Impact of Two Different Recruitment Procedures (Random versus Volunteer Selection) on the Results of Seroepidemiological Study (SARS-CoV-2)

The proper recruitment of subjects for population-based epidemiological studies is critical to the external validity of the studies and, above all, to the sound and correct interpretation of the findings. Since 2020, the novel coronavirus SARS-CoV-2 pandemic has been a new factor that has been, additionally, hindering studies. Therefore, the aim of our study is to compare demographic, socio-economic, health-related characteristics and the frequency of SARS-CoV-2 infection occurrence among the randomly selected group and the group composed of volunteers. We compare two groups of participants from the cross-sectional study assessing the seroprevalence of SARS-CoV-2 coronavirus, which was conducted in autumn 2020, in three cities of the Silesian Voivodeship in Poland. The first group consisted of a randomly selected, nationally representative, age-stratified sample of subjects (1167 participants, “RG” group) and was recruited using personal invitation letters and postal addresses obtained from a national registry. The second group (4321 volunteers, “VG” group) included those who expressed their willingness to participate in response to an advertisement published in the media. Compared with RG subjects, volunteers were more often females, younger and professionally active, more often had a history of contact with a COVID-19 patient, post-contact nasopharyngeal swab, fewer comorbidities, as well as declared the occurrence of symptoms that might suggest infection with SARS-CoV-2. Additionally, in the VG group the percentage of positive IgG results and tuberculosis vaccination were higher. The findings of the study confirm that surveys limited to volunteers are biased. The presence of the bias may seriously affect and distort inference and make the generalizability of the results more than questionable. Although effective control over selection bias in surveys, including volunteers, is virtually impossible, its impact on the survey results is impossible to predict. However, whenever possible, such surveys could include a small component of a random sample to assess the presence and potential effects of selection bias.