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.
Keywords
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Article info
Publication history
Published online: August 09, 2021
Accepted:
August 4,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
