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Individual participant data meta-analyses should not ignore clustering

2013; Elsevier BV; Volume: 66; Issue: 8 Linguagem: Inglês

10.1016/j.jclinepi.2012.12.017

1878-5921

Ghada Abo-Zaid, Boliang Guo, Jonathan J Deeks, Thomas P. A. Debray, Ewout W. Steyerberg, Karel G.M. Moons, Richard D. Riley,

Trauma and Emergency Care Studies

ObjectivesIndividual 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 SettingComparison of effect estimates from logistic regression models in real and simulated examples.ResultsThe 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.ConclusionResearchers must routinely account for clustering in IPD meta-analyses; otherwise, misleading effect estimates and conclusions may arise.