Jun 15, 2002 read quantifying heterogeneity in a meta. Hoffman, in biostatistics for medical and biomedical practitioners, 2015. Clinical researchers have often preferred to use a fixed effects model for the primary interpretation of a meta analysis. Some general points on the measure of heterogeneity in meta. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta analysis.
Quantifying, displaying and accounting for heterogeneity in the metaanalysis of rcts using standard and generalised q statistics. Interestingly, north american and european participants seemed to receive more benefits from magnesium intake than asians. By now, we have already shown you how to pool effect sizes in a metaanalysis. Quantifying, displaying and accounting for heterogeneity.
Study heterogeneity an overview sciencedirect topics. Any type of quantitative data may be combined through meta analysis. When pooling correlations, it is advised to perform fishers \z\transformation to. Stratification for exploring heterogeneity in systematic.
Both two and onestage approaches are evaluated via simulation study. Heterogeneity can manifest in two ways, with corresponding procedures. This shift in thinking has been termed meta analytic thinking. Quantifying, displaying and accounting for heterogeneity in. Quantifying heterogeneity in individual participant data meta. We prove that evidence cycles in the treatment network play critical roles in network meta analysis. Overview one goal of a meta analysis will often be to estimate the overall, or combined effect. Metaanalysis is a set of techniques used to combine the results of a number of different reports into one report to create a single, more precise estimate of an effect ferrer, 1998. Heterogeneity is usually assessed via the well known q and i 2 statistics, along with the random effects estimate they imply. The evidence for the efficacy of walking in reducing the risk of and preventing coronary heart disease chd is not completely understood.
Heterogeneity assessment is unavoidable under metaanalysis as it guides. However, the test is susceptible to the number of trials included in the meta analysis. Association between suicide reporting in the media and. The question of how to quantify heterogeneity in the multivariate setting is therefore raised.
Abstract metaanalysis has developed to be a most important tool in evaluation research. If all studies in an analysis shared the same true effect size, so that true heterogeneity is zero. Heterogeneity is an issue that is present in almost any metaanalysis. Fourth, to the best of our knowledge, this is the first study in which a cumulative meta analysis was performed to predict changes in the tendency of main risk estimates. Objectives to quantify the duration of each step of the diagnostic pathway for patients with multiple myeloma from symptom onset to confirmation of diagnosis. Its analysis is crucial for defining whether selected primary studies pooling is fit for metaanalysis. Tumor microvasculature possesses a high degree of heterogeneity in its structure and function. In order to get an approximate measure of heterogeneity, we also performed a meta analysis of the means for which we had cis or we could approximate online supplementary appendix a5, which resulted in an i 2 statistics of 98. My own view is that any amount of heterogeneity is acceptable, providing both that the predefined eligibility criteria for the meta analysis are sound and that the data are correct. Comparison of artifact correction with metaregression 348 sources of information about artifact values 349 how heterogeneity is assessed 349 reporting in psychometric metaanalysis 350 concluding remarks 351 summary points 351 part 9. A simple prediction interval for randomeffects meta analysis higgins jpt, thompson sg, spiegelhalter dj mrc biostatistics unit, cambridge, uk for situations in which heterogeneity cannot be suitably explained by study characteristics, a randomeffects meta analysis is a common approach to synthesizing results from a collection of clinical trials.
Pdf quantifying heterogeneity in individual participant data meta. Quantifying heterogeneity in individual participant data. Higgins i2 is conventionally interpreted, in the sense of. Commonly, the generic inversevariance pooling method is also used to combine correlations from different studies into one pooled correlation estimate.
Research article open access quantifying, displaying and. This may include key patient characteristics, such as age and disease severity, methods for diagnosis and evaluation, followup, treatment doses and duration, and study design features, such as level of blinding. There are 3 types of heterogeneity commonly considered in meta analysis. The exploratory efforts of quantifying tumor vascular heterogeneity with dcemri have led to promising results in a number of studies. However, this makes only sense if we arent comparing apples and oranges. Estimating and interpreting heterogeneity and summary effects. Weinstein november, 2015 abstract we develop and structurally estimate a model of heterogeneous multiproduct.
This is more useful for comparisons of heterogeneity among subgroups, but values depend on the treatment effect scale. Our meta analysis of logtransformed adiponectin levels and risk of type 2 diabetes included a total of studies 14 data points because results for men and women were reported separately for the hoorn study 22 including 14 598 participants and 2623 cases of type 2 diabetes. We describe what meta analysis is, what heterogeneity is, and how it affects meta analysis, effect size, the modeling techniques of meta analysis, and strengths and weaknesses of meta analysis. Its consideration further strengthens the drawn inferences. In meta analytic pooling, we aim to synthesize the effects of many different studies into one single effect. Chapter 6 betweenstudy heterogeneity doing metaanalysis in r. In statistics, study heterogeneity is a problem that can arise when attempting to undertake a meta analysis. Assuming a randomeffects model, the be tweenstudies variance re ects how much the true population effect sizes estimated in the single studies of a meta analysis differ.
Figure 3 shows the studyspecific rrs and the pooled estimate. However, the magnitude of heterogeneity differs across metaanalyses. First, we sought to quantify the percentage of patients with depression who had a history of childhood maltreatment to gain an understanding of the. This is a guide on how to conduct meta analyses in r. Heterogeneity assessment is unavoidable under metaanalysis as it guides the path to choose appropriate synthesizing method. Metaanalysis of observational studies in epidemiology. Ideally, the studies whose results are being combined in the meta analysis should all be undertaken in the same way and to the same experimental protocols. In the literature, there are various measures of heterogeneity, such as, q statistic, h2 statistic, hm2 statistic, r2 statistic and i2 statistic. Childhood maltreatment and characteristics of adult.
Quantifying the doseresponse of walking in reducing. However, the ability to predict the behaviour of a tumour in. This meta analysis aimed to quantify the doseresponse relationship between walking and chd risk reduction. For example, it could be the case that while the overall effect we calculate in the meta. If all studies in the analysis were equally precise we could simply compute the mean of the effect sizes. The 18 meta analysis are then used to illustrate the relative performance of the standard and generalised q statistics in measuring the extent of heterogeneity present.
We consider conventional i 2 and r 2 statistics estimated via a twostage approach and r 2 estimated via a onestage approach. This extent may be measured by estimating a between. Quantifying tumour heterogeneity in 18 ffdg petct imaging. Meta analysis results for pain scores are summarized in table 4. Speci cally, network meta analysis produces posterior distributions identical to separate pairwise meta analyses for all treatment comparisons when a treatment. Meta analyses can better quantify the combined evidence of a werther effect across published studies, but these studies are scarce. Quantifying, displaying and accounting for heterogeneity in the meta. The summary effect in the meta analysis is it follows an odds ratio of 0. Some general points on the i2measure of heterogeneity in meta. Assessing the amount of heterogeneity in random effects meta analysis. M quantitatively describes systematic nonrandom heterogeneity patterns acting across multiple variants in a gwas meta analysis. The i 2 value estimates the percentage of total variation across studies that is explained by true differences in the treatment effect rather than by chance, with a range from 0 to 100 %. Forest plot for 37 studies included in the prt meta analysis stratified by clear description of randomisationthe black squares represent the standardised mean differences with area proportional to the amount of information available in each study. Outlines the role of meta analysis in the research process shows.
From the standpoint that heterogeneity is inevitable in a metaanalysis, we are left with the question of whether there is an acceptable degree of heterogeneity. In metaanalytic pooling, we aim to synthesize the effects of many different studies into one single effect. Determining how substantial heterogeneity is is an important aspect of ma. Quantifying systematic heterogeneity in metaanalysis. We have developed a new quantity, i2, which we believe gives a better measure of the consistency between trials in a meta analysis. My own view is that any amount of heterogeneity is acceptable, providing both that the predefined eligibility criteria for the metaanalysis are sound and that the data are correct. Methodological standards for metaanalyses and qualitative. Analyses in nutritional epidemiology usually assume a uniform effect of a nutrient. Clinical researchers have often preferred to use a fixed effects model for the primary interpretation of a metaanalysis. Meta analyses often include small numbers of studies,6 8 and the power of the. Jun 15, 2002 quantifying heterogeneity in a meta analysis. We consider how best to quantify heterogeneity in the context of individual. The evaluation of metaanalysis techniques for quantifying.
Introduction to metaanalysis borenstein, hedges, higgins. Metaanalysis leads to a shift of emphasis from single studies to multiple studies. In this fictional example the five studies in the metaanalysis each showed precisely the same effect, an odds ratio of 0. An alternative quantification of heterogeneity in a meta analysis is the amongstudy variance often called. We consider how best to quantify heterogeneity in the context of individual participant data metaanalysis ipdma of binary data. The evaluation of metaanalysis techniques for quantifying prescribed fire effects on fuel loadings introduction an observant hiker, naturalist, or outdoor enthusiast is bound to encounter tree tags, duff pins, or plot stakes in the forest owing to the large number of forest research. Quantifying systematic heterogeneity in meta analysis view on github. Mar 01, 2017 the present work mainly aimed to appraise all existing methods and find the preferred measure of heterogeneity in meta analysis. It is the univariate r 2 statistic, the ratio of the variance of the estimated treatment effect under the random and fixed effects models, that generalises most naturally, so this statistic provides our basis. Confidence intervals for the amount of heterogeneity in meta analysis. Quantifying tumor vascular heterogeneity with dynamic. Draft please do not quote michael borenstein julian p. Quantifying, displaying and accounting for heterogeneity in the meta analysis of rcts using standard and generalised q statistics. In addition, meta analysis is also useful for listing and possibly exploring sources of bias, quantifying betweenstudy heterogeneity, and proposing some potential explanations for dissecting genuine heterogeneity from bias.
We develop measures of the impact of heterogeneity on a meta. Demystifying fixed and random effects metaanalysis. From the standpoint that heterogeneity is inevitable in a meta analysis, we are left with the question of whether there is an acceptable degree of heterogeneity. Quantifying the sources of firm heterogeneity colin hottman stephen j. By now, we have already shown you how to pool effect sizes in a meta analysis. In meta analyses ma, effect estimates that are pooled together will often be heterogeneous. Uncertainty in heterogeneity estimates in metaanalyses the bmj. Data sources and selection criteria the medline and embase databases were searched up until january 2018 to identify articles that reported time intervals from onset of symptoms to. Previously, four subgroups of the alphatocopherol, betacarotene cancer prevention atbc study of finnish male smokers aged 5069 years were identified in which vitamin e supplementation either significantly increased or decreased the risk of pneumonia. Heterogeneity is indicated by a chi2 statistic greater than the df degrees of freedom and a small p value eg p quantify heterogeneity. In recent years, alternative methods for quantifying heterogeneity have been proposed, that are based on a generalised q statistic. It emphasizes the practical importance of the effect size instead of the statistical significance of individual studies. Quantifying the amount of heterogeneity in metaanalysis. However, the ability to predict the behaviour of a tumour in terms of.
In metaanalyses ma, effect estimates that are pooled together will often be. A likelihood approach to meta analysis with random effects. Prevalence of mycobacterium leprae in armadillos in brazil. This book provides a clear and thorough introduction to metaanalysis, the process of synthesizing data from a series of separate studies. This extent may be measured by estimating a betweenstudy variance, but interpretation is then specific to a particular treatment effect metric. Association of magnesium intake with type 2 diabetes and. Overview one goal of a metaanalysis will often be to estimate the overall, or combined effect. We would not expect the observed effects to be identical to each other but because of withinstudy error, we would expect each to fall within some range of the common effect.
The purpose of this present study was to quantify the level of true heterogeneity in the effect of vitamin e on pneumonia incidence using the i 2 statistic. This book provides a clear and thorough introduction to meta analysis, the process of synthesizing data from a series of separate studies. Clinical heterogeneity refers to variation in the characteristics of the included studies. May 21, 2002 a test for the existence of heterogeneity exists, but depends on the number of studies in the meta. One meta analysis of 10 studies examined media reporting on deaths of celebrities by suicide and found an average increase of 2.
The extent of heterogeneity in a meta analysis partly determines the difficulty in drawing overall conclusions. Heterogeneity is usually assessed via the well known q and i2 statistics, along with the random effects estimate they imply. Meta analysis has become a critically important tool in fields as diverse as medicine, pharmacology, epidemiology, education, psychology, business, and ecology. Primary studies heterogeneity caused by betweenstudy differences is an expected circumstance. Pdf background in metaanalyses ma, effect estimates that are pooled together will often be heterogeneous. In this respect, higgins i2 has emerged to be one of the most used and, potentially, one of the most. Pdf which is the preferred measure of heterogeneity in meta. These features have been demonstrated to be important for disease diagnosis, response assessment, and treatment planning.
Oct, 2012 18ffluorodeoxyglucose positron emission tomographycomputed tomography 18ffdg petct is now routinely used in oncological imaging for diagnosis and staging and increasingly to determine early response to treatment, often employing semiquantitative measures of lesion activity such as the standardized uptake value suv. The evaluation of meta analysis techniques for quantifying prescribed fire effects on fuel loadings introduction an observant hiker, naturalist, or outdoor enthusiast is bound to encounter tree tags, duff pins, or plot stakes in the forest owing to the large number of forest research. The extent of heterogeneity in a metaanalysis partly determines the difficulty in drawing overall conclusions. We consider how best to quantify heterogeneity in the context of individual participant data meta analysis ipdma of binary data. Quantifying the impact of betweenstudy heterogeneity in. The goal of a meta analysis is not simply to report the mean effect size, but also to report how the effect sizes in the various studies are dispersed. Hence i2 is percentage of the chisquared statistic which. Pdf which is the preferred measure of heterogeneity in. M an aggregate statistic, to identify systematic heterogeneity patterns and their direction of effect in meta analysis. Performing a meta analysis of correlations is not too different from the methods we described before.
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