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Comparison of Pooled Risk Estimates for Adverse Effects from Different Observational Study Designs: Methodological Overview

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  • Su Golder
  • Yoon K Loke
  • Martin Bland

Abstract

Background: A diverse range of study designs (e.g. case-control or cohort) are used in the evaluation of adverse effects. We aimed to ascertain whether the risk estimates from meta-analyses of case-control studies differ from that of other study designs. Methods: Searches were carried out in 10 databases in addition to reference checking, contacting experts, and handsearching key journals and conference proceedings. Studies were included where a pooled relative measure of an adverse effect (odds ratio or risk ratio) from case-control studies could be directly compared with the pooled estimate for the same adverse effect arising from other types of observational studies. Results: We included 82 meta-analyses. Pooled estimates of harm from the different study designs had 95% confidence intervals that overlapped in 78/82 instances (95%). Of the 23 cases of discrepant findings (significant harm identified in meta-analysis of one type of study design, but not with the other study design), 16 (70%) stemmed from significantly elevated pooled estimates from case-control studies. There was associated evidence of funnel plot asymmetry consistent with higher risk estimates from case-control studies. On average, cohort or cross-sectional studies yielded pooled odds ratios 0.94 (95% CI 0.88–1.00) times lower than that from case-control studies. Interpretation: Empirical evidence from this overview indicates that meta-analysis of case-control studies tend to give slightly higher estimates of harm as compared to meta-analyses of other observational studies. However it is impossible to rule out potential confounding from differences in drug dose, duration and populations when comparing between study designs.

Suggested Citation

  • Su Golder & Yoon K Loke & Martin Bland, 2013. "Comparison of Pooled Risk Estimates for Adverse Effects from Different Observational Study Designs: Methodological Overview," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
  • Handle: RePEc:plo:pone00:0071813
    DOI: 10.1371/journal.pone.0071813
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    References listed on IDEAS

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    1. Su Golder & Yoon K Loke & Martin Bland, 2011. "Meta-analyses of Adverse Effects Data Derived from Randomised Controlled Trials as Compared to Observational Studies: Methodological Overview," PLOS Medicine, Public Library of Science, vol. 8(5), pages 1-13, May.
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    1. Stephen J. W. Evans, 2016. "What Is the Plural of a ‘Yellow’ Anecdote?," Drug Safety, Springer, vol. 39(1), pages 1-3, January.
    2. Amy Lanza & Philippe Ravaud & Carolina Riveros & Agnes Dechartres, 2016. "Comparison of Estimates between Cohort and Case–Control Studies in Meta-Analyses of Therapeutic Interventions: A Meta-Epidemiological Study," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-12, May.

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