TITLE

Potential Misinterpretation of Treatment Effects Due to Use of Odds Ratios and Logistic Regression in Randomized Controlled Trials

AUTHOR(S)
Knol, Mirjam J.; Duijnhoven, Ruben G.; Grobbee, Diederick E.; Moons, Karel G. M.; Groenwold, Rolf H. H.
PUB. DATE
June 2011
SOURCE
PLoS Clinical Trials;Jun2011, Vol. 6 Issue 6, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In randomized controlled trials (RCTs), the odds ratio (OR) can substantially overestimate the risk ratio (RR) if the incidence of the outcome is over 10%. This study determined the frequency of use of ORs, the frequency of overestimation of the OR as compared with its accompanying RR in published RCTs, and we assessed how often regression models that calculate RRs were used. Methods: We included 288 RCTs published in 2008 in five major general medical journals (Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, New England Journal of Medicine). If an OR was reported, we calculated the corresponding RR, and we calculated the percentage of overestimation by using the formula . Results: Of 193 RCTs with a dichotomous primary outcome, 24 (12.4%) presented a crude and/or adjusted OR for the primary outcome. In five RCTs (2.6%), the OR differed more than 100% from its accompanying RR on the log scale. Forty-one of all included RCTs (n = 288; 14.2%) presented ORs for other outcomes, or for subgroup analyses. Nineteen of these RCTs (6.6%) had at least one OR that deviated more than 100% from its accompanying RR on the log scale. Of 53 RCTs that adjusted for baseline variables, 15 used logistic regression. Alternative methods to estimate RRs were only used in four RCTs. Conclusion: ORs and logistic regression are often used in RCTs and in many articles the OR did not approximate the RR. Although the authors did not explicitly misinterpret these ORs as RRs, misinterpretation by readers can seriously affect treatment decisions and policy making.
ACCESSION #
88146189

 

Related Articles

  • Between-centre differences and treatment effects in randomized controlled trials: A case study in traumatic brain injury.  // Trials;2011, Vol. 12 Issue 1, p201 

    The article presents a case study that evaluates the influence of between-centre differences and treatment effect in a large randomized controlled trial (RCT) in Traumatic Brain Injury (TBI). The study used random effects logistic regression with a random intercept to estimate the treatment...

  • Mobility Disability and the Urban Built Environment. Philippa Clarke; Jennifer A. Ailshire; Michael Bader; Jeffrey D. Morenoff; James S. House // American Journal of Epidemiology;Sep2008, Vol. 168 Issue 5, p506 

    Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001–2003), the authors examined the effect of built environment characteristics on mobility disability among...

  • Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil). de Negreiros Cabral, Kelem; Perracini, Monica Rodrigues; Soares1, Aline Thomaz; de Cristo Stein, Francine; Nakagawa Sera, Celisa Tiemi; Tiedemann, Anne; Sherrington, Cathie; Filho, Wilson Jacob; Pacheco Paschoal, Sérgio Márcio // BMC Geriatrics;2013, Vol. 13 Issue 1, p1 

    Background: Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years....

  • A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients. El-Jawahri, Areej; Mitchell, Susan; Paasche-Orlow, Michael; Temel, Jennifer; Jackson, Vicki; Rutledge, Renee; Parikh, Mihir; Davis, Aretha; Gillick, Muriel; Barry, Michael; Lopez, Lenny; Walker-Corkery, Elizabeth; Chang, Yuchiao; Finn, Kathleen; Coley, Christopher; Volandes, Angelo // JGIM: Journal of General Internal Medicine;Aug2015, Vol. 30 Issue 8, p1071 

    BACKGROUND: Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided. OBJECTIVES: We aimed to examine the impact of a video decision tool for CPR...

  • Potential Misinterpretation of Treatment Effects Due to Use of Odds Ratios and Logistic Regression in Randomized Controlled Trials. Knol, Mirjam J.; Duijnhoven, Ruben G.; Grobbee, Diederick E.; Moons, Karel G. M.; Groenwold, Rolf H. H. // PLoS ONE;2011, Vol. 6 Issue 6, p1 

    Background: In randomized controlled trials (RCTs), the odds ratio (OR) can substantially overestimate the risk ratio (RR) if the incidence of the outcome is over 10%. This study determined the frequency of use of ORs, the frequency of overestimation of the OR as compared with its accompanying...

  • The Accuracy of Health Risk Appraisal in Predicting Mortality. Foxman, Betsy; Edington, Dee W. // American Journal of Public Health;Aug1987, Vol. 77 Issue 8, p971 

    Abstract: In order to determine the accuracy of the Centers for Disease Control Health Risk Appraisal (CDC/HRA) program the authors compared observed to predicted mortality for the 3,135 persons followed from 1959-79 as part of the Tecumseh Community Health Study. The analysis was limited to...

  • Otologic and Audiologic Outcomes With the Furlow and von Langenbeck With Intravelar Veloplasty Palatoplasties in Unilateral Cleft Lip and Palate. Antonelli, Patrick J.; Jorge, José C.; Feniman, Mariza R.; Piazentin-Penna, Sílvia H. A.; Dutka-Souza, Jeniffer C. R.; Seagle, M. Brent; Williams, William N.; Nackashi, John A.; Boggs, Steve; Graciano, Maria I. G.; Souza, Telma V.; Neto, José S. M.; Garla, Luis A.; Silva, Marcos L. N.; Marques, Ilza L.; Borgo, Hilton C.; Martinelli, Ângela P. M. C.; Shuster, Jonathan J.; Pimentel, Maria C. M.; Zimmermann, Maria C. // Cleft Palate-Craniofacial Journal;Jul2011, Vol. 48 Issue 4, p412 

    Objective: Cleft palate increases the risk of chronicmiddle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip...

  • Rocuronium for nonemergent intubation of term and preterm infants. Feltman, D. M.; Weiss, M. G.; Nicoski, P.; Sinacore, J. // Journal of Perinatology;Jan2011, Vol. 31 Issue 1, p38 

    Objective:The aim of this study was to analyze clinical characteristics of rocuronium as premedication for nonemergent intubation in infants.Study Design:Preterm infants requiring nonemergent intubation were randomized to receive atropine and fentanyl with or without rocuronium. Outcomes,...

  • Symptoms of depression and anxiety predict treatment response and long-term physical health outcomes in rheumatoid arthritis: secondary analysis of a randomized controlled trial. Matcham, Faith; Norton, Sam; Scott, David L.; Steer, Sophia; Hotopf, Matthew // Rheumatology;Feb2016, Vol. 55 Issue 2, p268 

    Objective. The aim of this analysis is to examine the longitudinal impact of symptoms of depression/ anxiety on treatment response, long-term disease activity and physical disability in RA. Methods. Secondary analysis of clinical trial data was performed. Data were collected at baseline and at...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics