Hamling Jan, Lee Peter, Weitkunat Rolf, Ambühl Mathias
P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey, U.K.
Stat Med. 2008 Mar 30;27(7):954-70. doi: 10.1002/sim.3013.
Epidemiological studies relating a particular exposure to a specified disease may present their results in a variety of ways. Often, results are presented as estimated odds ratios (or relative risks) and confidence intervals (CIs) for a number of categories of exposure, for example, by duration or level of exposure, compared with a single reference category, often the unexposed. For systematic literature review, and particularly meta-analysis, estimates for an alternative comparison of the categories, such as any exposure versus none, may be required. Obtaining these alternative comparisons is not straightforward, as the initial set of estimates is correlated. This paper describes a method for estimating these alternative comparisons based on the ideas originally put forward by Greenland and Longnecker, and provides implementations of the method, developed using Microsoft Excel and SAS. Examples of the method based on studies of smoking and cancer are given. The method also deals with results given by categories of disease (such as histological types of a cancer). The method allows the use of a more consistent comparison when summarizing published evidence, thus potentially improving the reliability of a meta-analysis.
将特定暴露因素与特定疾病相关联的流行病学研究,可能会以多种方式呈现其结果。通常,结果会以估计的比值比(或相对风险)以及若干暴露类别(例如,按暴露持续时间或暴露水平划分)的置信区间(CI)来呈现,与单一的参照类别(通常是未暴露者)进行比较。对于系统文献综述,尤其是荟萃分析,可能需要对这些类别进行另一种比较的估计值,例如任何暴露与无暴露的比较。获取这些替代比较并非易事,因为最初的一组估计值是相关的。本文描述了一种基于格陵兰岛和朗内克最初提出的理念来估计这些替代比较的方法,并提供了使用微软Excel和SAS开发的该方法的实现方式。给出了基于吸烟与癌症研究的该方法示例。该方法还适用于按疾病类别(如癌症的组织学类型)给出的结果。在总结已发表证据时,该方法允许使用更一致的比较,从而有可能提高荟萃分析的可靠性。