Synthesis of observational studies should consider credibility ceilings
Synthesis of observational studies should consider credibility ceilings
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DOI：
10.1016/j.jclinepi.2008.05.014
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发表时间：
2009-02-01
影响因子：
7.2
通讯作者：
Ioannidis, John P. A.
中科院分区：
文献类型：
--
作者：
Salanti, Georgia;Ioannidis, John P. A.
目的：观察性研究的荟萃分析通常会得到虚假的精确结果。研究设计和设置：我们开发了一个简单的敏感性分析，从任何单一的观察性研究不能给我们超过一个最大的确定性c%（称为可信度上限）的假设开始，一个效果是在一个特定的方向，而不是在其他。纳入荟萃分析的每项研究均针对不同的可信度上限c进行调整，并检查结论的一致性。我们将该方法应用于三项观察性研究的荟萃分析，这些研究具有名义上统计学显著的汇总效应。（教学与非教学卫生保健的死亡率;染发剂的非霍奇金淋巴瘤风险; ω-3脂肪酸的死亡率）。在三项荟萃分析中，研究间异质性I-2估计值从36%-72%（无上限效应）下降至0%（上限分别为9%、4%和4%）。标称统计学显著性损失的上限分别为10%、8%和11%。似然比表明，即使最小的上限效应，有没有强有力的支持，这三个associations.Conclusions的可信度的每一个：考虑可信度上限允许保守的解释观察证据，并可以定期应用到观察性研究的荟萃分析。(C)2008年爱思唯尔公司All rights reserved.
Objective: Meta-analyses of observational studies often get spuriously precise results. We aimed to factor this skepticism in meta-analysis calculations.Study Design and Setting: We developed a simple sensitivity analysis starting from the assumption that any single observational study cannot give us more than a maximum certainty c% (called credibility ceiling) that an effect is in a particular direction and not in the other. Each study included in meta-analysis is adjusted for different credibility ceilings c and the consistency of the conclusion examined. We applied the method in three meta-analyses of observational studies with nominally statistically significant summary effects (mortality with teaching versus nonteaching health care; risk of non-Hodgkin's lymphoma with hair dyes; mortality with omega-3 fatty acids).Results: Between-study heterogeneity I-2 estimates dropped from 36%-72% without a ceiling effect to 0% with ceilings of 9%, 4%, and 4% in the three meta-analyses, respectively. Nominal statistical significance was lost with ceilings of 10%, 8%, and 11 %, respectively. The likelihood ratios suggested that even with minimal ceiling effects, there was no strong support for the credibility of each of these three associations.Conclusions: Consideration of credibility ceilings allows conservative interpretation of observational evidence and can be applied routinely to meta-analyses of observational studies. (C) 2008 Elsevier Inc. All rights reserved.