Regression Dilution Bias in Blood Pressure and Body Mass Index in a Longitudinal Population-Based Cohort Study

Sima Masudi, Parvin Yavari, Yadollah Mehrabi, Davood Khalili, Fereidoun Azizi


Background: Use of single measurement of risk factors can distort their estimated effects, due to random error in measurements. The aim of this study was to examine the extent of underestimation in the estimated effect of common variables in physical exam i.e. systolic and diastolic blood pressure (SBP, DBP) and body mass index (BMI) on cardiovascular diseases in Tehran Lipid and Glucose Study (TLGS).

Methods: A subsample (1167 men and 1786 women) of the original cohort, who had replicate measures of the variables in triennial interval, was used to calculate the regression dilution ratios (RDRs) in men and women. RDRs were determined by parametric and nonparametric methods. Hazard ratios (HR) of risk factors, per one standard deviation change, were corrected for regression dilution bias.

Results: The estimated RDRs by parametric method in men and women were 45% and 35% for SBP and 54% and 64% for DBP respectively. There were 26% and 25% underestimation in HR of SBP and 23% and 33% in HR of DBP in men and women. The corresponding underestimation for BMI was about 8%. RDRs of men and women and in age groups by both methods were fairly similar. They were relatively constant during the 10-year follow-up for SBP and BMI.

Conclusion: Using baseline measurements of blood pressure underestimate its real association with CVD events and the estimated HRs. The underestimations are independent of age and sex, and it can be fairly constant in short to moderate time intervals.


Regression dilution bias; Systolic blood pressure; Diastolic blood pressure; Body mass index; Cardiovascular disease

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