THE RISK OF DETERMINING RISK WITH MULTIVARIABLE MODELS
THE RISK OF DETERMINING RISK WITH MULTIVARIABLE MODELS
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DOI：
10.7326/0003-4819-118-3-199302010-00009
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发表时间：
1993-02-01
影响因子：
39.2
通讯作者：
HOLFORD, TR
中科院分区：
文献类型：
--
作者：
CONCATO, J;FEINSTEIN, AR;HOLFORD, TR
目的：回顾多变量分析的原理，考察多变量统计方法在一般医学文献中的应用。资料来源：计算机辅助检索《柳叶刀》和《新英格兰医学杂志》1985年至1989年发表的451篇包含多变量分析方法的文章。资料提炼：随机抽取60篇使用Logistic回归和比例风险分析两种最常用方法的文献进行更深入的综述。资料提炼：在对这60篇随机抽取的文献进行综述时，重点放在可以防止影响多变量分析结果准确性和解释的问题的方法学指南上。结果：从1985年到1989年，多变量统计方法在两种期刊所有文章中的相对使用频率从10%左右逐年上升到18%。在使用Logistic或比例风险回归的60篇文章中，有44篇(73%)的风险估计是针对单个变量(“风险因素”)进行量化的。这44篇文章中违反和遗漏的方法学指南包括：数据过度拟合；变量与线性梯度的符合性检验；没有提到比例风险的相关检查；没有关于自变量之间相互作用的测试报告；以及未具体说明对自变量的编码或选择。这些问题会使报告的结果潜在地不准确、误导或难以解释。结论：这些发现表明在医学研究中的报告和多变量分析的进行方面需要改进。
Purpose: To review the principles of multivariable analysis and to examine the application of multivariable statistical methods in general medical literature.Data Sources: A computer-assisted search of articles in The Lancet and The New England Journal of Medicine identified 451 publications containing multivariable methods from 1985 through 1989. A random sample of 60 articles that used the two most common methods-logistic regression or proportional hazards analysis-was selected for more intensive review.Data Extraction: During review of the 60 randomly selected articles, the focus was on generally accepted methodologic guidelines that can prevent problems affecting the accuracy and interpretation of multivariable analytic results.Results: From 1985 to 1989, the relative frequency of multivariable statistical methods increased annually from about 10% to 18% among all articles in the two journals. In 44 (73%) of 60 articles using logistic or proportional hazards regression, risk estimates were quantified for individual variables (''risk factors''). Violations and omissions of methodologic guidelines in these 44 articles included overfitting of data; no test of conformity of variables to a linear gradient; no mention of pertinent checks for proportional hazards; no report of testing for interactions between independent variables; and unspecified coding or selection of independent variables. These problems would make the reported results potentially inaccurate, misleading, or difficult to interpret.Conclusions: The findings suggest a need for improvement in the reporting and perhaps conducting of multivariable analyses in medical research.