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Between-trial heterogeneity in meta-analyses may be partially explained by reported design characteristics.

Published version
Peer-reviewed

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Authors

Rhodes, Kirsty M 
Turner, Rebecca M 
Savović, Jelena 
Jones, Hayley E 
Mawdsley, David 

Abstract

OBJECTIVE: We investigated the associations between risk of bias judgments from Cochrane reviews for sequence generation, allocation concealment and blinding, and between-trial heterogeneity. STUDY DESIGN AND SETTING: Bayesian hierarchical models were fitted to binary data from 117 meta-analyses, to estimate the ratio λ by which heterogeneity changes for trials at high/unclear risk of bias compared with trials at low risk of bias. We estimated the proportion of between-trial heterogeneity in each meta-analysis that could be explained by the bias associated with specific design characteristics. RESULTS: Univariable analyses showed that heterogeneity variances were, on average, increased among trials at high/unclear risk of bias for sequence generation (λˆ 1.14, 95% interval: 0.57-2.30) and blinding (λˆ 1.74, 95% interval: 0.85-3.47). Trials at high/unclear risk of bias for allocation concealment were on average less heterogeneous (λˆ 0.75, 95% interval: 0.35-1.61). Multivariable analyses showed that a median of 37% (95% interval: 0-71%) heterogeneity variance could be explained by trials at high/unclear risk of bias for sequence generation, allocation concealment, and/or blinding. All 95% intervals for changes in heterogeneity were wide and included the null of no difference. CONCLUSION: Our interpretation of the results is limited by imprecise estimates. There is some indication that between-trial heterogeneity could be partially explained by reported design characteristics, and hence adjustment for bias could potentially improve accuracy of meta-analysis results.

Description

Keywords

Allocation concealment, Blinding, Heterogeneity, Meta-analysis, Randomized trials, Sequence generation, Bayes Theorem, Bias, Data Interpretation, Statistical, Epidemiologic Research Design, Humans, Meta-Analysis as Topic, Research Design

Journal Title

J Clin Epidemiol

Conference Name

Journal ISSN

0895-4356
1878-5921

Volume Title

95

Publisher

Elsevier BV