A comparison of observational studies and randomized, controlled trials.
A comparison of observational studies and randomized, controlled trials.
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DOI：
10.1056/nejm200006223422506
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发表时间：
2000-06-22
影响因子：
158.5
通讯作者：
Hartz, AJ
中科院分区：
文献类型：
--
作者：
Benson, K;Hartz, AJ
背景：多年来，人们据称观察性研究比随机，对照试验发现更强的治疗效果。我们将观察性研究的结果与随机，对照试验的结果进行了比较。方法：我们搜索了删节的指数医疗和Cochrane数据库，以确定1985年至1998年之间报道的观察性研究，这些研究比较了两种或多种或多种或多种治疗或多个治疗或干预措施。然后，我们搜索了MEDLINE和COCHRANE数据库，以确定所有随机，对照试验和观察性研究，并比较了这些条件的相同治疗方法。对于每种处理，各种观察性研究中效应的幅度通过壁炉架或加权分析的差异程序结合在一起，然后将其与随机，对照试验中效应的综合幅度进行比较，这些试验评估了相同的处理。分子：有136份有关19种不同治疗方法的报道，例如针对冠状动脉疾病的钙通道阻滞剂治疗，阑尾切除术和用于亚生育的干预措施。在大多数情况下，观察性研究和随机对照试验的治疗效果的估计值相似。在观察研究中，在19个治疗效应的19个分析中，效应的综合幅度在于在随机，对照试验中的组合幅度的95％置信区间之外。结论：我们几乎没有发现证据表明估计治疗效果的证据1984年以后报道的观察性研究始终大于与随机对照试验中获得的观察性研究。 （N Engl J Med 2000; 342：1878-86。）（C）2000，马萨诸塞州医学会。
Background: For many years it has been claimed that observational studies find stronger treatment effects than randomized, controlled trials. We compared the results of observational studies with those of randomized, controlled trials.Methods: We searched the Abridged Index Medicus and Cochrane data bases to identify observational studies reported between 1985 and 1998 that compared two or more treatments or interventions for the same condition. We then searched the Medline and Cochrane data bases to identify all the randomized, controlled trials and observational studies comparing the same treatments for these conditions. For each treatment, the magnitudes of the effects in the various observational studies were combined by the Mantel-Haenszel or weighted analysis-of-variance procedure and then compared with the combined magnitude of the effects in the randomized, controlled trials that evaluated the same treatment.Results: There were 136 reports about 19 diverse treatments, such as calcium-channel-blocker therapy for coronary artery disease, appendectomy, and interventions for subfertility. In most cases, the estimates of the treatment effects from observational studies and randomized, controlled trials were similar. In only 2 of the 19 analyses of treatment effects did the combined magnitude of the effect in observational studies lie outside the 95 percent confidence interval for the combined magnitude in the randomized, controlled trials.Conclusions: We found little evidence that estimates of treatment effects in observational studies reported after 1984 are either consistently larger than or qualitatively different from those obtained in randomized, controlled trials. (N Engl J Med 2000;342:1878-86.) (C)2000, Massachusetts Medical Society.