Open Access Highly Accessed Research article

Determinants of non- response to a second assessment of lifestyle factors and body weight in the EPIC-PANACEA study

Anne M May12*, Lotte E Adema1, Dora Romaguera3, Anne-Claire Vergnaud3, Antonio Agudo4, Ulf Ekelund5, Annika Steffen6, Philippos Orfanos7, Nadia Slimani8, Sabina Rinaldi8, Traci Mouw3, Sabine Rohrmann9, Silke Hermann9, Heiner Boeing6, Manuela M Bergmann6, Marianne Uhre Jakobsen10, Kim Overvad1011, Nicholas J Wareham5, Carlos Gonzalez4, Anne Tjonneland12, Jytte Halkjaer12, Timothy J Key13, Elizabeth A Spencer13, Veronica Hellstrom14, Jonas Manjer15, Bo Hedblad16, Eiliv Lund17, Tonje Braaten17, Françoise Clavel-Chapelon1819, Marie-Christine Boutron-Ruault1819, Laudina Rodríguez20, Maria J Sánchez21, Miren Dorronsoro22, Aurelio Barricarte23, Jose Maria Huerta24, Androniki Naska7, Antonia Trichopoulou7, Domenico Palli25, Valeria Pala26, Teresa Norat3, Amalia Mattiello27, Rosario Tumino28, Daphne van der A2, H Bas Bueno-de-Mesquita2, Elio Riboli3 and Petra HM Peeters13

Author Affiliations

1 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508, GA, Utrecht, The Netherlands

2 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

3 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom

4 Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain

5 Medical Research Council, Epidemiology Unit, Cambridge, United Kingdom

6 German Institute of Human Nutrition Potsdam-Rehbrücke, Heidelberg, Germany

7 Hellenic Health Foundation, Athens, Greece AND Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Athens, Greece

8 International Agency for Research on Cancer (IARC-WHO), Lyon, France

9 Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany

10 Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark

11 Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

12 Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark

13 Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom

14 Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden

15 Department of Surgery, Malmø University Hospital, Lund University, Malmø, Sweden

16 Department of Clinical Science, Malmø University Hospital, Lund University, Malmø, Sweden

17 Institute of Community Medicine, University of Tromsø, Tromsø, Norway

18 Institut National de la Santé et de la Recherche Médicale (INSERM), ERI 20, EA 4045, Villejuif, France

19 Institut Gustave Roussy, Villejuif, France

20 Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain

21 Andalusian School of Public Health, Granada, and CIBER de Epidemiology and Public Health (CIBERESP), Granada, Spain

22 Public Health Department of Gipuzkoa, San Sebastian, Spain

23 Public Health Institute of Navarra, Pamplona, Spain

24 Epidemiology Department, Council of Health and Consumer Affairs, Murcia& CIBER Epidemiología y Salud Pública (CIBERESP), Murcia, Spain

25 Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy

26 Nutritional Epidemiology Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy

27 Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli, Naples, Italy

28 Cancer Registry, Azienda Ospedaliera "Civile M.P.Arezzo", Ragusa, Italy

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BMC Medical Research Methodology 2012, 12:148  doi:10.1186/1471-2288-12-148

Published: 24 September 2012



This paper discusses whether baseline demographic, socio-economic, health variables, length of follow-up and method of contacting the participants predict non-response to the invitation for a second assessment of lifestyle factors and body weight in the European multi-center EPIC-PANACEA study.


Over 500.000 participants from several centers in ten European countries recruited between 1992 and 2000 were contacted 2–11 years later to update data on lifestyle and body weight. Length of follow-up as well as the method of approaching differed between the collaborating study centers. Non-responders were compared with responders using multivariate logistic regression analyses.


Overall response for the second assessment was high (81.6%). Compared to postal surveys, centers where the participants completed the questionnaire by phone attained a higher response. Response was also high in centers with a short follow-up period. Non-response was higher in participants who were male (odds ratio 1.09 (confidence interval 1.07; 1.11), aged under 40 years (1.96 (1.90; 2.02), living alone (1.40 (1.37; 1.43), less educated (1.35 (1.12; 1.19), of poorer health (1.33 (1.27; 1.39), reporting an unhealthy lifestyle and who had either a low (<18.5 kg/m2, 1.16 (1.09; 1.23)) or a high BMI (>25, 1.08 (1.06; 1.10); especially ≥30 kg/m2, 1.26 (1.23; 1.29)).


Cohort studies may enhance cohort maintenance by paying particular attention to the subgroups that are most unlikely to respond and by an active recruitment strategy using telephone interviews.

Non-response; Non-participation; Lost-to-follow-up