A Monte Carlo evaluation of five interval estimators for the relative risk in sparse data

The relative risk (RR) is one of the most frequently used indices to measure the strength of association between a disease and a risk factor in etiological studies or the efficacy of an experimental treatment in clinical trials. In this paper, we concentrate attention on interval estimation of RR for sparse data, in which we have only a few patients per stratum, but a moderate or large number of strata. We consider five asymptotic interval estimators for RR, including a weighted least-squares (WLS) interval estimator with an ad hoc adjustment procedure for sparse data, an interval estimator proposed elsewhere for rare events, an interval estimator based on the Mantel-Haenszel (MH) estimator with a logarithmic transformation, an interval estimator calculated from a quadratic equation, and an interval estimator derived from the ratio estimator with a logarithmic transformation. On the basis of Monte Carlo simulations, we evaluate and compare the performance of these five interval estimators in a variety of situations. We note that, except for the cases in which the underlying common RR across strata is around 1, using the WLS interval estimator with the adjustment procedure for sparse data can be misleading. We note further that using the interval estimator suggested elsewhere for rare events tends to be conservative and hence leads to loss of efficiency. We find that the other three interval estimators can consistently perform well even when the mean number of patients for a given treatment is approximately 3 patients per stratum and the number of strata is as small as 20. Finally, we use a mortality data set comparing two chemotherapy treatments in patients with multiple myeloma to illustrate the use of the estimators discussed in this paper.