Understanding heterogeneity in meta-analysis: the role of meta-regression

Baker, William L.; White, C Michael; Cappelleri, Joseph C.; Kluger, Jeffrey; Coleman, Craig I.

doi:10.1111/j.1742-1241.2009.02168.x

Cited by 326 publications

(228 citation statements)

References 42 publications

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“…Meta-analysis, which combines results from multiple studies to estimate the treatment outcome, is usually used to explore the heterogeneity issue. Ideally such exploration should be based on individual patient data obtained from the original clinical trials, but collection of individual patient data is time-consuming, and pertinent patient data may not be recorded in a standardized way and are usually not available from all relevant trials [21][22][23][24]. Meta-analysis based on aggregated patient data, on the other hand, is more feasible to perform, and the heterogeneity issue is analyzed by sub-group analysis.…”

Section: Introductionmentioning

confidence: 99%

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

et al. 2012

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Background The standard of chemotherapy regimens for advanced or metastatic gastric cancer and the clinical outcome were heterogeneous in Asian versus non-Asian countries. This study aimed to explore predictors of safety and efficacy of chemotherapy for patients with advanced or metastatic gastric cancer. Methods Treatment group-based meta-analysis and metaregression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines. Results Twenty-five trials (8 Asian, 17 Western or international) with 56 treatment groups were analyzed.Asian trials reported a lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffusetype histology, and more frequent use of second-line chemotherapy. Meta-analysis revealed significant heterogeneity both in treatment safety (grade 3-4 neutropenia and diarrhea) and efficacy [6-month progression-free survival (PFS) and 1-year overall survival (OS)]. Meta-regression analyses indicate that Asian trials are associated with an 8.2% lower incidence of grade 3-4 neutropenia and 2.1% lower incidence of grade 3-4 diarrhea. A lower percentage of patients with gastroesophageal junction carcinoma and the use of combination regimens predicted better PFS. The use of second-line chemotherapy predicts better 1-year OS, which will increase by 10% for every 10% increase in patients who received second-line chemotherapy. Conclusion Geographic region (Asian vs. non-Asian) is an independent predictor of safety in systemic therapy for gastric cancer.C. Hsu and Y.-C. Shen contributed equally to this work.Electronic supplementary material The online version of this article

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Section: Introductionmentioning

confidence: 99%

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

et al. 2012

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“…We then assessed differences in the association between countries by log-GDP and urbanization using randomeffects meta-regression, which utilized the countryspecific effect estimates to statistically test for differences in the employment-overweight effect size by country-level factors (e.g. log-GDP) [35][36][37]. Alpha was set to 0.05 for main effects and to 0.10 for interaction terms.…”

Section: Discussionmentioning

confidence: 99%

The weight of work: the association between maternal employment and overweight in low- and middle-income countries

Oddo

Bleich

Pollack

et al. 2017

Int J Behav Nutr Phys Act

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Background: Maternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC. Methods: Using cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m

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“…Values of I 2 lie between 0 and 100% where a value >75% may be considered substantially heterogeneous [24]. Heterogeneous results warrant investigation into its sources, either through meta-regression [25] or outlier treatment [17]. The former focuses on covariates and the latter is graphically assessed with the Galbraith plot [17], which is used to detect outlying studies.…”

Section: Heterogeneitymentioning

confidence: 99%

Evaluating Meta-Analysis Research of <i>Escherichia coli</i>

Pabalan¹,

Singian²,

Tabangay³

et al. 2017

≪i>Escherichia Coli

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This chapter summarizes the progress in Escherichia coli research that used the meta-analysis approach. Using systematic searches for E. coli literature, we tracked meta-analysis publications and analyzed them based on a number of parameters. These included subject/topic (epidemiology, clinical/intervention/prevention and environmental), geographical region (the Americas, Europe and Australasia) and clinical syndrome (enteric, renal, and sepsis/meningitis). These parameters were plotted in terms of time span to obtain a sense of dynamic change or its absence through the years since the turn of the twentieth century. In terms of region, topic and syndrome, highest meta-analysis productivity was attributed to the Americas, clinical/intervention/prevention and enteric, all of which took place in the last 5 years (2011)(2012)(2013)(2014)(2015)(2016). Over the combined time span of 16 years, the Americas significantly dominated meta-analysis outputs when compared to Europe and Australasia (P = 0.003). In conclusion, our findings facilitate awareness of the progress in this field wherein the studied parameters were analyzed for patterns over time and differential rates of publication productivity.

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Understanding heterogeneity in meta-analysis: the role of meta-regression

Abstract: The current review will enable clinicians and healthcare decision-makers to appropriately interpret the results of meta-regression when used within the constructs of a systematic review, and be able to extend it to their clinical practice.

Cited by 326 publications

References 42 publications

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

The weight of work: the association between maternal employment and overweight in low- and middle-income countries

Evaluating Meta-Analysis Research of <i>Escherichia coli</i>

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