[R-meta] Sample size and continuity correction

Gerta Ruecker ruecker @end|ng |rom |mb|@un|-|re|burg@de
Thu Aug 27 19:31:15 CEST 2020


To answer your question, Nelson:

If I have only two studies and the confidence intervals don't overlap, I 
would usually present a forest plot without a pooled estimate and 
discuss this in the text as indication of large heterogeneity.

However, this also depends on the relevance of the difference on the 
outcome scale, depending on subject-matter considerations. For example, 
if I am estimating incidence rate ratios or something similar based on 
very big populations, the CIs may be very short and thus 
non-overlapping, but this may not be important with respect to 
heterogeneity. For an example, see Figure 2b in the attached paper 
(antibiotics density): The first two CIs are not overlapping, but this 
doesn't seems to be a big difference. It's only due to the enormous size 
of the studies.

Best,

Gerta

Am 27.08.2020 um 18:49 schrieb Nelson Ndegwa:
> Haha, sorry, I  was editing a response that included your signature 
> and forgot to exclude your signature :-)
>
> nelson
>
> On Thu, 27 Aug 2020 at 18:47, ne gic <negic4 using gmail.com 
> <mailto:negic4 using gmail.com>> wrote:
>
>     Wait, are you also Nelly @Nelson?
>
>     On Thu, Aug 27, 2020 at 6:44 PM Nelson Ndegwa
>     <nelson.ndegwa using gmail.com <mailto:nelson.ndegwa using gmail.com>> wrote:
>
>         Dear Gerta,
>
>         I agree with you. In the interest of playing the devil's
>         advocate - and my (and some list members) learning more, what
>         would your opinion be if the CI of the 2 studies did not overlap?
>
>         Appreciate your response.
>
>         Sincerely,
>         nelly
>
>         On Thu, 27 Aug 2020 at 18:21, Gerta Ruecker
>         <ruecker using imbi.uni-freiburg.de
>         <mailto:ruecker using imbi.uni-freiburg.de>> wrote:
>
>             Dear Nelly and all,
>
>             With respect to (only) the first question (sample size):
>
>             I think nothing is wrong, at least in principle, with a
>             meta-analysis of
>             two studies. We analyze single studies, so why not
>             combining two of
>             them? They may even include hundreds of patients.
>
>             Of course, it is impossible to obtain a decent estimate of
>             the
>             between-study variance/heterogeneity from two or three
>             studies. But if
>             the confidence intervals are overlapping, I don't see any
>             reason to
>             mistrust the pooled effect estimate.
>
>             Best,
>
>             Gerta
>
>
>
>             Am 27.08.2020 um 16:07 schrieb ne gic:
>             > Many thanks for the insights Wolfgang.
>             >
>             > Apologies for my imprecise questions. By "agreed upon" &
>             "what
>             > conclusions/interpretations", I was thinking if there is
>             a minimum sample
>             > size whose pooled estimate can be considered somewhat
>             reliable to produce
>             > robust inferences e.g. inferences drawn from just 2
>             studies can be
>             > drastically changed by the publication of a third study
>             for instance - but
>             > it seems like there isn't. But I guess readers have to
>             then check this for
>             > themselves to access how much weight they can place on
>             the conclusions of
>             > specific meta-analyses.
>             >
>             > Again, I appreciate it!
>             >
>             > Sincerely,
>             > nelly
>             >
>             > On Thu, Aug 27, 2020 at 3:43 PM Viechtbauer, Wolfgang (SP) <
>             > wolfgang.viechtbauer using maastrichtuniversity.nl
>             <mailto:wolfgang.viechtbauer using maastrichtuniversity.nl>> wrote:
>             >
>             >> Dear nelly,
>             >>
>             >> See my responses below.
>             >>
>             >>> -----Original Message-----
>             >>> From: R-sig-meta-analysis [mailto:
>             >> r-sig-meta-analysis-bounces using r-project.org
>             <mailto:r-sig-meta-analysis-bounces using r-project.org>]
>             >>> On Behalf Of ne gic
>             >>> Sent: Wednesday, 26 August, 2020 10:16
>             >>> To: r-sig-meta-analysis using r-project.org
>             <mailto:r-sig-meta-analysis using r-project.org>
>             >>> Subject: [R-meta] Sample size and continuity correction
>             >>>
>             >>> Dear List,
>             >>>
>             >>> I have general meta-analysis questions that are not
>             >>> platform/software related.
>             >>>
>             >>> *=======================*
>             >>> *1. Issue of few included studies *
>             >>> * =======================*
>             >>> It seems common to see published meta-analyses with
>             few studies e.g. :
>             >>>
>             >>> (A). An analysis of only 2 studies.
>             >>> (B). In another, subgroup analyses ending up with only
>             one study in one of
>             >>> the subgroups.
>             >>>
>             >>> Nevertheless, they still end up providing a pooled
>             estimate in their
>             >>> respective forest plots.
>             >>>
>             >>> So my question is, is there an agreed upon (or rule of
>             thumb, or in your
>             >>> view) minimum number of studies below which
>             meta-analysis becomes
>             >>> unacceptable?
>             >> Agreed upon? Not that I am aware of. Some may want at
>             least 5 studies (per
>             >> group or overall), some 10, others may be fine with if
>             one group only
>             >> contains 1 or 2 studies.
>             >>
>             >>> What interpretations/conclusions can one really draw
>             from such analyses?
>             >> That's a vague question, so I can't really answer this
>             in general. Of
>             >> course, estimates will be imprecise when k is small
>             (overall or within
>             >> groups).
>             >>
>             >>> *===================*
>             >>> *2. Continuity correction *
>             >>> * ===================*
>             >>>
>             >>> In studies of rare events, zero events tend to occur
>             and it seems common
>             >> to
>             >>> add a small value so that the zero is taken care of
>             somehow.
>             >>>
>             >>> If for instance, the inclusion of this small value via
>             continuity
>             >>> correction leads to differing results e.g. from
>             non-significant results
>             >>> when not using correction, to significant results when
>             using it, what does
>             >>> make of that? Can we trust such results?
>             >> If this happens, then the p-value is probably
>             fluctuating around 0.05 (or
>             >> whatever cutoff is used for declaring results as
>             significant). The
>             >> difference between p=.06 and p=.04 is (very very
>             unlikely) to be
>             >> significant (Gelman & Stern, 2006). Or, to use the
>             words of Rosnow and
>             >> Rosenthal (1989): "[...] surely, God loves the .06
>             nearly as much as the
>             >> .05".
>             >>
>             >> Gelman, A., & Stern, H. (2006). The difference between
>             "significant" and
>             >> "not significant" is not itself statistically
>             significant. American
>             >> Statistician, 60(4), 328-331.
>             >>
>             >> Rosnow, R.L. & Rosenthal, R. (1989). Statistical
>             procedures and the
>             >> justification of knowledge in psychological science.
>             American Psychologist,
>             >> 44, 1276-1284.
>             >>
>             >>> If one instead opts to calculate a risk difference
>             instead, and test that
>             >>> for significance, would this be a better solution
>             (more reliable result?)
>             >>> to the continuity correction problem above?
>             >> If one is worried about the use of 'continuity
>             corrections', then I think
>             >> the more appropriate reaction is to use 'exact
>             likelihood' methods (such as
>             >> using (mixed-effects) logistic regression models or
>             beta-binomial models)
>             >> instead of switching to risk differences (nothing wrong
>             with the latter,
>             >> but risk differences are really a fudamentally
>             different effect size
>             >> measure compared to risk/odds ratios).
>             >>
>             >>> Looking forward to hearing your views as diverse as
>             they may be in cases
>             >>> where there is no consensus.
>             >>>
>             >>> Sincerely,
>             >>> nelly
>             >       [[alternative HTML version deleted]]
>             >
>             > _______________________________________________
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>             > https://stat.ethz.ch/mailman/listinfo/r-sig-meta-analysis
>
>             -- 
>
>             Dr. rer. nat. Gerta Rücker, Dipl.-Math.
>
>             Institute of Medical Biometry and Statistics,
>             Faculty of Medicine and Medical Center - University of
>             Freiburg
>
>             Stefan-Meier-Str. 26, D-79104 Freiburg, Germany
>
>             Phone:    +49/761/203-6673
>             Fax:      +49/761/203-6680
>             Mail: ruecker using imbi.uni-freiburg.de
>             <mailto:ruecker using imbi.uni-freiburg.de>
>             Homepage:
>             https://www.uniklinik-freiburg.de/imbi-en/employees.html?imbiuser=ruecker
>
>             _______________________________________________
>             R-sig-meta-analysis mailing list
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>
-- 

Dr. rer. nat. Gerta Rücker, Dipl.-Math.

Institute of Medical Biometry and Statistics,
Faculty of Medicine and Medical Center - University of Freiburg

Stefan-Meier-Str. 26, D-79104 Freiburg, Germany

Phone:    +49/761/203-6673
Fax:      +49/761/203-6680
Mail:     ruecker using imbi.uni-freiburg.de
Homepage: https://www.uniklinik-freiburg.de/imbi-en/employees.html?imbiuser=ruecker


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