Guidelines for Application of Metaanalysis in Environmental Epidemiology
Abstract
The use of meta-analysis in environmental epidemiology can enhance the value of epidemiologic data in debates about environmental health risks. Meta-analysis may be particularly useful to formally examine sources of heterogeneity, to clarify the relationship between environmental exposures and health effects, and to generate information beyond that provided by individual studies or a narrative review. However, meta-analysis may not be useful when the relationship between exposure and disease is obvious, when there are only a few studies of the key health outcomes, or when there is substantial confounding or other biases which cannot be adjusted for in the analysis. Recent increases in the use of meta-analysis in environmental epidemiology have highlighted the need for guidelines for the application of the technique. Guidelines, in the form of desirable and undesirable attributes, are presented in this paper for various components of a meta-analysis including study identification and selection; data extraction and analysis; and interpretation, presentation, and communication of results. Also discussed are the appropriateness of the use of meta-analysis in environmental health studies and when meta-analysis should or should not be used.
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Sixteen articles (17%) provided recommendations on the key item "protocol development", with publication dates between 1994 and 2015 (median year 2009).
“Sixteen articles (17%) provided recommendations on the key item “protocol development” (Table 3), [29–44] with publication dates between 1994 and 2015 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Further reasons mentioned for writing a protocol were to ensure replicability and to document all procedures used in the review.
“Further reasons mentioned were to ensure replicability [34], and to document all procedures used in the review [31].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
The majority of articles discussed aspects general to systematic reviews including advantages and limitations of different literature sources and databases, search tools, the importance of identifying unpublished studies, literature searching techniques including how to build a search string and reporting.
“The majority of articles discussed aspects general to systematic reviews including advantages and limitations of different literature sources and databases, search tools, the importance of identifying unpublished studies, literature searching techniques including how to build a search string and reporting [12, 29, 33–36, 46, 48, 50, 51, 53, 54, 57, 59–62, 67, 68].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Thirty-three articles (35%) made recommendations about the key item "search strategy", with publication dates between 1995 and 2016 (median year 2007).
“Thirty-three articles (35%) made recommendations about the key item “search strategy” [12, 29, 30, 33–36, 38, 39, 43, 46–51, 53–69], with publication dates between 1995 and 2016 (median year of publication 2007).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Nine articles (10%) made recommendations on how to perform data extraction, with publication dates between 1995 and 2016 (median year 2009).
“Nine articles (10%) made recommendations on how to perform data extraction [29, 33–35, 38, 43, 47, 48, 74], with publication dates between 1995 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Twenty-two articles (24%) provided recommendations on the key item "study eligibility", with publication dates between 1995 and 2016 (median year 2009).
“Twenty-two articles (24%) provided recommendations on the key item “study eligibility”, [12, 29, 30, 33, 34, 37–39, 41–43, 46–48, 54, 55, 61, 65, 70–73] with publication dates between 1995 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Twenty-five (27%) articles gave recommendations on item "considering different study designs", with publication dates between 1995 and 2016 (median year 2007).
“Twenty-five (27%) articles gave recommendations on item “considering different study designs” [8, 29, 34, 35, 37–39, 42, 44, 49, 51, 56, 61, 65, 70, 73, 75, 76, 77–83], with publication dates between 1995 and 2016 (median year of publication 2007).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Recommendations were made mainly on two topics: whether different study designs should be included in a systematic review; and whether different study designs should be analysed together in a single meta-analysis.
“Recommendations were made mainly on 2 topics: whether different study designs should be included in a systematic review; [29, 34, 37–39, 49, 56, 65, 73, 75] and whether different study designs should be analysed together in a single meta-analysis [8, 34, 35, 37, 38, 42, 49, 51, 56, 61, 70, 75–78].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Several articles recommended that the data should be extracted by two independent reviewers to avoid errors, or that blinding those assessing methodological quality to the names of the authors, their institutions and the names of journals would lead to more consistent extraction.
“Several articles recommended that the data should be extracted by two independent reviewers to avoid errors [29, 33], or that blinding those assessing methodological quality to the names of the authors, their institutions and the names of journals would lead to more consistent extraction [29, 34].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Some authors agreed that study design should be investigated as a potential source of between study heterogeneity, and others recommended presenting meta-analyses for each study type alongside results from an overall meta-analysis.
“Some authors agreed that study design should be investigated as a potential source of between study heterogeneity [8, 34, 42, 77], and others recommended presenting meta-analyses for each study type alongside results from an overall meta-analysis [42, 83].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Twenty (22%) articles reported on item "publication bias", with publication dates between 1994 and 2012 (median year 2001).
“Twenty (22%) articles reported on item “publication bias” [16, 29, 33, 34, 36, 46, 48–50, 55, 56, 61, 70, 78, 85, 95–99], with publication dates between 1994 and 2012 (median year of publication 2001).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
An explicit recommendation to search for and include unpublished studies was given in several articles, with the argument that the results of unpublished studies may differ systematically from published studies.
“An explicit recommendation to search for and include unpublished studies was given in several articles [34, 48, 50, 61, 96], with the argument that the results of unpublished studies may differ systematically from published studies.”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, with publication dates between 1994 and 2016 (median year 2009).
“Thirty-nine articles (42%) made recommendations on the assessment of quality and risk of bias of individual studies, [12, 16, 29, 30, 32–35, 37, 38, 43, 47–50, 52–54, 56, 64–66, 70, 71, 73, 75, 77, 82, 84–94] with publication dates between 1994 and 2016 (median year of publication 2009).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Some authors suggested that results should be combined in a single meta-analysis only in the absence of marked heterogeneity.
“Some authors suggested that results should be combined in a single meta-analysis only in the absence of marked heterogeneity [34, 51].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Some authors suggested that the inclusion of unpublished studies could also introduce bias due to poor methodological quality of non-peer reviewed articles.
“However, some authors suggested that the inclusion of unpublished studies could also introduce bias due to poor methodological quality on non-peer reviewed articles: “the quality of unpublished reports must be closely scrutinized since they presumably have not undergone the same kind of peer review as published literature” [34].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Thirty-nine articles (42%) provided recommendations on heterogeneity and its assessment, with publication dates between 1994 and 2016 (median year 2006).
“Thirty-nine articles (42%) provided recommendations on heterogeneity and its assessment, [8, 12, 16, 29, 30, 33, 34, 36, 38, 39, 41–44, 47, 49–52, 54–56, 61, 66, 70, 72, 77, 82, 85, 87, 98, 100–107] with publication dates between 1994 and 2016 (median year of publication 2006).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
One common recommendation was to explore heterogeneity in sensitivity analyses, comparing studies stratified by design or clinical features.
“One common recommendation was to explore heterogeneity in sensitivity analyses, comparing studies stratified by design or clinical features [12, 16, 29, 34, 39, 51, 55, 56, 66, 77, 85, 100, 102].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Fifty-two articles (56%) provided recommendations on the statistical analysis in the context of meta-analysis of observational studies, with publication dates between 1994 and 2016 (median year 2006).
“Fifty-two articles (56%), provided recommendations on the statistical analysis in the context of meta-analysis of observational studies [8, 12, 16, 29–31, 33–36, 38, 41–44, 47, 48, 52, 54–56, 61, 66, 70, 72, 73, 77, 79–83, 85, 87, 96, 100, 101, 103–105, 107–118], with publication dates between 1994 and 2016 (median year of publication 2006).”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
The use of a random-effects model for meta-analysis of observational studies by default was frequently recommended.
“Second, the use of a random-effects model for meta-analysis of observational studies by default was frequently recommended [8, 16, 29, 34, 70, 77, 100, 101].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
Many considered heterogeneity important for the decision whether to pool the data.
“Many considered heterogeneity important for the decision whether to pool the data [34, 36, 47, 55, 56, 66, 101, 103].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [34]
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- Authors
- Blair, A., Burg, J., Foran, J., Gibb, H., Greenland, S., Morris, R., Raabe, G., Savitz, D., Teta, J., Wartenberg, D., Wong, O., & Zimmerman, R.
- Affiliations
- National Institutes of Health (US)
- University of North Carolina at Chapel Hill (US)
- Venue
- Regulatory Toxicology and Pharmacology
- Publisher
- Elsevier BV
- Published
- 1995-10
- Volume
- 22
- Issue
- 2
- Pages
- 189-197
- ISSN
- 0273-2300 (ISSN-L)
- OpenAlex
- W2004112009
- Cited by
- 109
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 1 · 2018: 3 · 2016: 1 · 2015: 3 · 2014: 5 · 2013: 7 · 2012: 5
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Regulatory Toxicology and Pharmacology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Environmental Science › Health, Toxicology and Mutagenesis › Health, Environment, Cognitive Aging
- Keywords
- meta-analysis, environmental epidemiology, environmental health risk, heterogeneity, exposure-disease relationship, study selection, data extraction, confounding, bias, reporting guidelines, interpretation of results
- MeSH terms
- Environmental Exposure, Epidemiologic Methods, Meta-Analysis as Topic
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