Institute for Clinical Evaluative Sciences, Toronto, Ontario M4N 3M5, Canada.
J Clin Epidemiol. 2010 Jan;63(1):2-6. doi: 10.1016/j.jclinepi.2008.11.004. Epub 2009 Feb 20.
Logistic regression models are frequently used in cohort studies to determine the association between treatment and dichotomous outcomes in the presence of confounding variables. In a logistic regression model, the association between exposure and outcome is measured using the odds ratio (OR). The OR can be difficult to interpret and only approximates the relative risk (RR) in certain restrictive settings. Several authors have suggested that for dichotomous outcomes, RRs, RR reductions, absolute risk reductions, and the number needed to treat (NNT) are more clinically meaningful measures of treatment effect.
We describe a method for deriving clinically meaningful measures of treatment effect from a logistic regression model. This method involves determining the probability of the outcome if each subject in the cohort was treated and if each subject was untreated. These probabilities are then averaged across the study cohort to determine the average probability of the outcome in the population if all subjects were treated and if they were untreated.
Risk differences, RRs, and NNTs were derived using a logistic regression model.
Clinically meaningful measures of effect can be derived from a logistic regression model in a cohort study. These methods can also be used in randomized controlled trials when logistic regression is used to adjust for possible imbalance in prognostically important baseline covariates.
在存在混杂变量的情况下,逻辑回归模型常用于队列研究,以确定治疗与二分类结局之间的关联。在逻辑回归模型中,暴露与结局之间的关联使用比值比(OR)来衡量。OR 难以解释,并且仅在某些限制条件下近似相对风险(RR)。一些作者认为,对于二分类结局,RR、RR 减少、绝对风险降低和需要治疗的人数(NNT)是更有临床意义的治疗效果衡量指标。
我们描述了一种从逻辑回归模型中得出临床有意义的治疗效果衡量指标的方法。该方法涉及确定队列中每个受试者接受治疗和每个受试者未接受治疗时的结局概率。然后,将这些概率在研究队列中平均,以确定如果所有受试者都接受治疗和未接受治疗时,人群中结局的平均概率。
使用逻辑回归模型得出了风险差异、RR 和 NNT。
可以从队列研究中的逻辑回归模型中得出临床有意义的效果衡量指标。当使用逻辑回归来调整预后重要的基线协变量的可能不平衡时,这些方法也可以用于随机对照试验。