Cited by 108Meta-analysis and systematic reviewsStatistical Methods in EpidemiologyAdvanced Causal Inference Techniques

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Synthesis of observational studies should consider credibility ceilings

Salanti, Georgia, Ioannidis, John P.A.·2009·Journal of Clinical Epidemiology

DOI 10.1016/j.jclinepi.2008.05.014

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Abstract

Objective Meta-analyses of observational studies often get spuriously precise results. We aimed to factor this skepticism in meta-analysis calculations.Study design and setting We developed a simple sensitivity analysis starting from the assumption that any single observational study cannot give us more than a maximum certainty c% (called credibility ceiling) that an effect is in a particular direction and not in the other. Each study included in meta-analysis is adjusted for different credibility ceilings c and the consistency of the conclusion examined. We applied the method in three meta-analyses of observational studies with nominally statistically significant summary effects (mortality with teaching versus nonteaching health care; risk of non-Hodgkin's lymphoma with hair dyes; mortality with omega-3 fatty acids).Results Between-study heterogeneity I(2) estimates dropped from 36%-72% without a ceiling effect to 0% with ceilings of 9%, 4%, and 4% in the three meta-analyses, respectively. Nominal statistical significance was lost with ceilings of 10%, 8%, and 11%, respectively. The likelihood ratios suggested that even with minimal ceiling effects, there was no strong support for the credibility of each of these three associations.Conclusions Consideration of credibility ceilings allows conservative interpretation of observational evidence and can be applied routinely to meta-analyses of observational studies.

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Additional file 9 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
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Additional file 5 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
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Additional file 10 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072290
Additional file 11 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606995
Additional file 2 of Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies
Cupp, M. A., Cariolou, M., Tzoulaki, I., Aune, D., Evangelou, E., & Berlanga‐Taylor, A. J. (2020) · Figshare · doi:10.6084/m9.figshare.13265825
Additional file 5 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072305
Additional file 2 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655484
Additional file 2 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072296
Additional file 7 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655499
Additional file 3 of Neutrophil to lymphocyte ratio and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies
Cupp, M. A., Cariolou, M., Tzoulaki, I., Aune, D., Evangelou, E., & Berlanga‐Taylor, A. J. (2020) · Figshare · doi:10.6084/m9.figshare.13265828
Additional file 7 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606983
Additional file 7 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072311
Additional file 10 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655508
Additional file 11 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655511
Additional file 8 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606986
Additional file 1 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072293
Additional file 1 of Compositional alterations of gut microbiota in nonalcoholic fatty liver disease patients: a systematic review and Meta-analysis
Li, F., Ye, J., Shao, C., & Zhong, B. (2021) · Figshare · doi:10.6084/m9.figshare.14129363
Additional file 3 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072299
Additional file 1 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655481
Additional file 9 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655505
Additional file 1 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606965
Additional file 3 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606971
Additional file 2 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606968
Additional file 10 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606992
Additional file 4 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606974
Additional file 8 of A meta-analysis of HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis
Xie, B., He, J., Liu, Y., Liu, T., & Liu, C. (2021) · Figshare · doi:10.6084/m9.figshare.14072314
Additional file 9 of Risk factors for human papillomavirus infection, cervical intraepithelial neoplasia and cervical cancer: an umbrella review and follow-up Mendelian randomisation studies
Bowden, S. J., Doulgeraki, T., Bouras, E., Markozannes, G., Athanasiou, A., Grout-Smith, H., Kechagias, K. S., Ellis, L. B., Zuber, V., Chadeau‐Hyam, M., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26606989
Additional file 6 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655496
Additional file 5 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655493
Additional file 3 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655487
Additional file 4 of Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature
Semertzidou, A., Grout-Smith, H., Kalliala, I. E. J., Garg, A., Terzidou, V., Marchesi, J., MacIntyre, D., Bennett, P., Tsilidis, K., & Kyrgiou, M. (2023) · Figshare · doi:10.6084/m9.figshare.22655490

Authors: Salanti, G., & Ioannidis, J. P. A.
Affiliations: University of Ioannina (GR)
Tufts University (US)
Corresponding author: Ioannidis, John P.A.
ORCID: Salanti, Georgia
Ioannidis, John P.A.
Venue: Journal of Clinical Epidemiology
Publisher: Elsevier BV
Published: 2009-02
Volume: 62
Issue: 2
Pages: 115-122
ISSN: 0895-4356 (ISSN-L)
DOI: 10.1016/j.jclinepi.2008.05.014
OpenAlex: W2010361292
Cited by: 108
References: 25
Citations by year: 2026: 5 · 2025: 4 · 2024: 16 · 2023: 15 · 2022: 6 · 2021: 18 · 2020: 18 · 2019: 6 · 2018: 6 · 2017: 4 · 2016: 2 · 2014: 3 · 2012: 1
FWCI: 1.93
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)
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 › Advanced Causal Inference Techniques
Keywords: observational studies, sensitivity analysis, study heterogeneity, direction of effect, likelihood ratios, non-Hodgkin lymphoma, hair dyes, omega-3 fatty acids, mortality
MeSH terms: Algorithms, Data Interpretation, Statistical, Hair Dyes, Hospitals, Teaching, Humans, Lymphoma, Non-Hodgkin, Research Design, Risk, Meta-Analysis as Topic, Fatty Acids, Omega-3, Bias, Likelihood Functions, Hospital Mortality

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