Meta-analyses of chronic disease trials with competing causes of death may yield biased odds ratios.
M. Koller, T. Stijnen, E. Steyerberg, and J. Lubsen. Journal of clinical epidemiology, 61 (4):
365-72(April 2008)4586<m:linebreak></m:linebreak>PUBM: Print-Electronic; JID: 8801383; 2006/05/23 received; 2007/05/08 revised; 2007/05/10 accepted; 2007/10/15 aheadofprint; ppublish;<m:linebreak></m:linebreak>Mesures d'associació.
DOI: 10.1016/j.jclinepi.2007.05.009
Abstract
OBJECTIVE: To study the odds ratio (OR) as measure of treatment effect in the context of mutually exclusive causes of death. STUDY DESIGN AND SETTING: As example we consider meta-analyses of randomized trials of implantable cardioverter defibrillator implantation (ICD). We compare the pooled OR to the pooled cause-specific hazard ratio (HR) for each of the mutually exclusive outcomes "sudden cardiac death" (SCD) and "death other than SCD." RESULTS: The pooled OR and cause-specific HR for the reduction of SCD are similar (0.43 and 0.44, respectively) for nine included trials. However, the OR erroneously presumes a potential trend toward an adverse effect of the ICD on "death other than arrhythmia" (OR 1.11 0.84-1.45), whereas such an effect is small with the cause-specific HR (HR 1.03 0.79-1.32). In general, it is shown that a spurious association of treatment with öther death" may be seen when a substantial number of death from the cause of interest is postponed. CONCLUSION: The OR should be used with caution to study effects of treatment on mutually exclusive causes of death. Practically this concern applies primarily to meta-analysis where the use of the cause-specific HR, whenever available, is recommended.
%0 Journal Article
%1 Koller2008
%A Koller, Michael T
%A Stijnen, Theo
%A Steyerberg, Ewout W
%A Lubsen, Jacobus
%D 2008
%J Journal of clinical epidemiology
%K Bias(Epidemiology) CauseofDeath ChronicDisease ClinicalTrialsasTopic ClinicalTrialsasTopic:statistics&numericald DataInterpretation Humans Meta-AnalysisasTopic OddsRatio ResearchDesign Statistical TreatmentOutcome RCT
%N 4
%P 365-72
%R 10.1016/j.jclinepi.2007.05.009
%T Meta-analyses of chronic disease trials with competing causes of death may yield biased odds ratios.
%U http://www.ncbi.nlm.nih.gov/pubmed/18313561
%V 61
%X OBJECTIVE: To study the odds ratio (OR) as measure of treatment effect in the context of mutually exclusive causes of death. STUDY DESIGN AND SETTING: As example we consider meta-analyses of randomized trials of implantable cardioverter defibrillator implantation (ICD). We compare the pooled OR to the pooled cause-specific hazard ratio (HR) for each of the mutually exclusive outcomes "sudden cardiac death" (SCD) and "death other than SCD." RESULTS: The pooled OR and cause-specific HR for the reduction of SCD are similar (0.43 and 0.44, respectively) for nine included trials. However, the OR erroneously presumes a potential trend toward an adverse effect of the ICD on "death other than arrhythmia" (OR 1.11 0.84-1.45), whereas such an effect is small with the cause-specific HR (HR 1.03 0.79-1.32). In general, it is shown that a spurious association of treatment with öther death" may be seen when a substantial number of death from the cause of interest is postponed. CONCLUSION: The OR should be used with caution to study effects of treatment on mutually exclusive causes of death. Practically this concern applies primarily to meta-analysis where the use of the cause-specific HR, whenever available, is recommended.
%@ 0895-4356
@article{Koller2008,
abstract = {OBJECTIVE: To study the odds ratio (OR) as measure of treatment effect in the context of mutually exclusive causes of death. STUDY DESIGN AND SETTING: As example we consider meta-analyses of randomized trials of implantable cardioverter defibrillator implantation (ICD). We compare the pooled OR to the pooled cause-specific hazard ratio (HR) for each of the mutually exclusive outcomes "sudden cardiac death" (SCD) and "death other than SCD." RESULTS: The pooled OR and cause-specific HR for the reduction of SCD are similar (0.43 and 0.44, respectively) for nine included trials. However, the OR erroneously presumes a potential trend toward an adverse effect of the ICD on "death other than arrhythmia" (OR 1.11 [0.84-1.45]), whereas such an effect is small with the cause-specific HR (HR 1.03 [0.79-1.32]). In general, it is shown that a spurious association of treatment with "other death" may be seen when a substantial number of death from the cause of interest is postponed. CONCLUSION: The OR should be used with caution to study effects of treatment on mutually exclusive causes of death. Practically this concern applies primarily to meta-analysis where the use of the cause-specific HR, whenever available, is recommended.},
added-at = {2023-02-03T11:44:35.000+0100},
author = {Koller, Michael T and Stijnen, Theo and Steyerberg, Ewout W and Lubsen, Jacobus},
biburl = {https://www.bibsonomy.org/bibtex/2ca384a4005171b657aab7fedfd24c588/jepcastel},
city = {Basel Institute for Clinical Epidemiology, University Hospital Basel, CH-4031 Basel, Switzerland. kollerm@uhbs.ch},
doi = {10.1016/j.jclinepi.2007.05.009},
interhash = {137c1f2aff701db8ed3b0b3ce3247711},
intrahash = {ca384a4005171b657aab7fedfd24c588},
isbn = {0895-4356},
issn = {0895-4356},
journal = {Journal of clinical epidemiology},
keywords = {Bias(Epidemiology) CauseofDeath ChronicDisease ClinicalTrialsasTopic ClinicalTrialsasTopic:statistics&numericald DataInterpretation Humans Meta-AnalysisasTopic OddsRatio ResearchDesign Statistical TreatmentOutcome RCT},
month = {4},
note = {4586<m:linebreak></m:linebreak>PUBM: Print-Electronic; JID: 8801383; 2006/05/23 [received]; 2007/05/08 [revised]; 2007/05/10 [accepted]; 2007/10/15 [aheadofprint]; ppublish;<m:linebreak></m:linebreak>Mesures d'associació},
number = 4,
pages = {365-72},
pmid = {18313561},
timestamp = {2023-05-04T08:59:38.000+0200},
title = {Meta-analyses of chronic disease trials with competing causes of death may yield biased odds ratios.},
url = {http://www.ncbi.nlm.nih.gov/pubmed/18313561},
volume = 61,
year = 2008
}