International Journal of Epidemiology, Vol 28, 1-9, Copyright © 1999 by International Epidemiological Association
M Blettner, W Sauerbrei, B Schlehofer, T Scheuchenpflug and C Friedenreich
BACKGROUND: The use of review articles and meta-analysis has become an
important part of epidemiological research, mainly for reconciling
previously conducted studies that have inconsistent results. Numerous
methodologic issues particularly with respect to biases and the use of
meta-analysis are still controversial. METHODS: Four methods summarizing
data from epidemiological studies are described. The rationale for
meta-analysis and the statistical methods used are outlined. The strengths
and limitations of these methods are compared particularly with respect to
their ability to investigate heterogeneity between studies and to provide
quantitative risk estimation. RESULTS: Meta-analyses from published data
are in general insufficient to calculate a pooled estimate since published
estimates are based on heterogeneous populations, different study designs
and mainly different statistical models. More reliable results can be
expected if individual data are available for a pooled analysis, although
some heterogeneity still remains. Large prospective planned meta-analysis
of multicentre studies would be preferable to investigate small risk
factors, however this type of meta-analysis is expensive and
time-consuming. CONCLUSION: For a full assessment of risk factors with a
high prevalence in the general population, pooling of data will become
increasingly important. Future research needs to focus on the deficiencies
of review methods, in particular, the errors and biases that can be
produced when studies are combined that have used different designs,
methods and analytic models.
ARTICLES
Traditional reviews, meta-analyses and pooled analyses in epidemiology
German Cancer Research Center, Division of Epidemiology, Heidelberg.
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