Cited by 1,734Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyStatistical Methods in Clinical Trials

What to add to nothing? Use and avoidance of continuity corrections in meta‐analysis of sparse data

J. Sweeting, Michael, J. Sutton, Alexander, C. Lambert, Paul·2004·Statistics in Medicine

Abstract

Objectives To compare the performance of different meta-analysis methods for pooling odds ratios when applied to sparse event data with emphasis on the use of continuity corrections. Background Meta-analysis of side effects from RCTs or risk factors for rare diseases in epidemiological studies frequently requires the synthesis of data with sparse event rates. Combining such data can be problematic when zero events exist in one or both arms of a study as continuity corrections are often needed, but, these can influence results and conclusions. Methods A simulation study was undertaken comparing several meta-analysis methods for combining odds ratios (using various classical and Bayesian methods of estimation) on sparse event data. Where required, the routine use of a constant and two alternative continuity corrections; one based on a function of the reciprocal of the opposite group arm size; and the other an empirical estimate of the pooled effect size from the remaining studies in the meta-analysis, were also compared. A number of meta-analysis scenarios were simulated and replicated 1000 times, varying the ratio of the study arm sizes. Results Mantel-Haenszel summary estimates using the alternative continuity correction factors gave the least biased results for all group size imbalances. Logistic regression was virtually unbiased for all scenarios and gave good coverage properties. The Peto method provided unbiased results for balanced treatment groups but bias increased wit…

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Crossref · 10.1002/sim.1761

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  • Lithium therapy is associated with an increased risk of reduced ability to concentrate urine and reduced renal function, hypothyroidism, hyperparathyroidism, and weight gain.

    “lithium therapy is associated with an increased risk of reduced ability to concentrate urine and reduced renal function, hypothyroidism, hyperparathyroidism, and weight gain.18”
  • Peto's method was used to calculate odds ratios and 95% confidence intervals because it is the most reliable method for sparse events from studies without extreme imbalances.

    “We used Peto's method to calculate odds ratios and 95% confidence intervals because it does not apply continuity corrections and has been shown to be the most reliable method when applied to data on sparse events from studies without extreme imbalances.18 19”
  • Given the known toxic effects of lithium, any reduction in suicide might be offset by an increase in deaths from other causes.

    “and also because, given the known toxic effects of lithium, 18 any reduction in suicide might be offset by an increase in deaths from other causes.”

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Authors
J. Sweeting, M., J. Sutton, A., & C. Lambert, P.
Venue
Statistics in Medicine
Publisher
Wiley
Published
2004-04-06
Volume
23
Issue
9
Pages
1351-1375
ISSN
  • 0277-6715 (ISSN-L)
  • 1097-0258
OpenAlex
W2170952317
Cited by
1,734
References
3
Citations by year
2026: 115 · 2025: 85 · 2024: 86 · 2023: 85 · 2022: 102 · 2021: 112 · 2020: 105 · 2019: 86 · 2018: 100 · 2017: 92 · 2016: 103 · 2015: 77 · 2014: 91 · 2013: 87 · 2012: 61
FWCI
36.92
Type
journal article
Language
en
Open access
closed
Locations
  • Statistics in Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
Funders
AstraZeneca
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Keywords
continuity correction, meta-analysis methodology, Mantel-Haenszel estimator, logistic regression, rare events, sensitivity analysis
MeSH terms
Bayes Theorem, Breast Neoplasms, Cardiovascular Diseases, Epidemiologic Methods, Female, Fetal Monitoring, Heart Rate, Humans, Infant Mortality, Infant, Newborn, Pregnancy, Risk Factors, Statistics as Topic, Meta-Analysis as Topic, Estrogen Replacement Therapy, Logistic Models, Odds Ratio, Randomized Controlled Trials as Topic, Sample Size

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