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American Journal of Epidemiology Advance Access published online on April 12, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj141
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received June 30, 2005
Accepted December 21, 2005

PRACTICE OF EPIDEMIOLOGY

Combining Risk Estimates from Observational Studies with Different Exposure Cutpoints: A Meta-analysis on Body Mass Index and Diabetes Type 2

Nienke Hartemink 1, Hendriek C. Boshuizen 2 *, Nico J. D. Nagelkerke 3, Monique A. M. Jacobs 2, and Hans C. van Houwelingen 4

1 National Institute of Public Health and the Environment, Bilthoven, the Netherlands; Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
2 National Institute of Public Health and the Environment, Bilthoven, the Netherlands
3 Department of Community Health, United Arab Emirates University, Al-Ain, United Arab Emirates
4 Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands

* To whom correspondence should be addressed.
Hendriek C. Boshuizen, E-mail: hendriek.boshuizen{at}rivm.nl


  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.

Keywords: body mass index; diabetes mellitus; meta-analysis; obesity.
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