary of epidemiology. 6th edition. New York: Oxford University Press: 2014

Sackett DL. Bias in analytic research. J Chron Dis 1979; 32: 51-63.

Vrijheid M, et al.  Recall bias in the assessment of exposure to mobile phones. J Expo Sci Environ Epidemiol. 2009 May;19(4):369-81. doi: 10.1038/jes.2008.27. 


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