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Meta-Analysis
. 2011 Mar 16;2011(3):CD006776.
doi: 10.1002/14651858.CD006776.pub2.

Using alternative statistical formats for presenting risks and risk reductions

Elie A Akl  1 , Andrew D Oxman, Jeph Herrin, Gunn E Vist, Irene Terrenato, Francesca Sperati, Cecilia Costiniuk, Diana Blank, Holger Schünemann
Affiliations
Meta-Analysis

Using alternative statistical formats for presenting risks and risk reductions

Elie A Akl et al. Cochrane Database Syst Rev. .

Abstract

Background: The success of evidence-based practice depends on the clear and effective communication of statistical information.

Objectives: To evaluate the effects of using alternative statistical presentations of the same risks and risk reductions on understanding, perception, persuasiveness and behaviour of health professionals, policy makers, and consumers.

Search strategy: We searched Ovid MEDLINE (1966 to October 2007), EMBASE (1980 to October 2007), PsycLIT (1887 to October 2007), and the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2007, Issue 3). We reviewed the reference lists of relevant articles, and contacted experts in the field.

Selection criteria: We included randomized and non-randomized controlled parallel and cross-over studies. We focused on four comparisons: a comparison of statistical presentations of a risk (eg frequencies versus probabilities) and three comparisons of statistical presentation of risk reduction: relative risk reduction (RRR) versus absolute risk reduction (ARR), RRR versus number needed to treat (NNT), and ARR versus NNT.

Data collection and analysis: Two authors independently selected studies for inclusion, extracted data, and assessed risk of bias. We contacted investigators to obtain missing information. We graded the quality of evidence for each outcome using the GRADE approach. We standardized the outcome effects using adjusted standardized mean difference (SMD).

Main results: We included 35 studies reporting 83 comparisons. None of the studies involved policy makers. Participants (health professionals and consumers) understood natural frequencies better than probabilities (SMD 0.69 (95% confidence interval (CI) 0.45 to 0.93)). Compared with ARR, RRR had little or no difference in understanding (SMD 0.02 (95% CI -0.39 to 0.43)) but was perceived to be larger (SMD 0.41 (95% CI 0.03 to 0.79)) and more persuasive (SMD 0.66 (95% CI 0.51 to 0.81)). Compared with NNT, RRR was better understood (SMD 0.73 (95% CI 0.43 to 1.04)), was perceived to be larger (SMD 1.15 (95% CI 0.80 to 1.50)) and was more persuasive (SMD 0.65 (95% CI 0.51 to 0.80)). Compared with NNT, ARR was better understood (SMD 0.42 (95% CI 0.12 to 0.71)), was perceived to be larger (SMD 0.79 (95% CI 0.43 to 1.15)).There was little or no difference for persuasiveness (SMD 0.05 (95% CI -0.04 to 0.15)). The sensitivity analyses including only high quality comparisons showed consistent results for persuasiveness for all three comparisons. Overall there were no differences between health professionals and consumers. The overall quality of evidence was rated down to moderate because of the use of surrogate outcomes and/or heterogeneity. None of the comparisons assessed behaviourbehaviour.

Authors' conclusions: Natural frequencies are probably better understood than probabilities. Relative risk reduction (RRR), compared with absolute risk reduction (ARR) and number needed to treat (NNT), may be perceived to be larger and is more likely to be persuasive. However, it is uncertain whether presenting RRR is likely to help people make decisions most consistent with their own values and, in fact, it could lead to misinterpretation. More research is needed to further explore this question.

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Conflict of interest statement

Some of the review authors were also authors of two included studies: Carling 2008 and Carling 2009. A review author who was not a study author (IT), as well as EA, were involved in data abstraction and analysis for these studies.

Figures

1
1
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgments about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 Natural frequencies versus percentages, outcome: 1.1 Understanding.
4
4
Forest plot of comparison: 2 RRR versus ARR, outcome: 2.1 Understanding.
5
5
Forest plot of comparison: 2 RRR versus ARR, outcome: 2.2 Perception.
6
6
Funnel plot of comparison: 2 RRR versus ARR, outcome: 2.3 Persuasiveness.
7
7
Forest plot of comparison: 2 RRR versus ARR, outcome: 2.3 Persuasiveness
8
8
Additional analysis: RRR versus ARR persuasiveness (binary data) (risk difference)
9
9
Additional analysis: RRR versus ARR persuasiveness (binary data) (risk ratio)
10
10
Forest plot of comparison: 3 RRR versus NNT, outcome: 3.2 Perception
11
11
Funnel plot of comparison: 3 RRR versus NNT, outcome: 3.3 Persuasiveness
12
12
Forest plot of comparison: 3 RRR versus NNT, outcome: 3.3 Persuasiveness
13
13
Additional analysis: RRR versus NNT persuasiveness (binary data) (risk difference)
14
14
Additional analysis: RRR versus NNT persuasiveness (binary data) (risk ratio)
15
15
Forest plot of comparison: 4 ARR versus NNT, outcome: 4.2 Perception.
16
16
Forest plot of comparison: 4 ARR versus NNT, outcome: 4.3 Persuasiveness
1.1
1.1. Analysis
Comparison 1 Natural frequencies versus percentages, Outcome 1 Understanding.
2.1
2.1. Analysis
Comparison 2 RRR versus ARR, Outcome 1 Understanding.
2.2
2.2. Analysis
Comparison 2 RRR versus ARR, Outcome 2 Perception.
2.3
2.3. Analysis
Comparison 2 RRR versus ARR, Outcome 3 Persuasiveness.
3.1
3.1. Analysis
Comparison 3 RRR versus NNT, Outcome 1 Understanding.
3.2
3.2. Analysis
Comparison 3 RRR versus NNT, Outcome 2 Perception.
3.3
3.3. Analysis
Comparison 3 RRR versus NNT, Outcome 3 Persuasiveness.
4.1
4.1. Analysis
Comparison 4 ARR versus NNT, Outcome 1 Understanding.
4.2
4.2. Analysis
Comparison 4 ARR versus NNT, Outcome 2 Perception.
4.3
4.3. Analysis
Comparison 4 ARR versus NNT, Outcome 3 Persuasiveness.
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