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Investigating Potential Gender-Based Differential Item Functioning for Items in the Kansas City Cardiomyopathy Questionnaire (KCCQ) Physical Limitations Domain

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Abstract

Women with heart failure report worse health-related quality of life on average, than men. This may result from actual differences in care or differing interpretations of and responses to survey questions. We investigated potential gender-based differential item functioning on the Kansas City Cardiomyopathy Questionnaire (KCCQ) Physical Limitations domain. Using data from the HF-ACTION trial, a multicenter, randomized controlled trial of exercise training in patients with chronic heart failure with reduced ejection fraction (661 women, 1670 men), we assessed gender-based differential item functioning using a Wald test based on item response theory and ordinal logistic regression. Both methods evaluated how men and women responded to each KCCQ item after adjusting for physical limitation status. No item exhibited statistically significant differential item functioning using the Wald method. Two items exhibited differential item functioning using the ordinal logistic regression method (KCCQ1e: Climbing a flight of stairs without stopping; KCCQ1f: Hurrying or jogging) (P < 0.01), but the magnitude of differential item functioning was negligible. To accurately measure patient-reported outcomes, it is important to evaluate potential biases that may influence the ability to compare patient subgroups. The magnitude of differential item functioning on a 5-item KCCQ Physical Limitation domain was negligible.

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Data Availability

The data that support the findings of this study are available upon request from https://biolincc.nhlbi.nih.gov/studies/hf_action/ Restrictions may apply to the availability of these data.

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Acknowledgements

The authors acknowledge Heidi Dohse, a patient partner, for her insight on the patients’ perspective. The authors acknowledge patients and clinicians from the HF-ACTION trial, Ashley J. Wilson, our Center for Health Measurement intern for her support with the DIF worksheets, as well as Karen Staman, Liz Wing, and Terren Green, who provided medical editing support.

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Authors and Affiliations

  1. Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA

    Theresa M. Coles, Li Lin, Kevin Weinfurt & Bryce B. Reeve

  2. Healthcare Institute for Innovations in Quality, University of Missouri-Kansas City, Kansas City, MO, USA

    John A. Spertus

  3. Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA

    John A. Spertus

  4. Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA

    Robert J. Mentz

  5. Wayne State University, Central Michigan University, Mount Pleasant, MI, USA

    Ileana L. Piña

  6. Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA

    Ileana L. Piña, Fraser D. Bocell, Michelle E. Tarver, Anindita Saha & Brittany Caldwell

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  1. Theresa M. Coles
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Correspondence to Theresa M. Coles.

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Competing Interests

Dr. John Spertus owns the copyright to the KCCQ. Dr. Mentz received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim/Eli Lilly, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Medtronic, Merck, Novartis, Relypsa, Respicardia, Roche, Sanofi, Vifor, and Windtree Therapeutics. Dr. Coles received research support from Merck and is a consultant with Regenxbio. Ms. Lin, Dr. Weinfurt, Dr. Reeve, Dr. Piña, Dr. Bocell, Dr. Tarver, Ms. Saha, and Dr. Caldwell have no competing interests to disclose.

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Coles, T.M., Lin, L., Weinfurt, K. et al. Investigating Potential Gender-Based Differential Item Functioning for Items in the Kansas City Cardiomyopathy Questionnaire (KCCQ) Physical Limitations Domain. Applied Research Quality Life 18, 1785–1798 (2023). https://doi.org/10.1007/s11482-023-10162-3

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