Am J Epidemiol 2004; 159:882-890.
Copyright © 2004 by the Johns
Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Limitations of the Odds Ratio in Gauging the Performance of a Diagnostic, Prognostic, or Screening Marker
1 Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
2 Department of Biostatistics, University of Washington, Seattle, WA.
3 Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA.
A marker strongly associated with outcome (or disease) is often assumed to be effective for classifying persons according to their current or future outcome. However, for this assumption to be true, the associated odds ratio must be of a magnitude rarely seen in epidemiologic studies. In this paper, an illustration of the relation between odds ratios and receiver operating characteristic curves shows, for example, that a marker with an odds ratio of as high as 3 is in fact a very poor classification tool. If a marker identifies 10% of controls as positive (false positives) and has an odds ratio of 3, then it will correctly identify only 25% of cases as positive (true positives). The authors illustrate that a single measure of association such as an odds ratio does not meaningfully describe a marker’s ability to classify subjects. Appropriate statistical methods for assessing and reporting the classification power of a marker are described. In addition, the serious pitfalls of using more traditional methods based on parameters in logistic regression models are illustrated.
biological markers; diagnostic test; logistic regression; odds ratio; ROC curve; screening test
Abbreviations: Abbreviations: FPF, false-positive fraction; ROC, receiver operating characteristic; TPF, true-positive fraction.
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D. M. Lloyd-Jones and P. Greenland Letter Regarding Article by Ridker et al, "Should C-Reactive Protein Be Added to Metabolic Syndrome and to Assessment of Global Cardiovascular Risk?" Circulation, December 14, 2004; 110(24): e532 - e532. [Full Text] [PDF]
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M. P. Stern, K. Williams, C. Gonzalez-Villalpando, K. J. Hunt, and S. M. Haffner Does the Metabolic Syndrome Improve Identification of Individuals at Risk of Type 2 Diabetes and/or Cardiovascular Disease? Diabetes Care, November 1, 2004; 27(11): 2676 - 2681. [Abstract] [Full Text] [PDF]
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