Nurminen M
Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, Finland.
Eur J Epidemiol. 1995 Aug;11(4):365-71. doi: 10.1007/BF01721219.
This paper argues that the use of the odds ratio parameter in epidemiology needs to be considered with a view to the specific study design and the types of exposure and disease data at hand. Frequently, the odds ratio measure is being used instead of the risk ratio or the incidence-proportion ratio in cohort studies or as an estimate for the incidence-density ratio in case-referent studies. Therefore, the analyses of epidemiologic data have produced biased estimates and the presentation of results has been misleading. However, the odds ratio can be relinquished as an effect measure for these study designs; and, the application of the case-base sampling approach permits the incidence ratio and difference measures to be estimated without any untenable assumptions. For the Poisson regression, the odds ratio is not a parameter of interest; only the risk or rate ratio and difference are relevant. For the conditional logistic regression in matched case-referent studies, the odds ratio remains useful, but only when it is interpreted as an estimate of the incidence-density ratio. Thus the odds ratio should, in general, give way to the incidence ratio and difference as the measures of choice for exposure effect in epidemiology.
本文认为，流行病学中比值比参数的使用需要结合具体的研究设计以及手头暴露和疾病数据的类型来考虑。在队列研究中，比值比测量常常被用来替代风险比或发病比例比，或者在病例对照研究中被用作发病密度比的估计值。因此，流行病学数据分析产生了有偏差的估计，结果呈现也具有误导性。然而，对于这些研究设计，比值比可以不再作为效应测量指标；而且，病例基数抽样方法的应用使得发病率比和差异测量无需任何不合理假设即可估计。对于泊松回归，比值比不是感兴趣的参数；只有风险或率比以及差异才是相关的。对于匹配病例对照研究中的条件逻辑回归，比值比仍然有用，但前提是将其解释为发病密度比的估计值。因此，一般而言，比值比应让位于发病率比和差异，作为流行病学中暴露效应的首选测量指标。
