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      Odds ratio: aspectos teóricos y prácticos Translated title: Odds ratio: Theoretical and practical issues

      research-article
      , ,
      Revista médica de Chile
      Sociedad Médica de Santiago
      Biostatistics, Odds Ratio, Research report

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          Abstract

          Odds Ratio (OR) es una medida de efecto comúnmente utilizada para comunicar los resultados de una investigación en salud. Matemáticamente un OR corresponde a un cociente entre dos odds, siendo un odds una forma alternativa de expresar la posibilidad de ocurrencia de un evento de interés o de presencia de una exposición. Desde un punto de vista metodológico, los OR pueden ser calculados en diseños prospectivos, retrospectivos y transversales, y bajo ciertas condiciones pueden reemplazar al Riesgo Relativo. En base a una serie de preguntas y ejemplos, el presente artículo explica los fundamentos matemáticos y metodológicos subyacentes al concepto de OR, con el objetivo de facilitar su interpretación a clínicos e investigadores.

          Translated abstract

          Odds Ratio (OR) is an effect measure frequently used to communicate results of health research. Mathematically, OR is the quotient between two odds, being odds an alternative way to express possibility of occurrence of an outcome or presence of an exposition. From a methodological perspective, OR can be calculated from prospective, retrospective and cross-sectional designs, and under certain conditions it can replace the Relative Risk. Based on a series of questions and examples, this article explains theoretical and methodological grounds underlying the concept of OR, in order to facilitate its interpretation for clinicians and researchers.

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          Estimating the relative risk in cohort studies and clinical trials of common outcomes.

          Logistic regression yields an adjusted odds ratio that approximates the adjusted relative risk when disease incidence is rare (<10%), while adjusting for potential confounders. For more common outcomes, the odds ratio always overstates the relative risk, sometimes dramatically. The purpose of this paper is to discuss the incorrect application of a proposed method to estimate an adjusted relative risk from an adjusted odds ratio, which has quickly gained popularity in medical and public health research, and to describe alternative statistical methods for estimating an adjusted relative risk when the outcome is common. Hypothetical data are used to illustrate statistical methods with readily accessible computer software.
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            Bias and causal associations in observational research.

            Readers of medical literature need to consider two types of validity, internal and external. Internal validity means that the study measured what it set out to; external validity is the ability to generalise from the study to the reader's patients. With respect to internal validity, selection bias, information bias, and confounding are present to some degree in all observational research. Selection bias stems from an absence of comparability between groups being studied. Information bias results from incorrect determination of exposure, outcome, or both. The effect of information bias depends on its type. If information is gathered differently for one group than for another, bias results. By contrast, non-differential misclassification tends to obscure real differences. Confounding is a mixing or blurring of effects: a researcher attempts to relate an exposure to an outcome but actually measures the effect of a third factor (the confounding variable). Confounding can be controlled in several ways: restriction, matching, stratification, and more sophisticated multivariate techniques. If a reader cannot explain away study results on the basis of selection, information, or confounding bias, then chance might be another explanation. Chance should be examined last, however, since these biases can account for highly significant, though bogus results. Differentiation between spurious, indirect, and causal associations can be difficult. Criteria such as temporal sequence, strength and consistency of an association, and evidence of a dose-response effect lend support to a causal link.
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              Epidemiology

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                Author and article information

                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                0034-9887
                October 2013
                : 141
                : 10
                : 1329-1335
                Affiliations
                [03] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2División de Obstetricia y Ginecología Chile
                [04] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Medicina Interna Chile
                [01] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Unidad de Medicina Basada en Evidencia Chile jcerda@ 123456med.puc.cl
                [02] Santiago orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Departamento de Salud Pública Chile
                Article
                S0034-98872013001000014 S0034-9887(13)14101000014
                10.4067/S0034-98872013001000014
                4f7c2e80-d0f2-4067-80b4-d5cc1b989c65

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 May 2013
                : 04 January 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 7
                Product

                SciELO Chile

                Categories
                MEDICINA BASADA EN EVIDENCIA

                Biostatistics,Research report,Odds Ratio
                Biostatistics, Research report, Odds Ratio

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