在具有低,中等和高对照组事件率的人群中相对治疗效果的变化:一项超流行病学研究
M Hassan Murad1, Zhen Wang2, Mengli Xiao3
1Evidence-Based Practice Center, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First ST SW, Rochester, MN, 55905, USA. Murad.mohammad@mayo.edu.
BMC medical research methodology
|November 2, 2024
概括
在许多元分析中,相对治疗效应可能无法跨越不同的基线风险. 使用对照组事件率 (CR) 或总事件率 (TR) 作为基线风险的替代品可以限制推断.
科学领域:
- 医学统计 医学统计
- 证据综合 证据综合
- 临床指南开发 临床指南开发
背景情况:
- 目前的指导方针发展假设相对治疗效应是可移植的跨不同的基线风险.
- 对照组事件率 (CR) 通常被用作基线风险的替代品.
研究的目的:
- 利用大量元分析数据集,模仿当前的指南制定实践.
- 为了研究相对治疗效应在不同基线风险水平的可移植性.
主要方法:
- 分析了来自Cochrane系统评价数据库 (2003-2020) 中二元结果和至少4项研究的元分析数据.
- 用几率比率和相对风险进行了元分析.
- 根据CR的三分位数进行了子组分析,使用总事件率 (TR) 和四分位数进行了灵敏度分析.
主要成果:
- 分析包括2531个系统评论,27,692个元分析和226,975个研究.
- 基于CR的三角形/四角形的统计学显著相互作用 (P < 0.05) 范围为12-18%,随着研究数量或CR范围的增加而增加.
- 同时也观察到与TR定量体有显著的相互作用,尽管比CR少得多.
结论:
- 当使用CR或TR作为替代品时,相对治疗效应可能无法跨越不同的基线风险.
- 将CR分类,而不是解决测量误差极限推断,表明CR是一个不良的基线风险来源.
- 指南制定者应使用基线风险条件或类似的基线风险衍生治疗效应.
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