Reconsidering the odds ratio as a measure of 2x2 association in a population.

The odds ratio (OR) is probably the most widely used measure of 2x2 association in epidemiology, but it often produces results that are puzzling or misleading. Receiver operating characteristic (ROC) methods are used to take a fresh look at the OR and show where and why such puzzling results arise. When researchers choose to report a summary measure of association, the OR is one of many measures of association that might be considered, not one that should be considered the 'gold standard' of 2x2 measures of association. In a randomized clinical trial with binary outcome for success, either the success or failure rates in treatment and control groups might be reported separately or the number needed to treat to achieve one extra success, to emphasize the cost of unnecessary treatment needed to achieve a success. In studies assessing reliability or heritability, we recommend the intraclass kappa. In studies in which one binary variable is assessed against a binary criterion, we recommend the weighted kappa. Copyright 2004 John Wiley & Sons, Ltd.