Systematic Evaluation and Comparison of Statistical Tests for Publication Bias
Open accessAbstract
BACKGROUND: This study evaluates the statistical and discriminatory powers of three statistical test methods (Begg's, Egger's, and Macaskill's) to detect publication bias in meta-analyses. METHODS: The data sources were 130 reviews from the Cochrane Database of Systematic Reviews 2002 issue, which considered a binary endpoint and contained 10 or more individual studies. Funnel plots with observers'agreements were selected as a reference standard. We evaluated a trade-off between sensitivity and specificity by varying cut-off p-values, power of statistical tests given fixed false positive rates, and area under the receiver operating characteristic curve. RESULTS: In 36 reviews, 733 original studies evaluated 2,874,006 subjects. The number of trials included in each ranged from 10 to 70 (median 14.5). Given that the false positive rate was 0.1, the sensitivity of Egger's method was 0.93, and was larger than that of Begg's method (0.86) and Macaskill's method (0.43). The sensitivities of three statistical tests increased as the cut-off p-values increased without a substantial decrement of specificities. The area under the ROC curve of Egger's method was 0.955 (95% confidence interval, 0.889-1.000) and was not different from that of Begg's method (area=0.913, p=0.2302), but it was larger than that of Macaskill's method (area=0.719, p=0.0116). CONCLUSION: Egger's linear regression method and Begg's method had stronger statistical and discriminatory powers than Macaskill's method for detecting publication bias given the same type I error level. The power of these methods could be improved by increasing the cut-off p-value without a substantial increment of false positive rate.
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Publication bias was evaluated visually with funnel plots and statistically via Egger's test.
“Publication bias was evaluated visually with funnel plots and statistically via Egger's test [23].”
From Ketogenic diet-induced changes in adult lipid metabolism: a comprehensive systematic review and meta-regression of randomized controlled trials (2026) · cites this paper as [23]
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“Begg’s test and Egger’s test were employed to evaluate the publication bias.(12)”
MethodXue, X., Yan, S., Cai, X., Shi, M., & Lin, T. (2013) · Injury · doi:10.1016/j.injury.2013.10.024 · Cited by 64 · see citing works
“If there were asymmetrical plots, we used the trim and fill analysis to assess the stability [25].”
MethodZhao, Z., Ge, J., Sun, Y., Tian, L., Lu, J., Liu, M., & Zhao, Y. (2012) · Oral Oncology · doi:10.1016/j.oraloncology.2012.02.024 · Cited by 60 · see citing works
Li, Y., Gu, M., Jing, F., Cai, S., Bao, C., Wang, J., Jin, M., & Chen, K. (2015) · International Journal of Cancer · doi:10.1002/ijc.29828 · Cited by 60 · see citing works
The safety and serious adverse events of approved ALK inhibitors in malignancies: a meta-analysis
Hou, H., Sun, D., Liu, K., Jiang, M., Liu, D., Zhu, J., Zhou, N., Cong, J., & Zhang, X. (2019) · Cancer Management and Research · doi:10.2147/cmar.s190098 · Cited by 62 · see citing works
“When atypism occurred between two tests for one index in this meta-analysis, we accepted the results of Egger’s test.(27) The publication bias evaluation results are shown in the supplementary files (Table S4).”
MethodButalia, S., Leung, A. A. C., Ghali, W. A., & Rabi, D. M. (2011) · Cardiovascular Diabetology · doi:10.1186/1475-2840-10-25 · Cited by 59 · see citing works
“Assessment for publication bias was performed for the main outcome of interest with Egger’s linear regression test [23,24].”
MethodMesenchymal stem cell therapy in pulmonary fibrosis: a meta-analysis of preclinical studies
Li, D., Li, R.-F., Sun, D., Pu, D., & Zhang, Y. (2021) · Stem Cell Research & Therapy · doi:10.1186/s13287-021-02496-2 · Cited by 58 · see citing works
Degarege, A., Veledar, E., Degarege, D., Erko, B., Nacher, M., & Madhivanan, P. (2016) · Parasites & Vectors · doi:10.1186/s13071-016-1594-2 · Cited by 58 · see citing works
Guan, X., Fan, G., Wu, X., Gu, G., Gu, X., Zhang, H., & He, S. (2015) · PLoS ONE · doi:10.1371/journal.pone.0117707 · Cited by 55 · see citing works
“Publication bias was examined by visual inspection of funnel plot asymmetry and Egger test [18].”
MethodCereda, E., Klersy, C., Rondanelli, M., & Caccialanza, R. (2011) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2011.09.005 · Cited by 55 · see citing works
Degarege, A., Degarege, D., Veledar, E., Erko, B., Nacher, M., Beck‐Sagué, C. M., & Madhivanan, P. (2016) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0005193 · Cited by 53 · see citing works
Rivas, C. A., Ramsay, J., Sadowski, L. S., Davidson, L. L., Dunnes, D., Eldridge, S. M., Hegarty, K. L., Taft, A., & Feder, G. S. (2016) · Campbell Systematic Reviews · doi:10.4073/csr.2016.2 · Cited by 52 · see citing works
Huang, J., Li, X., Zhu, Q., Wang, M., Xie, Z., & Zhao, T. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1425847 · Cited by 52 · see citing works
“The Begg test and Egger test were applied to evaluate publication bias (33, 34).”
MethodMeta-analysis of the association between variants in MAPT and neurodegenerative diseases
Zhang, C., Zhu, J., Wan, Y., Tan, L., Wang, H.-F., Yu, J., & Tan, L. (2017) · Oncotarget · doi:10.18632/oncotarget.16690 · Cited by 53 · see citing works
Association of progranulin polymorphism rs5848 with neurodegenerative diseases: a meta-analysis
Chen, Y., Li, S., Su, L., Sheng, J., Lv, W., Chen, G., & Xu, Z. (2015) · Journal of Neurology · doi:10.1007/s00415-014-7630-2 · Cited by 50 · see citing works
“Publication bias was detected by Egger’s test [21] and Begg’s [22] test for the overall pooled analysis of different”
MethodFiorino, S., Chili, E., Reggiani, M. L. B., Masetti, M., Deleonardi, G., Grondona, A. G., Silvestri, T., Magrini, E., Zanini, N., Cuppini, A., et al. (2013) · Pancreatology · doi:10.1016/j.pan.2013.01.005 · Cited by 50 · see citing works
“Risk of publication bias was explored with Begg’s test as well as with funnel plot [51,52].”
MethodBukkapatnam, R. N., Gabler, N. B., & Lewis, W. R. (2009) · Preventive Cardiology · doi:10.1111/j.1751-7141.2009.00059.x · Cited by 50 · see citing works
Li, Y., Cai, S., Ling, Y., Mi, S., Fan, C., Zhong, Y., & Shen, Q. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.03.026 · Cited by 50 · see citing works
Hybrid test for publication bias in meta-analysis
Lin, L. (2020) · Statistical Methods in Medical Research · doi:10.1177/0962280220910172 · Cited by 50 · see citing works
“resampling-based p-values, the hybrid test statistics can be obtained in the original and all resampled metaanalyses, and the p-value of the hybrid test can be thus calculated as in equation (4).”
MethodResultInfluentialAssociation between lead exposure and DNA damage (genotoxicity): systematic review and meta-analysis
Nagaraju, R., Kalahasthi, R., Balachandar, R., & Bagepally, B. S. (2022) · Archives of Toxicology · doi:10.1007/s00204-022-03352-9 · Cited by 49 · see citing works
Association between systemic lupus erythematosus and disruption of gut microbiota: a meta-analysis
Xiang, S., Qu, Y., Qian, S., Wang, R., Wang, Y., Jin, Y., Li, J., & Ding, X. (2022) · Lupus Science & Medicine · doi:10.1136/lupus-2021-000599 · Cited by 48 · see citing works
“Nonetheless, publication bias was evaluated by Egger’s test, 33 Begg’s test 34 and a funnel plot.”
Zhao, Q., Yang, X., Tian, S., An, R., Zheng, J., & Xu, Y. (2015) · Neurological Sciences · doi:10.1007/s10072-015-2414-8 · Cited by 47 · see citing works
“Egger’s and/or Begg’s tests were used to assess risk of publication bias [14, 15].”
Method(2017) · International journal of research studies in biosciences · doi:10.20431/2349-0365.0505003 · Cited by 46 · see citing works
“General speaking, both ET and BT are considered to have stronger statistical and discriminatory powers than other methods in detecting PB with the same type I error level [23], as they both can fully use the information rather than qualitative descriptions and graphs.”
BackgroundLi, X.-C., Huang, C., Zhong, C.-F., Liang, R.-W., & Luo, S. (2017) · PLoS ONE · doi:10.1371/journal.pone.0171546 · Cited by 44 · see citing works
Rashedi, S., Tavolinejad, H., Kazemian, S., Mardani, M., Masoudi, M., Masoudkabir, F., & Haghjoo, M. (2022) · Clinical Cardiology · doi:10.1002/clc.23778 · Cited by 42 · see citing works
“05, indicating the presence of publication bias.(25)”
Shen, Y., Miao, J., Li, C., Fang, L., Cao, S., Zhang, M., Yan, J., & Kuang, Y. (2015) · European Spine Journal · doi:10.1007/s00586-015-3893-2 · Cited by 43 · see citing works
“Publication bias was assessed by Egger’s Test [21] and funnel plot [22].”
MethodYang, M., Duan, Y., Liang, W., Peiris, D. L. I. H. K., & Baker, J. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021560 · Cited by 43 · see citing works
“(2017) US [37] N = 371 (IG = 174; CG = 197) Postpartum women aged 18–40 years; 100% (F) Age: 28.”
MethodPaediatric Hypertension in Africa: A Systematic Review and Meta-Analysis
Crouch, S. H., Soepnel, L. M., Kolkenbeck‐Ruh, A., Maposa, I., Naidoo, S., Davies, J. I., Norris, S. A., & Ware, L. J. (2021) · EClinicalMedicine · doi:10.1016/j.eclinm.2021.101229 · Cited by 44 · see citing works
“[25] Additionally, meta-regression analysis was performed to further explore heterogeneity with respect to prevalence of hypertension.”
BackgroundMethodSchwab, S., Kreiliger, G., & Held, L. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045942 · Cited by 37 · see citing works
A Systematic Review and Meta-Analysis of Risk Factors for Sexual Transmission of HIV in India
Arora, P., Nagelkerke, N. J. D., & Jha, P. (2012) · PLoS ONE · doi:10.1371/journal.pone.0044094 · Cited by 41 · see citing works
“Publication bias was tested using Egger’s test and visually assessed with funnel plots [27].”
MethodYe, D., Jiang, D., Li, Y., Jin, M., & Chen, K. (2017) · International Journal of Clinical Oncology · doi:10.1007/s10147-017-1106-1 · Cited by 41 · see citing works
“Publication bias was assessed using Egger’s linear regression [26] and Begg’s rank correlation [27].”
MethodKotepui, M., & Kotepui, K. U. (2019) · BMC Public Health · doi:10.1186/s12889-019-7488-4 · Cited by 41 · see citing works
Exposing the Weaknesses: A Systematic Review of Azathioprine Efficacy in Ulcerative Colitis
Leung, Y., Panaccione, R., Hemmelgarn, B. R., & Jones, J. (2007) · Digestive Diseases and Sciences · doi:10.1007/s10620-007-0036-6 · Cited by 41 · see citing works
“Potential publication bias was assessed using the Begg’s test for asymmetry as well as the Egger’s test [21].”
MethodKarami, S., Bassig, B. A., Stewart, P. A., Lee, K.-M., Rothman, N., Moore, L. E., & Qing Lan, B. (2013) · Occupational and Environmental Medicine · doi:10.1136/oemed-2012-101212 · Cited by 40 · see citing works
Chuh, A. A. T., Zawar, V. P., Law, M., & Sciallis, G. F. (2012) · Infectious Disease Reports · doi:10.4081/idr.2012.e12 · Cited by 39 · see citing works
Bauer, T. M., Choi, J. H., Luc, J. G. Y., Weber, M. P., Escrivà, E. M., Patel, S., Maynes, E. J., Boyle, A. J., Samuels, L. E., Entwistle, J. W., et al. (2018) · Artificial Organs · doi:10.1111/aor.13378 · Cited by 39 · see citing works
Abiramalatha, T., Bandyopadhyay, T., Ramaswamy, V. V., Shaik, N. B., Thanigainathan, S., Pullattayil, A. K., & Amboiram, P. (2021) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2021.08.003 · Cited by 38 · see citing works
Wang, Y., Qian, G., Mao, S., & Zhang, S. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1475019 · Cited by 37 · see citing works
“The combination of these two methods offers a comprehensive assessment of bias risk and enhances the robustness of our fi ndings, as their effectiveness and reliability have been validated in multiple studies (27, 28).”
Lalu, M. M., Moher, D., Marshall, J. C., Fergusson, D. A., Mei, S. H. J., Macleod, M. R., Griffin, G., Turgeon, A. F., Rudnicki, M. A., Fishman, J., et al. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-48 · Cited by 36 · see citing works
“presence of publication bias will be conducted with funnel plot techniques, and Egger’s regression test [46].”
MethodSon, S., Yoo, B. R., Lee, S. G., Kim, W. K., & Jung, J.-M. (2022) · Journal of Korean Neurosurgical Society · doi:10.3340/jkns.2021.0168 · Cited by 36 · see citing works
Wei, X., Ai-li, X., Yin, Y., & Zhang, R. (2015) · Maturitas · doi:10.1016/j.maturitas.2015.08.013 · Cited by 36 · see citing works
E‐cigarette users are associated with asthma disease: A meta‐analysis
Xian, S., & Chen, Y. (2021) · The Clinical Respiratory Journal · doi:10.1111/crj.13346 · Cited by 35 · see citing works
Basic Empathy Scale: A Systematic Review and Reliability Generalization Meta-Analysis
Cabedo-Peris, J., Vilar, M. M., Merino‐Soto, C., & Morán, M. O. (2021) · Healthcare · doi:10.3390/healthcare10010029 · Cited by 34 · see citing works
“20 in order to increase its sensitivity [45].”
BackgroundLiu, Y., Bao, Y., Yang, X., Sun, S., Yuan, M., Ma, Z., Zhang, W., Zhai, Y., Wang, Y., Men, Y., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1117448 · Cited by 33 · see citing works
“Considering that Egger’s test is more sensitive (57), potential publication bias might not exist in these outcomes.”
BackgroundOuyang, X., Wang, Q., Li, X., Zhang, T., & Rastogi, S. (2023) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-023-03992-2 · Cited by 34 · see citing works
“4 , and the p values of both tests are non-significant (p > 0.05) [32].”
BackgroundInfluentialKhan, S., & Gupta, S. (2023) · Sustainability Accounting Management and Policy Journal · doi:10.1108/sampj-01-2022-0016 · Cited by 32 · see citing works
- Authors
- Hayashino, Y., Noguchi, Y., & Fukui, T.
- Affiliations
- Kyoto University (JP)
- Fujita Health University (JP)
- St. Luke's International Hospital (JP)
- Venue
- Journal of Epidemiology
- Publisher
- Japan Epidemiological Association
- Published
- 2005
- Volume
- 15
- Issue
- 6
- Pages
- 235-243
- ISSN
- 0917-5040 (ISSN-L)
- 1349-9092
- PMC
- PMC7904376
- OpenAlex
- W2084494571
- Cited by
- 379
- References
- 27
- Citations by year
- 2026: 29 · 2025: 27 · 2024: 26 · 2023: 37 · 2022: 30 · 2021: 38 · 2020: 25 · 2019: 27 · 2018: 14 · 2017: 24 · 2016: 12 · 2015: 25 · 2014: 16 · 2013: 9 · 2012: 13
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Epidemiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- 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 › Decision Sciences › Statistics, Probability and Uncertainty › scientometrics and bibliometrics research
- Keywords
- publication bias, Egger's test, funnel plot, sensitivity and specificity, statistical power, discriminatory power, binary outcomes, meta-analysis
- MeSH terms
- ROC Curve, Meta-Analysis as Topic, Linear Models, Publication Bias
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