Sources of heterogeneity in the meta-analysis of observational studies The example of SIDS and sleeping position
Open accessAbstract
The study objective was to provide an example of how risk estimates might vary across studies of observational design, even when a causal association is present and to explore the possible sources of such variation. A meta-analysis of studies on the association between prone sleeping position and sudden infant death syndrome (SIDS) is used to illustrate how risk estimates might vary across studies. Data used were reported case-control studies of the association between sleeping position and SIDS that were published between 1970 and 1994. If the pooled odds ratio had been relied on to assess the association between sleeping position and SIDS without an accompanying examination of the reasons for heterogeneity, important insights into the causal significance of the relationship may have been lost. In meta-analyses of observational studies it is important to investigate the reasons for heterogeneity across studies.
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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 [101]
This test-based approach was often criticised because of low power to detect heterogeneity in case of few (< 10) included studies.
“This approach was, however, often criticised because of low power to detect heterogeneity in case of few (< 10) included studies [52, 77, 101, 104, 116, 118].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [101]
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 [101]
Cites
Draper, N. R., & Smith, H. (2005) · Technometrics · doi:10.1198/tech.2005.s303 · Cited by 17,993 · see citing works
Hahn, G. J., Draper, N. R., & Smith, H. C. (1982) · Technometrics · doi:10.2307/1267833 · Cited by 5,820 · see citing works
Altman, R., Carreras, L., Díaz, R. S., Figueroa, E. B., Paolasso, E., Parodi, J. C., Cade, J. F., Donnan, G. A., Eadie, M. J., Gavaghan, T. P., et al. (1994) · Cited by 3,322 · see citing works
Applied Regression Analysis (2nd ed).
de Carvalho, J. F., Draper, N. R., & Smith, H. (1981) · Journal of the American Statistical Association · doi:10.2307/2287608 · Cited by 3,054 · see citing works
QUANTITATIVE METHODS IN THE REVIEW OF EPIDEMIOLOGIC LITERATURE1
GREENLAND, S. (1987) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a036298 · Cited by 1,644 · see citing works
Review papers : The statistical basis of meta-analysis
Fleiss, J. (1993) · Statistical Methods in Medical Research · doi:10.1177/096228029300200202 · Cited by 1,284 · see citing works
Some Statistical Methods for Combining Experimental Results
Laird, N. M., & Mosteller, F. C. (1990) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462300008916 · Cited by 559 · see citing works
Fleming, P. J., Gilbert, R. E., Azaz, Y., Berry, P. J., Rudd, P., Stewart, A. J., & Hall, E. J. (1990) · BMJ · doi:10.1136/bmj.301.6743.85 · Cited by 532 · see citing works
Invited commentary: a critical look at some popular meta-analytic methods
Greenland, S. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117248 · Cited by 511 · see citing works
Meta-analysis: State-of-the-Science
Dickersin, K., & Berlin, J. A. (1992) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a036084 · Cited by 502 · see citing works
Results from the first year of the New Zealand cot death study.
Mitchell, E., Scragg, R. K. R., Stewart, A., Becroft, D. M. O., Taylor, B. J., Ford, R. P., Hassall, I. B., Barry, D. M., Allen, E. M., & Roberts, A. P. (1991) · PubMed · Cited by 389 · see citing works
Factors Potentiating the Risk of Sudden Infant Death Syndrome Associated with the Prone Position
Ponsonby, A., Dwyer, T., Gibbons, L. E., Cochrane, J., & Wang, Y. (1993) · New England Journal of Medicine · doi:10.1056/nejm199308053290601 · Cited by 366 · see citing works
Self-citationModeling Publication Selection Effects in Meta-Analysis
Hedges, L. V. (1992) · Statistical Science · doi:10.1214/ss/1177011364 · Cited by 359 · see citing works
Shapiro, S. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117324 · Cited by 354 · see citing works
Prospective cohort study of prone sleeping position and sudden infant death syndrome
Dwyer, T., Ponsonby, A., Newman, N. M., & Gibbons, L. E. (1991) · The Lancet · doi:10.1016/0140-6736(91)92917-q · Cited by 318 · see citing works
Self-citationSubramaniam, P., Ho, J. J., & Davis, P. G. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001243.pub3 · Cited by 317 · see citing works
Nelson, E. A. S., Taylor, B. J., & Weatherall, I. L. (1989) · The Lancet · doi:10.1016/s0140-6736(89)91211-7 · Cited by 203 · see citing works
Epidemiology of the Sudden Infant Death Syndrome: Maternal, Neonatal, and Postneonatal Risk Factors
Hoffman, H. J., & Hillman, L. S. (1992) · Clinics in Perinatology · doi:10.1016/s0095-5108(18)30427-5 · Cited by 195 · see citing works
Dwyer, T. (1995) · JAMA · doi:10.1001/jama.1995.03520340039033 · Cited by 168 · see citing works
Self-citationCot death and prone sleeping position in The Netherlands.
de Jonge, G. A., Engelberts, A. C., Koomen-Liefting, A. J., et al. (1989) · BMJ · doi:10.1136/bmj.298.6675.722 · Cited by 150 · see citing works
Sudden infant death syndrome in Hong Kong: confirmation of low incidence.
Lee, N. N., Chan, Y. F., Davies, D. P., Lau, E., & Yip, D. C. (1989) · BMJ · doi:10.1136/bmj.298.6675.721 · Cited by 136 · see citing works
Thiazide diuretics and fractures: Can meta-analysis help?
Menzies, G. J. D., Nguyen, T. V., Sambrook, P. N., & Eisman, J. A. (1995) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650100115 · Cited by 125 · see citing works
Petitti, D. B. (1994) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117325 · Cited by 120 · see citing works
(1971) · Archives of Disease in Childhood · doi:10.1136/adc.46.248.579-a · Cited by 108 · see citing works
Beal, S. M., & Finch, C. F. (1991) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.1991.tb00414.x · Cited by 93 · see citing works
[Sudden infant death syndrome].
Piquer, F. C. (1999) · PubMed · Cited by 86 · see citing works
Beal, S. M. (1988) · The Lancet · doi:10.1016/s0140-6736(88)90158-4 · Cited by 63 · see citing works
Kahn, A., Blum, D., Hennart, P., et al. (1984) · European Journal of Pediatrics · doi:10.1007/bf00445795 · Cited by 62 · see citing works
Gibbons, L. E., Ponsonby, A., & Dwyer, T. (1993) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116723 · Cited by 45 · see citing works
Self-citationGastrointestinal hypersensitivity to cow's milk protein: The diagnostic value of gut function tests
Ford, R., BARNES, G. L., & Hill, D. J. (1986) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.1986.tb00180.x · Cited by 41 · see citing works
Infant sleep position: a New Zealand survey.
Hassall, I. B., & Vandenberg, M. (1985) · PubMed · Cited by 41 · see citing works
Subramaniam, P., Henderson‐Smart, D., & Davis, P. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001243 · Cited by 41 · see citing works
Miettinen, O. S., Neff, R. K., & Jick, H. (1976) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112202 · Cited by 37 · see citing works
Sleeping position and sudden infant death svndrome
Beal, S. M. (1988) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1988.tb120774.x · Cited by 36 · see citing works
Sudden and Unexpected Deaths in Infancy (Cot Deaths)
Emery, J. L. (1972) · Journal of Clinical Pathology · doi:10.1136/jcp.25.7.612-c · Cited by 31 · see citing works
Nicholl, J. P., O’Cathain, A., & McGlashan, N. D. (1988) · The Lancet · doi:10.1016/s0140-6736(88)90036-0 · Cited by 29 · see citing works
The Non-Comparability of Relative Risks from Different Studies
Peacock, P. B. (1971) · Biometrics · doi:10.2307/2528827 · Cited by 24 · see citing works
The Relation between Climatic Temperature and Sudden Infant Death Syndrome Differs among Communities
Jones, M. E., Ponsonby, A., Dwyer, T., & Gilbert, N. (1994) · Epidemiology · doi:10.1097/00001648-199405000-00012 · Cited by 23 · see citing works
Self-citationDwyer, T. (1995) · JAMA · doi:10.1001/jama.273.10.783 · Cited by 23 · see citing works
Self-citationInteraction between bedding and sleeping position in the sudden infant death syndrome
Fleming, P., Gilbert, R. E., Azaz, Y., et al. (1991) · Bristol Research (University of Bristol) · Cited by 11 · see citing works
Sudden and unexpected deaths in infants.
Cg, G. (1950) · PubMed · Cited by 11 · see citing works
Schweitzer, K. (2000) · MCN The American Journal of Maternal/Child Nursing · doi:10.1097/00005721-200005000-00017 · Cited by 9 · see citing works
Sudden and Unexpected Deaths in Infancy (Cot Deaths)
(1972) · Archives of Disease in Childhood · doi:10.1136/adc.47.255.839 · Cited by 9 · see citing works
Sudden infant death syndrome in Hong Kong
Lau, E. (1989) · BMJ · doi:10.1136/bmj.299.6692.183 · Cited by 3 · see citing works
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Bartsch, E., Medcalf, K. E., Park, A. L., & Ray, J. G. (2016) · BMJ · doi:10.1136/bmj.i1753 · Cited by 996 · see citing works
Mueller, M., D’Addario, M., Egger, M., Cevallos, M., Dekkers, O., Mugglin, C., & Scott, P. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0495-9 · Cited by 400 · see citing works
The prevalence of chronic pain in young adults: a systematic review and meta-analysis
Murray, C. B., de la Vega, R., Murphy, L. K., Kashikar-Zuck, S., & Palermo, T. M. (2022) · Pain · doi:10.1097/j.pain.0000000000002541 · Cited by 133 · see citing works
- Authors
- Dwyer, T., Couper, D., & Walter, S. D.
- Affiliations
- University of Tasmania (AU)
- University of North Carolina at Chapel Hill (US)
- McMaster University Medical Centre (CA)
- Corresponding author
- Dwyer, Terence
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 2001-05
- Volume
- 54
- Issue
- 5
- Pages
- 440-447
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W1993828216
- Cited by
- 48
- References
- 44
- Citations by year
- 2025: 1 · 2024: 7 · 2023: 1 · 2022: 3 · 2021: 6 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 1 · 2014: 2 · 2012: 2
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- 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
- heterogeneity, sudden infant death syndrome, prone sleeping, case-control study, odds ratio, risk estimates, causal inference, research design
- MeSH terms
- Humans, Infant, Newborn, Risk Factors, Sleep, Sudden Infant Death, Bias, Confounding Factors, Epidemiologic, Odds Ratio, Case-Control Studies, Prone Position
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