When can odds ratios mislead?

Davies, Huw; Crombie, Iain K.; Tavakoli, Manouche

doi:10.1136/bmj.316.7136.989

Cited by 831 publications

(604 citation statements)

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“…The estimated odds ratio may overestimate the true relative risk of having detectable CAC under the condition of high disease prevalence. 48 Inferences from the models (e.g., elevated risk of having detectable CAC presence among women with HDP compared with women without HDP), however remain the same whether using odds ratios or relative risks to quantify the association.…”

Section: Discussionmentioning

confidence: 99%

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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Background: Hypertension during pregnancy (HDP) increases the risk of future coronary heart disease (CHD), but it is unknown whether this association is mediated by renal injury. Reduced renal function is both a complication of HDP and a risk factor for CHD. Methods: Logistic regression models were fit to examine the association between a history of HDP and the presence and extent of coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, in 498 women from the Epidemiology of Coronary Artery Calcification Study (mean age 63.3 AE 9.3 years). Results: Fifty-two (10.4%) women reported a history of HDP. After adjusting for age at time of study participation, HDP was associated with increased serum creatinine later in life ( p ¼ 0.014). HDP was positively associated with the presence of CAC after adjusting for age at time of study participation (OR ¼ 2.7, 95% CI 1.4-5.4). This association was slightly attenuated with adjustment for body size and blood pressure (OR ¼ 2.4, 95% CI 1.2-4.9) but was not further attenuated with adjustment for serum creatinine and urinary albumin=creatinine ratio (OR ¼ 2.6, 95% CI 1.3-5.3). Results were similar for CAC extent. Conclusions: HDP may increase a woman's risk of future CHD beyond traditional risk factors and renal function. Women with a history of HDP should be monitored for potential increased risk of CHD as they age.

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Section: Discussionmentioning

confidence: 99%

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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“…10 Because the proportion who did not participate was large, our data violated the rare outcome assumption. To confirm the validity of our odds ratios, we compared them to the risk ratio estimates obtained using log-link binominal regression in GLIM.…”

Section: Statistical Analysesmentioning

confidence: 99%

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Blom

Yin

Lidén

et al. 2008

Intl Journal of Cancer

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Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR 5 1.27, 95% CI 5 1.03-1.57, relative to female), unmarried or divorced (OR 5 1.69, 95% CI 5 1.23-2.30 and OR 5 1.49, 95% CI 5 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR 5 1.68, 95% CI 5 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status. ' 2007 Wiley-Liss, Inc.Key words: mass screening; colorectal neoplasms; sigmoidoscopy; patient participation; registers To be effective on a population level, screening programs have to be widely accepted. To minimize nonparticipation, it is important to understand the reasons for nonattendance and to identify groups that would benefit from extra recruitment efforts. Further, understanding of selection forces is necessary for valid interpretation of the effects of screening.Investigators of nonparticipation, whether in screening, public health campaigns or scientific investigations typically have to resort to interviews or questionnaires. As the motivation among nonparticipants generally is low, such studies are characterized by low response rates and questionable data quality. For example, in a recently published Norwegian study concerning a colorectal cancer screening program, only 11% of the nonparticipants responded to a follow-up questionnaire. 1 To our knowledge, no comprehensive model explaining nonparticipation in cancer screening has yet gained widespread acceptance. The scarcity of unbiased background information among nonparticipants may have contributed to this lack of a firm conceptual basis for the understanding of underlying mechanisms.We took advantage of 8 national ...

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“…In cases with high prevalence the relative risk will give a better estimate, which should be observed when the odds ratios are interpreted. 24,25 Multivariate logistic regression analyses were carried out with Proc Logistic in the SAS-system. 26 Point estimates and 95% con®dence intervals for obesity were obtained from self-reported weight and height in adult men and women after adjustment for medicated and non-medicated asthma and other related covariables ( Table 3).…”

Section: Statistical Analysesmentioning

confidence: 99%

Body weight characteristics of subjects on asthma medication

Hedberg

Rössner

2000

Int J Obes

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OBJECTIVE: Weight gain is a frequently documented side effect after long-term anti-in¯ammatory treatment with systemic corticosteroid drugs in patients with asthma. In recent years new types of inhaled corticosteroids have been introduced, which act locally and are more rapidly bio-transformed. Even such corticosteroids may have a detectable, clinically relevant systemic side effect on weight. The aim of this study is to investigate if there is any relationship between body weight and asthma medication. DESIGN: The relationship between asthma medication and body weight was analysed in two combined randomized samples of the adult Swedish population 16 ± 60 y of age (n 17,912). Multivariate logistic regression analyses were carried out to obtain estimates for (1) body mass index (BMI) indicating`obesity' (BMI b29.9 kgam 2 ) in men and women controlling for self-reported asthma medication, and (2) self-reported asthma medication controlling for BMI. In both cases we furthermore controlled for interview period, age, Swedish region, smoking habits, physical activities and level of education. RESULTS: We found no signi®cantly higher odds for obesity in men (OR 1.21 (0.55 ± 2.64) or women (OR 1.97 (0.89 ± 4.38) on asthma medication compared to men and women with pharmacologically untreated asthma even after adjustment for smoking habits, physical activities, level of education and other related co-variables. However, we found signi®cant positive associations between obesity and interview period, age and former smoking and inverse signi®cant relationships with the degree of physical activity. We also found signi®cantly higher adjusted odds for asthma, indicated by self-reported asthma medication, in women (OR 2.74 (1.91 ± 3.91)) but not in men (OR 1.57 (0.96 ± 2.56)) with BMI indicating`obesity'. CONCLUSION: There is no strong evidence to suggest that modern pharmacological asthma treatment may contribute much to the development of obesity in either men or women on asthma medication. Adjustment for smoking habits, physical activities, level of education and other related co-variables have minor effects on these relationships. Obesity may still be an independent risk factor for asthma since we observed signi®cantly higher odds for self-reported asthma medication in women and an almost signi®cant relationship in men even after control for BMI and other related co-variables.

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When can odds ratios mislead?

Cited by 831 publications

References 1 publication

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Toward understanding nonparticipation in sigmoidoscopy screening for colorectal cancer

Body weight characteristics of subjects on asthma medication

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