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Cited by 107Statistical Methods and Bayesian InferenceStatistical Methods in EpidemiologyAdvanced Causal Inference Techniques

Bias arising from missing data in predictive models.

Gorelick, Marc H.·2006·Journal of Clinical Epidemiology
DOI 10.1016/j.jclinepi.2004.11.029
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Abstract

Objective The purpose of this study is to determine the effect of three common approaches to handling missing data on the results of a predictive model.Study design and setting Monte Carlo simulation study using simulated data was used. A baseline logistic regression using complete data was performed to predict hospital admission, based on the white blood cell count (WBC) (dichotomized as normal or high), presence of fever, or procedures performed (PROC). A series of simulations was then performed in which WBC data were deleted for varying proportions (15-85%) of patients under various patterns of missingness. Three analytic approaches were used: analysis restricted to cases with complete data, missing data assumed to be normal (MAN), and use of imputed values.Results In the baseline analysis, all three predictors were all significantly associated with admission. Using either the MAN approach or imputation, the odds ratio (OR) for WBC was substantially over- or underestimated depending on the missingness pattern, and there was considerable bias toward the null in the OR estimates for fever. In the CC analyses, OR for WBC was consistently biased toward the null, OR for PROC was biased away from the null, and the OR for fever was biased toward or away from the null. Estimates for overall model discrimination were substantially biased using all analytic approaches.Conclusions All three methods of handling large amounts of missing data can lead to biased estimates of the OR and of model performance in predictive models. Predictor variables that are measured inconsistently can affect the validity of such models.

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Authors
Gorelick, M. H.
Affiliations
Medical College of Wisconsin (US)
Corresponding author
Gorelick, Marc H.
Venue
Journal of Clinical Epidemiology
Publisher
Elsevier BV
Published
2006-10
Volume
59
Issue
10
Pages
1115-1123
ISSN
0895-4356 (ISSN-L)
DOI
10.1016/j.jclinepi.2004.11.029
OpenAlex
W2011744517
Cited by
107
References
15
Citations by year
2026: 3 · 2025: 3 · 2024: 23 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 4 · 2014: 6 · 2013: 6 · 2012: 3
FWCI
3.14
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Clinical Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Agency for Healthcare Research and Quality (R03-HS11395)
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Bayesian Inference
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
Keywords
missing data, bias, prediction model, logistic regression, multiple imputation, complete case analysis, missing at random, model discrimination, hospital admission prediction, white blood cell count, fever, measurement discrepancy
MeSH terms
Adolescent, Child, Child, Preschool, Emergencies, Emergency Service, Hospital, Epidemiologic Methods, Fever, Hospitalization, Humans, Infant, Infant, Newborn, Leukocyte Count, Bias

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