BackgroundSelf‐reported data can extend the reach of oral health research, but “Don't know” responses may threaten validity. We explored characteristics of participants who responded “Don't know” to a periodontal health question across three distinct cohorts.MethodsWe used data from three questionnaire‐based observational studies, namely, the Pregnancy Study Online (PRESTO) (N = 10,996), the Black Women's Health Study (BWHS) (N = 479), and the National Health and Nutrition Examination Survey (NHANES) (N = 15,502), to evaluate responses to questionnaire items related to periodontal health (e.g., “Has a dentist or dental hygienist ever told you that you have periodontitis or gum disease?”). We compared sociodemographic and behavioral factors across each response category (“Yes,” “No,” “Don't know”). We used Monte Carlo simulation to create multiple datasets of 100,000 participants under different scenarios to calculate the percent change in observed effect estimates in analyses using the full cohort compared to analytic cohorts excluding “Don't know” respondents.Results“Don't know” prevalences ranged from 1.6% to 4.1%. We observed differences between “Don't know” responders and those who answered “Yes” or “No” across all three cohorts. “Don't know” responders were more likely to have lower educational attainment, lower income, and reduced engagement with oral healthcare services. We observed substantial bias in complete‐case effect estimates in some simulated scenarios. Bias was larger when the underlying population prevalence of “Don't know” responses was higher.Conclusions“Don't know” responders had distinct patterns of sociodemographic characteristics and oral healthcare engagement. The degree of bias in complete‐case analysis was dependent on simulated factors.Plain Language SummaryResearch about oral health often asks people to answer questions about their teeth and gums. Sometimes people respond that they “Don't know” the answer to these questions, which can make data challenging for researchers to analyze. In this study, we used three different data sources to look at whether there were particular characteristics that were more common among people who said they “Don't know” in response to a question about their gum health. “Don't know” responses were not very common in any of the three groups, ranging from 1.6% in a representative survey of people in the United States to 4.1% in a group of women in the United States and Canada trying to become pregnant. In all three groups, people who said “Don't know” had a lower household income, less education, and were less likely to have seen a dentist recently. We also used simulated datasets to evaluate when excluding people who responded “Don't know” would be expected to cause the most bias in analyses. The expected bias increased with the number of “Don't know” responses in the data.

中文翻译：

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对自我报告的口腔健康问题的“不知道”响应者的多队列评估：对病因学研究的影响

背景自我报告的数据可以扩大口腔健康研究的范围，但“不知道”的回答可能会威胁到有效性。我们探讨了三个不同队列中对牙周健康问题回答“不知道”的参与者的特征。方法我们使用三项基于问卷的观察性研究的数据，即在线妊娠研究（PRESTO）（N = 10,996）、黑人女性健康研究（BWHS）（N = 479）和国家健康与营养检查调查（NHANES）（N = 15,502），来评估对与牙周健康相关的问卷项目的回答（例如，“牙医或牙科保健员是否曾经告诉您您患有牙周炎或牙龈疾病？我们比较了每个响应类别（“是”、“否”、“不知道”）的社会人口统计学和行为因素。我们使用蒙特卡洛模拟创建了不同场景下 100,000 名参与者的多个数据集，以计算使用完整队列的分析与不包括“不知道”受访者的分析队列相比观察到的效果估计的百分比变化。结果“不知道”患病率在 1.6% 到 4.1% 之间。我们观察到在所有三个队列中，“不知道”的回答者与回答“是”或“否”的回答者之间的差异。“不知道”的响应者更有可能受教育程度较低、收入较低，并且对口腔保健服务的参与度较低。在一些模拟场景中，我们观察到完全案例效应估计存在显着偏差。当“不知道”回答的潜在人群患病率较高时，偏差更大。结论 “不知道”的响应者在社会人口特征和口腔保健参与方面具有不同的模式。 完整案例分析中的偏差程度取决于模拟因素。通俗易懂的语言摘要关于口腔健康的研究经常要求人们回答有关牙齿和牙龈的问题。有时人们回答说他们“不知道”这些问题的答案，这可能会使研究人员难以分析数据。在这项研究中，我们使用了三种不同的数据源来研究在回答有关牙龈健康的问题时表示“不知道”的人中是否存在更常见的特定特征。“不知道”的回答在这三组中的任何一组都不是很常见，从一项针对美国人的代表性调查中的 1.6% 到美国和加拿大一组试图怀孕的女性中的 4.1% 不等。在这三组中，说“不知道”的人家庭收入较低，受教育程度较低，并且最近看过牙医的可能性较小。我们还使用模拟数据集来评估排除回答“不知道”的人何时会在分析中造成最大的偏差。预期偏差随着数据中“不知道”回答的数量而增加。