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J Clin Epidemiol. 2013 Aug;66(8):865-873.e4. doi: 10.1016/j.jclinepi.2012.12.017. Epub 2013 May 4.

Individual participant data meta-analyses should not ignore clustering.

Author information

1
European Centre for Environment and Human Health, Peninsula College of Medicine and Dentistry, University of Exeter, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.

Abstract

OBJECTIVES:

Individual participant data (IPD) meta-analyses often analyze their IPD as if coming from a single study. We compare this approach with analyses that rather account for clustering of patients within studies.

STUDY DESIGN AND SETTING:

Comparison of effect estimates from logistic regression models in real and simulated examples.

RESULTS:

The estimated prognostic effect of age in patients with traumatic brain injury is similar, regardless of whether clustering is accounted for. However, a family history of thrombophilia is found to be a diagnostic marker of deep vein thrombosis [odds ratio, 1.30; 95% confidence interval (CI): 1.00, 1.70; P = 0.05] when clustering is accounted for but not when it is ignored (odds ratio, 1.06; 95% CI: 0.83, 1.37; P = 0.64). Similarly, the treatment effect of nicotine gum on smoking cessation is severely attenuated when clustering is ignored (odds ratio, 1.40; 95% CI: 1.02, 1.92) rather than accounted for (odds ratio, 1.80; 95% CI: 1.29, 2.52). Simulations show models accounting for clustering perform consistently well, but downwardly biased effect estimates and low coverage can occur when ignoring clustering.

CONCLUSION:

Researchers must routinely account for clustering in IPD meta-analyses; otherwise, misleading effect estimates and conclusions may arise.

PMID:
23651765
PMCID:
PMC3717206
DOI:
10.1016/j.jclinepi.2012.12.017
[Indexed for MEDLINE]
Free PMC Article

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