Misclassification of rental assistance in the national health interview survey evidence and implications

Background: Federal surveys could play a role in measuring the association of rental assistance and health and in identifying the health needs of the assisted population. However, self-reports of rental assistance could be biased. Our objective was to assess the accuracy of reported rental assistance in the National Health Interview Survey (NHIS). Methods: We conducted a record-check study of reports of US Department of Housing and Urban Development rental assistance in the 2004-2012 NHIS, using survey responses linked to administrative records. Misclassification measures were limited to the false-negative rate because the survey ascertained participation in all rental assistance programs, but the administrative data pertained only to US Department of Housing and Urban Development. False-negative rates were calculated for the total population, for sociodemographic subgroups, across levels of self-reported health status, and for specific assistance types (Housing Choice Vouchers, Public Housing, and Multifamily Housing). Results: We estimated a false-negative rate of 22.6%. Misclassification was higher among Public Housing residents compared to those receiving other forms of assistance, even after controlling for sociodemographics. Rates varied across region and other demographics. Those self-reporting fair or poor health were less likely to misreport assistance compared with those in better health, but the difference was explained by covariates. Misreporting assistance had little independent impact on the adjusted association of assistance and health. Conclusions: False-negative reporting of rental assistance is moderately high in the NHIS, but we did not find evidence that it independently biased estimates of the association of health and rental assistance.