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Systematic Review: Why sources of heterogeneity in meta-analysis should be investigated
Open accessAbstract
Although meta-analysis is now well established as a method of reviewing evidence, an uncritical use of the technique can be very misleading. One common problem is the failure to investigate appropriately the sources of heterogeneity, in particular the clinical differences between the studies included. This paper distinguishes between the concepts of clinical and statistical heterogeneity and exemplifies the importance of investigating heterogeneity by using published meta-analyses of epidemiological studies of serum cholesterol concentration and clinical trials of its reduction. Although not without some dangers of speculative conclusions, prompted by overzealous inspection of the data to hand, a sensible investigation of sources of heterogeneity should increase both the scientific and the clinical relevance of the results of meta-analyses.
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Metadata
- Authors
- Thompson, S. G.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Thompson, S G
- ORCID
- Thompson, S G
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1994-11-19
- Volume
- 309
- Issue
- 6965
- Pages
- 1351-1355
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2541868
- OpenAlex
- W1511524925
- Cited by
- 1,017
- References
- 32
- Citations by year
- 2026: 23 · 2025: 35 · 2024: 38 · 2023: 29 · 2022: 30 · 2021: 47 · 2020: 38 · 2019: 32 · 2018: 36 · 2017: 26 · 2016: 24 · 2015: 24 · 2014: 31 · 2013: 48 · 2012: 51
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (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
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- meta-analysis heterogeneity, clinical heterogeneity, statistical heterogeneity, serum cholesterol, cholesterol lowering, meta-analysis methodology, overfitting
- MeSH terms
- Adult, Aged, Aging, Cholesterol, Clinical Trials as Topic, Humans, Middle Aged, Neoplasms, Research Design, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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