Mengli Xiao1, Yong Chen2, Stephen R Cole3, Richard F MacLehose4, David B Richardson3, Haitao Chu5. 1. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN. 2. Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA. 3. Department of Epidemiology, University of North Carolina, Chapel Hill, NC. 4. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. 5. Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN. Electronic address: chux0051@umn.edu.
Abstract
OBJECTIVES: A recent paper by Doi et al. advocated completely replacing the relative risk (RR) with the odds ratio (OR) as the effect measure in clinical trials and meta-analyses with binary outcomes. Besides some practical advantages of RR over OR, Doi et al.'s key assumption that the OR is "portable" in the meta-analysis, that is, study-specific ORs are likely not correlated with baseline risks, was not well justified. STUDY DESIGNS AND SETTINGS: We summarized Spearman's rank correlation coefficient between study-specific ORs and baseline risks in 40,243 meta-analyses from the Cochrane Database of Systematic Reviews. RESULTS: Study-specific ORs tend to be higher in studies with lower baseline risks of disease for most meta-analyses in Cochrane Database of Systematic Reviews. Using an actual meta-analysis example, we demonstrate that there is a strong negative correlation between OR (RR or RD) with the baseline risk and the conditional effects notably vary with baseline risks. CONCLUSIONS: Replacing RR or RD with OR is currently unadvisable in clinical trials and meta-analyses. It is possible that no effect measure is "portable" in a meta-analysis. In addition to the overall (or marginal) effect, we suggest presenting the conditional effect based on the baseline risk using a bivariate generalized linear mixed model.
OBJECTIVES: A recent paper by Doi et al. advocated completely replacing the relative risk (RR) with the odds ratio (OR) as the effect measure in clinical trials and meta-analyses with binary outcomes. Besides some practical advantages of RR over OR, Doi et al.'s key assumption that the OR is "portable" in the meta-analysis, that is, study-specific ORs are likely not correlated with baseline risks, was not well justified. STUDY DESIGNS AND SETTINGS: We summarized Spearman's rank correlation coefficient between study-specific ORs and baseline risks in 40,243 meta-analyses from the Cochrane Database of Systematic Reviews. RESULTS: Study-specific ORs tend to be higher in studies with lower baseline risks of disease for most meta-analyses in Cochrane Database of Systematic Reviews. Using an actual meta-analysis example, we demonstrate that there is a strong negative correlation between OR (RR or RD) with the baseline risk and the conditional effects notably vary with baseline risks. CONCLUSIONS: Replacing RR or RD with OR is currently unadvisable in clinical trials and meta-analyses. It is possible that no effect measure is "portable" in a meta-analysis. In addition to the overall (or marginal) effect, we suggest presenting the conditional effect based on the baseline risk using a bivariate generalized linear mixed model.
Authors: Mengli Xiao; Haitao Chu; Stephen R Cole; Yong Chen; Richard F MacLehose; David B Richardson; Sander Greenland Journal: J Clin Epidemiol Date: 2021-08-11 Impact factor: 6.437