SynthesisJournal of clinical epidemiology2022
Controversy and Debate : Questionable utility of the relative risk in clinical research: Paper 4 :Odds Ratios are far from "portable" - A call to use realistic models for effect variation in meta-analysis.
Synthesis in Journal of clinical epidemiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative meta-analysis of robot- and video-assisted surgery for thymoma: efficacy, learning curve, and economic burden in 7347 patients.World journal of surgical oncology · 2025Pooled it
- Article
- Collapsibility in case-control studies.International journal of epidemiology · 2026Article
- ZIBGLMM: Zero-inflated bivariate generalized linear mixed model for meta-analysis with double-zero-event studies.Research synthesis methods · 2025Article
- Advancing Interpretable Regression Analysis for Binary Data: A Novel Distributed Algorithm Approach.Statistics in medicine · 2024Article
- Variability of relative treatment effect among populations with low, moderate and high control group event rates: a meta-epidemiological study.BMC medical research methodology · 2024Article
- Evaluation of randomized controlled trials: a primer and tutorial for mental health researchers.Trials · 2023Article
- Systematic review and meta-analysis on laparoscopic cystectomy in bladder cancer: reply letter.Translational andrology and urology · 2022Article
- A Utilitarian Perspective on Risk Quantification for Clinical Significance in Binary Outcomes.Inquiry : a journal of medical care organization, provision and financingArticle
- A review and comparison of arm-based versus contrast-based network meta-analysis for binary outcomes-Understanding their differences and limitations.Wiley interdisciplinary reviews. Computational statisticsArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveRecently Doi et al. argued that risk ratios should be replaced with odds ratios in clinical research. We disagreed, and empirically documented the lack of portability of odds ratios, while Doi et al. defended their position. In this response we highlight important errors in their position. STUDY DESIGN AND
settingWe counter Doi et al.'s arguments by further examining the correlations of odds ratios, and risk ratios, with baseline risks in 20,198 meta-analyses from the Cochrane Database of Systematic Reviews.
resultsDoi et al.'s claim that odds ratios are portable is invalid because 1) their reasoning is circular: they assume a model under which the odds ratio is constant and show that under such a model the odds ratio is portable; 2) the method they advocate to convert odds ratios to risk ratios is biased; 3) their empirical example is readily-refuted by counter-examples of meta-analyses in which the risk ratio is portable but the odds ratio isn't; and 4) they fail to consider the causal determinants of meta-analytic inclusion criteria: Doi et al. mistakenly claim that variation in odds ratios with different baseline risks in meta-analyses is due to collider bias. Empirical comparison between the correlations of odds ratios, and risk ratios, with baseline risks show that the portability of odds ratios and risk ratios varies across settings.
conclusionThe suggestion to replace risk ratios with odds ratios is based on circular reasoning and a confusion of mathematical and empirical results. It is especially misleading for meta-analyses and clinical guidance. Neither the odds ratio nor the risk ratio is universally portable. To address this lack of portability, we reinforce our suggestion to report variation in effect measures conditioning on modifying factors such as baseline risk; understanding such variation is essential to patient-centered practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.