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2015 ; 14
(ä): 434
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Bias in logistic regression due to imperfect diagnostic test results and
practical correction approaches
#MMPMID26537373
Valle D
; Lima JM
; Millar J
; Amratia P
; Haque U
Malar J
2015[Nov]; 14
(ä): 434
PMID26537373
show ga
BACKGROUND: Logistic regression is a statistical model widely used in
cross-sectional and cohort studies to identify and quantify the effects of
potential disease risk factors. However, the impact of imperfect tests on
adjusted odds ratios (and thus on the identification of risk factors) is
under-appreciated. The purpose of this article is to draw attention to the
problem associated with modelling imperfect diagnostic tests, and propose simple
Bayesian models to adequately address this issue. METHODS: A systematic
literature review was conducted to determine the proportion of malaria studies
that appropriately accounted for false-negatives/false-positives in a logistic
regression setting. Inference from the standard logistic regression was also
compared with that from three proposed Bayesian models using simulations and
malaria data from the western Brazilian Amazon. RESULTS: A systematic literature
review suggests that malaria epidemiologists are largely unaware of the problem
of using logistic regression to model imperfect diagnostic test results.
Simulation results reveal that statistical inference can be substantially
improved when using the proposed Bayesian models versus the standard logistic
regression. Finally, analysis of original malaria data with one of the proposed
Bayesian models reveals that microscopy sensitivity is strongly influenced by how
long people have lived in the study region, and an important risk factor (i.e.,
participation in forest extractivism) is identified that would have been missed
by standard logistic regression. CONCLUSION: Given the numerous diagnostic
methods employed by malaria researchers and the ubiquitous use of logistic
regression to model the results of these diagnostic tests, this paper provides
critical guidelines to improve data analysis practice in the presence of
misclassification error. Easy-to-use code that can be readily adapted to WinBUGS
is provided, enabling straightforward implementation of the proposed Bayesian
models.