Combining risk estimates from observational studies with different exposure cutpoints: A meta-analysis on body mass index and diabetes type 2

Nienke Hartemink, Hendriek C. Boshuizen, Nico J.D. Nagelkerke, Monique A.M. Jacobs, Hans C. Van Houwelingen

Research output: Contribution to journalArticlepeer-review

152 Citations (Scopus)

Abstract

Studies on a dose-response relation often report separate relative risks for several risk classes compared with a referent class. When performing a meta-analysis of such studies, one has to convert these relative risks into an overall relative risk for a continuous effect. Apart from taking the dependence between separate relative risks into account, this implies assigning an exposure level to each risk factor class and allowing for the nonlinearity of the dose-response relation. The authors describe a relatively simple method solving these problems. As an illustration, they applied this method in a meta-analysis of the association between body mass index and diabetes type 2, restricted to results of follow-up studies (n = 31). Results were compared with a more ad hoc method of assigning exposure levels and with a method in which the nonlinearity of the dose-response method was not taken into account. Differences with the ad hoc method were larger in studies with fewer categories. Not incorporating the nonlinearity of the dose response leads to an overestimation of the pooled relative risk, but this bias is relatively small.

Original languageEnglish
Pages (from-to)1042-1052
Number of pages11
JournalAmerican Journal of Epidemiology
Volume163
Issue number11
DOIs
Publication statusPublished - Jun 2006

Keywords

  • Body mass index
  • Diabetes mellitus
  • Meta-analysis
  • Obesity

ASJC Scopus subject areas

  • Epidemiology

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