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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 [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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“The small number of studies that could be pooled for the depression symptoms meta-analysis precluded the use of such plots [46,61,62] for this health correlate.”
BackgroundHow evidence‐based medicine is failing due to biased trials and selective publication
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Prevalence of Adjacent Segment Degeneration After Spine Surgery
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“231) failed to confirm the stability of this effect.(36) Almost all studies published before 2000 were removed due to”
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“Publication bias was examined using Begg’s test [ 16 ], in which the internal consistency estimates (divided by SEM in order to standardize variance) were correlated with sample size.”
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“We did not perform Egger's test because visual inspection of the funnel plots revealed no noticeable asymmetry in square distribution as a sign of publication bias (Hayashino et al., 2005).”
MethodAssociation between markers of glucose metabolism and risk of colorectal cancer
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“Egger’s method had stronger statistical power than Begg’s method.(61) Please find the detailed information in the online supplementary methods part.”
MethodPublication Bias in Neuroimaging Research: Implications for Meta-Analyses
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BackgroundGuo, J., Jin, M., Zhang, M., & Chen, K. (2012) · PLoS ONE · doi:10.1371/journal.pone.0030585 · Cited by 100
“Publication bias was diagnosed with Egger’s linear regression method [27,28] and funnel plot.”
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Jiang, L., Jiang, S., Zhang, M., Zheng, Z., & Ma, Y. (2014) · PLoS ONE · doi:10.1371/journal.pone.0114666 · Cited by 95
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BackgroundMethodIndoor air pollution from solid fuels and hypertension: A systematic review and meta-analysis
Li, L., Yang, A., He, X., Liu, J., Ma, Y., Niu, J., & Luo, B. (2020) · Environmental Pollution · doi:10.1016/j.envpol.2020.113914 · Cited by 90
Occupational trichloroethylene exposure and kidney cancer risk: a meta-analysis
Karami, S., Qing Lan, B., Rothman, N., Stewart, P. A., Lee, K.-M., Vermeulen, R. C. H., & Moore, L. E. (2012) · Occupational and Environmental Medicine · doi:10.1136/oemed-2012-100932 · Cited by 88
“Publication bias was assessed statistically using Egger ’s and Begg’s methods as well as by evaluating funnel plots.(29) The influence of potential publication bias on risk estimates was further evaluated by implementing the Duval and Tweedie non-parametric ‘trim-and-fill’ method.”
MethodHeart failure and risk of venous thromboembolism: a systematic review and meta-analysis
Tang, L. V., Wu, Y., Lip, G. Y. H., Yin, P., & Hu, Y. (2015) · The Lancet Haematology · doi:10.1016/s2352-3026(15)00228-8 · Cited by 83
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“Publication bias was assessed by Egger’s linear regression [31] and Begg’s rank correlation [32].”
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Liu, X., Ma, J., Huang, L., Zhu, W., Yuan, P., Wan, R., & Hong, K. (2017) · Medicine · doi:10.1097/md.0000000000008273 · Cited by 71
Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis
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“Publication bias was assessed using Egger’s test [31] and Begg’s test [32].”
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ELBW and ELGAN outcomes in developing nations–Systematic review and meta-analysis
Ramaswamy, V. V., Abiramalatha, T., Bandyopadhyay, T., Shaik, N. B., Bandiya, P., Nanda, D., Pullattayil, A. K., Murki, S., & Roehr, C. C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255352 · Cited by 75
“Though publication bias assessment in meta-analysis of prognosis studies is a contentious topic, we assessed publication bias using funnel plots and Begg’s rank test based on GRADE working group guidelines [24, 25].”
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“Additionally, if bias was suspected, publication bias was quantitatively assessed using the Begg adjusted rank correlation test and the Egger regression asymmetry test.(10) We selected the following outcomes of interest a priori: acute postoperative pain intensity, delirium, other adverse events, myocardial infarction…”
Progranulin polymorphism rs5848 is associated with increased risk of Alzheimer's disease
Sheng, J., Su, L., Xu, Z., & Chen, G. (2014) · Gene · doi:10.1016/j.gene.2014.03.041 · Cited by 64
“Publication bias was detected by Egger's test (Hayashino et al., 2005) and Begg's (Begg and Mazumdar, 1994) test for the overall pooled analysis of different models of rs5848.”
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“1 has been recommended to indicate significant publication bias [32,33].”
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Hou, Q., Li, S., Li, L., Li, Y., Sun, X., & Tian, H. (2015) · Medicine · doi:10.1097/md.0000000000001268 · Cited by 66
“Begg’s test and Egger’s test were employed to evaluate the publication bias.(12)”
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“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
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
The safety and serious adverse events of approved ALK inhibitors in malignancies: a meta-analysis
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“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
“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
Degarege, A., Veledar, E., Degarege, D., Erko, B., Nacher, M., & Madhivanan, P. (2016) · Parasites & Vectors · doi:10.1186/s13071-016-1594-2 · Cited by 57
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
“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
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
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 54
Huang, J., Li, X., Zhu, Q., Wang, M., Xie, Z., & Zhao, T. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1425847 · Cited by 54
“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 57
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
“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
“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
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
Hybrid test for publication bias in meta-analysis
Lin, L. (2020) · Statistical Methods in Medical Research · doi:10.1177/0962280220910172 · Cited by 51
“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
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 54
“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
“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
“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
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
“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
“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 45
“(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
“[25] Additionally, meta-regression analysis was performed to further explore heterogeneity with respect to prevalence of hypertension.”
BackgroundMethodSchwab, S., Giuachin, K., & Held, L. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045942 · Cited by 44
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
“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 42
“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
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
“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
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
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
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
Wang, Y., Qian, G., Mao, S., & Zhang, S. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1475019 · Cited by 54
“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 39
“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
Wei, X., Ai-li, X., Yin, Y., & Zhang, R. (2015) · Maturitas · doi:10.1016/j.maturitas.2015.08.013 · Cited by 36
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
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
“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
“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
“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
Metadata
- 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 › Library and Information Sciences › 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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