Cited by 1,952Statistical Methods in EpidemiologyMeta-analysis and systematic reviewsStatistical Methods in Clinical Trials

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How Big is a Big Odds Ratio? Interpreting the Magnitudes of Odds Ratios in Epidemiological Studies

Chen, Henian, Cohen, Patricia, Chen, Sophie·2010·Communications in Statistics - Simulation and Computation

DOI 10.1080/03610911003650383

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Abstract

The odds ratio (OR) is probably the most widely used index of effect size in epidemiological studies. The difficulty of interpreting the OR has troubled many clinical researchers and epidemiologists for a long time. We propose a new method for interpreting the size of the OR by relating it to differences in a normal standard deviate. Our calculations indicate that OR = 1.68, 3.47, and 6.71 are equivalent to Cohen's d = 0.2 (small), 0.5 (medium), and 0.8 (large), respectively, when disease rate is 1% in the nonexposed group; Cohen's d < 0.2 when OR <1.5, and Cohen's d > 0.8 when OR > 5.

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10.1002/sim.1032 · DOI
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Background
Predicting personal physical activity of parents during participation in a family intervention targeting their children
Rhodes, R. E., Quinlan, A., Naylor, P., Warburton, D. E. R., & Blanchard, C. M. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00116-2 · Cited by 32
Child maltreatment (neglect and abuse) in the 1958 birth cohort: an overview of associations with developmental trajectories and long-term outcomes
Power, C., Li, L., & Pereira, S. M. P. (2020) · Longitudinal and Life Course Studies · doi:10.1332/175795920x15891281805890 · Cited by 26
“For example, for an outcome with a 5% prevalence in the non-exposed group, OR reference points for a “weak”, “moderate”, and “strong” association (i.e. equivalent to a SMD of 0.2, 0.5 and 0.8) are 1.52, 2.74, and 4.72 respectively(Chen et al., 2010).”
BackgroundMethodInfluential
Increased health‐related quality of life impairments of male and female survivors of childhood cancer: DCCSS LATER 2 psycho‐oncology study
van Gorp, M., van Erp, L. M. E., Maas, A., Kremer, L. C. M., Broeder, E. V. D., Tissing, W. J. E., Loonen, J. J., van der Pal, H. J. H., de Vries, A. C. H., van den Heuvel‐Eibrink, M. M., et al. (2021) · Cancer · doi:10.1002/cncr.34003 · Cited by 26
“8, and they accounted for 25% of individuals with impairment in the reference group (Henian Chen, personal written communication, July 16, 2020).(17) Medical determinants of impaired HRQOL in CCSs were studied with multivariable logistic regression analyses for each domain.”
Method
The impact of participant mental health on attendance and engagement in a trial of behavioural weight management programmes: secondary analysis of the WRAP randomised controlled trial
Jones, R. A., Mueller, J., Sharp, S. J., Vincent, A., Duschinsky, R., Griffin, S. J., & Ahern, A. L. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01216-6 · Cited by 26
“The effect sizes of the associations between mental health and attendance and engagement were considered to be small, suggesting a small increase in risk of reporting lower attendance and engagement when reporting poor mental health at baseline [48].”
Background
Are dietary supplement users more likely to dope than non-users?: A systematic review and meta-analysis
Hurst, P., Schiphof‐Godart, L., Kavussanu, M., Barkoukis, V., Petróczi, A., & Ring, C. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.104077 · Cited by 26
Predicting commercial wind farm site suitability in the conterminous United States using a logistic regression model
Wimhurst, J. J., Greene, J. S., & Koch, J. (2023) · Applied Energy · doi:10.1016/j.apenergy.2023.121880 · Cited by 26
Did mpox knowledge, attitudes and beliefs affect intended behaviour in the general population and men who are gay, bisexual and who have sex with men? An online cross-sectional survey in the UK
Smith, L., POTTS, H. W. W., Brainard, J. S., May, T., Oliver, I., Amlôt, R., Yardley, L., & Rubin, G. J. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-070882 · Cited by 26
Comorbidities Among Women with Vulvovaginal Complaints in Family Practice
Leusink, P., Kaptheijns, A., Laan, E. T. M., van Boven, K., & Lagro-Janssen, A. L. M. (2016) · The Journal of Sexual Medicine · doi:10.1016/j.jsxm.2015.12.010 · Cited by 26
Helping intentions of undergraduates towards their depressed peers: a cross-sectional study in Sri Lanka
Amarasuriya, S. D., Reavley, N. J., Rossetto, A., & Jorm, A. F. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1192-7 · Cited by 25
“However, the small effect sizes of some of the examined relationships indicated by the odds ratios [76], standardised regression coefficients and R(2) estimates [77] indicate that the practical significance of these associations may be small.”
Background
Prevalence and course of pregnancy symptoms using self-reported pregnancy app symptom tracker data
Nissen, M., Campo, N. B., Flaucher, M., Jaeger, K. M., Titzmann, A., Blunck, D., Fasching, P. A., Engelhardt, V., Eskofier, B. M., & Leutheuser, H. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00935-3 · Cited by 28
Determinants determining the adoption of technological innovation of urban farming: Employing binary logistic regression model in examining Rogers' framework
Yuniarsih, E. T., Salam, M., Jamil, M. H., & Tenriawaru, A. N. (2024) · Journal of Open Innovation Technology Market and Complexity · doi:10.1016/j.joitmc.2024.100307 · Cited by 25
Food insecurity impacts diet quality and adherence to the gluten‐free diet in youth with celiac disease
Wang, X., Anders, S., Jiang, Z., Bruce, M., Gidrewicz, D., MARCON, M. A., Turner, J. M., & Mager, D. R. (2024) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.12398 · Cited by 26
Didactic impact of educational robotics on the development of STEM competence in primary education: a systematic review and meta-analysis
González, I. T., Lucena, F. J. H., Rodríguez, J. M. R., & Menéndez, A. M. (2024) · Frontiers in Education · doi:10.3389/feduc.2024.1480908 · Cited by 25
Craving and substance use: Examining psychophysiological and behavioral moderators
Bresin, K., & Verona, E. (2019) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2019.03.006 · Cited by 26
A Risk Assessment of Factors for the Presence of Angiodysplasias During Endoscopy and Factors Contributing to Symptomatic Bleeding and Rebleeds
Grooteman, K. V., Holleran, G. E., Matheeuwsen, M., van Geenen, E. J. M., McNamara, D. A., & Drenth, J. P. H. (2019) · Digestive Diseases and Sciences · doi:10.1007/s10620-019-05683-7 · Cited by 25
Individuals with spinal cord injury have greater odds of substance use disorders than non-sci comparisons
Graupensperger, S. A., Corey, J. J., Turrisi, R., & Evans, M. B. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.107608 · Cited by 25
Age Discrimination and Suicidal Ideation Among Korean Older Adults
Kim, G., & Lee, M. (2019) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2019.12.002 · Cited by 23
Social-psychological correlates of personal-sphere and diffusion behavior for wildscape gardening
Jones, M. S., & Niemiec, R. M. (2020) · Journal of Environmental Management · doi:10.1016/j.jenvman.2020.111271 · Cited by 27
Association between panic disorder and childhood adversities: a systematic review and meta-analysis
Zhang, J., Wiecaszek, P., Sami, S., & Meiser‐Stedman, R. (2021) · Psychological Medicine · doi:10.1017/s0033291721004505 · Cited by 28
“Effect size interpretation To interpret the strength of the OR in epidemiological studies, Chen, Cohen, and Chen (2010) provided a calculation that maps OR to Cohen’s d.”
Background
First-Generation College Students’ Mental Health During the COVID-19 Pandemic
Soria, K. M., Kelling, C., Mossinghoff, M., & Beahm, R. (2022) · Journal of First-generation Student Success · doi:10.1080/26906015.2022.2070442 · Cited by 25
Examining equity in access and utilization of a freely available meditation app
Jiwani, Z., Tatar, R., Dahl, C. J., Wilson‐Mendenhall, C. D., Hirshberg, M. J., Davidson, R. J., & Goldberg, S. B. (2023) · npj Mental Health Research · doi:10.1038/s44184-023-00025-y · Cited by 23
“Guidelines suggested by Cohen 38 were followed to interpret the magnitude of effect sizes for continuous variables and guidelines suggested by Chen and colleagues 39 for the interpretation of odds ratios.”
Method
Size matters: the use and misuse of statistical significance in discrete choice models in the transportation academic literature
Parady, G., & Axhausen, K. W. (2023) · Transportation · doi:10.1007/s11116-023-10423-y · Cited by 25
“It is important, however, to note that the research in the psychology field rests on the extensive work on statistical power by Cohen (9, 13) who defined “scale-free” conventions to characterize “small,” “medium,” and “large” effects, and while Cohen largely focused on t-test for means, correlation coefficients, propo…”
An evaluation of the replicability of analyses using synthetic health data
Emam, K. E., Mosquera, L., Fang, X., & El‐Hussuna, A. (2024) · Scientific Reports · doi:10.1038/s41598-024-57207-7 · Cited by 35
Neuropsychiatric symptoms in South‐East Asian patients with mild cognitive impairment and dementia: prevalence, subtypes, and risk factors
Yatawara, C., Hiu, S. K. W., Tan, L., & Kandiah, N. (2017) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4693 · Cited by 24
“ORs were interpreted using the Chen et al. (2010) guidelines, where OR = 1.68, 3.47, and 6.71 were equivalent to Cohen’s d = 0.2 (small), 0.5 (moderate), and 0.8 (large), respectively.”
MethodInfluential
Co-adaptation of ball reception to the serve constrains outcomes in elite competitive volleyball
Paulo, A., Davids, K., & Araújo, D. (2017) · International Journal of Sports Science & Coaching · doi:10.1177/1747954117722727 · Cited by 25
Lifetime Risks of Valvular Heart Disease and Pacemaker Use in Patients With Ankylosing Spondylitis
Ward, M. M. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.118.010016 · Cited by 25
“13 were considered to represent small, medium, and large effects, respectively, for associations when the prevalence in the control group was 10%.(25) Results Likelihood of VHD and Pacemaker Use”
Background
Compliance with COVID-19 public health guidelines: an attitude-behaviour gap bridged by personal concern and distance to conspiracy ideation
Schnell, T., Spitzenstätter, D., & Krampe, H. (2021) · Psychology and Health · doi:10.1080/08870446.2021.1974861 · Cited by 22
“The odds ratios for both effects (1.21 and 0.72, respectively; standardised predictors) were very small (<1.5; Chen et al., 2010).”
BackgroundInfluential
The association of changes in repetitive negative thinking with changes in depression and anxiety
Hijne, K., Penninx, B. W., van Hemert, A. M., & Spinhoven, P. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.002 · Cited by 24
“Odds ratios of the binomial logistic regression analyses were interpreted according to the findings of Chen et al. (2010), considering an OR of 1.68 a small effect, 3.47 a medium effect, and 6.71 a large effect.”
MethodInfluential
The Social and Emotional Dimensions of a Single Item Overall School Readiness Screener and its Relation to Academic Outcomes
Stormont, M. A., Thompson, A. M., Herman, K. C., & Reinke, W. M. (2016) · Assessment for Effective Intervention · doi:10.1177/1534508416652070 · Cited by 24
Skeuomorph Versus Flat Design: User Experience and Age-Related Preferences
Backhaus, N., Trapp, A. K., & Thüring, M. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-91803-7_40 · Cited by 24
Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people
Eckhoff, C., Sørvold, M. T., & Kvernmo, S. E. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01406-5 · Cited by 24
Mental disorders, attrition at follow‐up, and questionnaire non‐completion in epidemiologic research. Illustrations from the CoLaus|PsyCoLaus study
Dupuis, M., Strippoli, M. F., Gholam‐Rezaee, M., Preisig, M., & Vandeleur, C. L. (2019) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1805 · Cited by 24

Authors: Chen, H., Cohen, P., & Chen, S.
Affiliations: Winthrop-University Hospital (US)
New York State Psychiatric Institute (US)
Health Canada (CA)
Corresponding author: Chen, Henian
ORCID: Chen, Henian
Chen, Sophie
Venue: Communications in Statistics - Simulation and Computation
Publisher: Informa UK Limited
Published: 2010-03-31
Volume: 39
Issue: 4
Pages: 860-864
ISSN: 0361-0918 (ISSN-L)
1532-4141
DOI: 10.1080/03610911003650383
OpenAlex: W2029059557
Cited by: 1,952
References: 20
Citations by year: 2026: 170 · 2025: 201 · 2024: 259 · 2023: 234 · 2022: 254 · 2021: 242 · 2020: 196 · 2019: 123 · 2018: 93 · 2017: 65 · 2016: 44 · 2015: 31 · 2014: 18 · 2013: 11 · 2012: 4
FWCI: 5.45
Type: journal article
Language: en
Open access: closed
Locations: Communications in Statistics - Simulation and Computation (publishedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Keywords: odds ratio, effect size interpretation, Cohen's d, standardized mean difference, disease incidence

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How Big is a Big Odds Ratio? Interpreting the Magnitudes of Odds Ratios in Epidemiological Studies

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