ArticleJournal of clinical epidemiology2016
The occurrence of Simpson's paradox if site-level effect was ignored in the TREAT Asia HIV Observational Database.
Article in Journal of clinical epidemiology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Low Cholesterol Associated With TB in People Living With HIV in an Asia-Pacific Cohort.Journal of acquired immune deficiency syndromes (1999) · 2026Article
- Development of an iron status biomarker-based sepsis prognostic model using MIMIC-IV data.World journal of emergency medicine · 2024Article
- Weight changes, metabolic syndrome and all-cause mortality among Asian adults living with HIV.HIV medicine · 2022Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectivesIn multisite human immunodeficiency virus (HIV) observational cohorts, clustering of observations often occurs within sites. Ignoring clustering may lead to "Simpson's paradox" (SP) where the trend observed in the aggregated data is reversed when the groups are separated. This study aimed to investigate the SP in an Asian HIV cohort and the effects of site-level adjustment through various Cox regression models. STUDY DESIGN AND
settingSurvival time from combination antiretroviral therapy (cART) initiation was analyzed using four Cox models: (1) no site adjustment; (2) site as a fixed effect; (3) stratification through site; and (4) shared frailty on site.
resultsA total of 6,454 patients were included from 23 sites in Asia. SP was evident in the year of cART initiation variable. Model (1) shows the hazard ratio (HR) for years 2010-2014 was higher than the HR for 2006-2009, compared to 2003-2005 (HR = 0.68 vs. 0.61). Models (2)-(4) consistently implied greater improvement in survival for those who initiated in 2010-2014 than 2006-2009 contrasting findings from model (1). The effects of other significant covariates on survival were similar across four models.
conclusionsIgnoring site can lead to SP causing reversal of treatment effects. Greater emphasis should be made to include site in survival models when possible.
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