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. 2013 Aug;66(8):865-873.e4.
doi: 10.1016/j.jclinepi.2012.12.017. Epub 2013 May 4.

Individual participant data meta-analyses should not ignore clustering

Ghada Abo-Zaid  1 , Boliang Guo, Jonathan J Deeks, Thomas P A Debray, Ewout W Steyerberg, Karel G M Moons, Richard David Riley
Affiliations

Individual participant data meta-analyses should not ignore clustering

Ghada Abo-Zaid et al. J Clin Epidemiol. 2013 Aug.

Abstract

Objectives: Individual participant data (IPD) meta-analyses often analyze their IPD as if coming from a single study. We compare this approach with analyses that rather account for clustering of patients within studies.

Study design and setting: Comparison of effect estimates from logistic regression models in real and simulated examples.

Results: The estimated prognostic effect of age in patients with traumatic brain injury is similar, regardless of whether clustering is accounted for. However, a family history of thrombophilia is found to be a diagnostic marker of deep vein thrombosis [odds ratio, 1.30; 95% confidence interval (CI): 1.00, 1.70; P = 0.05] when clustering is accounted for but not when it is ignored (odds ratio, 1.06; 95% CI: 0.83, 1.37; P = 0.64). Similarly, the treatment effect of nicotine gum on smoking cessation is severely attenuated when clustering is ignored (odds ratio, 1.40; 95% CI: 1.02, 1.92) rather than accounted for (odds ratio, 1.80; 95% CI: 1.29, 2.52). Simulations show models accounting for clustering perform consistently well, but downwardly biased effect estimates and low coverage can occur when ignoring clustering.

Conclusion: Researchers must routinely account for clustering in IPD meta-analyses; otherwise, misleading effect estimates and conclusions may arise.

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Figures

Fig. 1
Fig. 1
Comparison of the 1,000 simulation results from the one-step accounting clustering vs. the one-step ignoring clustering for scenario 13 with five studies, small study sample sizes, and a binary factor, in which the standard deviation of alpha was 1.5, the true beta was 0.9, and the prevalence was 0.2. (A) Effect estimates. (B) Standard error of effect estimates.
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