A bias correction method in meta-analysis of randomized clinical trials with no adjustments for zero-inflated outcomes

Zhengyang Zhou, Minge Xie, David Huh, Eun Young Mun

Research output: Contribution to journalArticlepeer-review

Abstract

Many clinical endpoint measures, such as the number of standard drinks consumed per week or the number of days that patients stayed in the hospital, are count data with excessive zeros. However, the zero-inflated nature of such outcomes is sometimes ignored in analyses of clinical trials. This leads to biased estimates of study-level intervention effect and, consequently, a biased estimate of the overall intervention effect in a meta-analysis. The current study proposes a novel statistical approach, the Zero-inflation Bias Correction (ZIBC) method, that can account for the bias introduced when using the Poisson regression model, despite a high rate of inflated zeros in the outcome distribution of a randomized clinical trial. This correction method only requires summary information from individual studies to correct intervention effect estimates as if they were appropriately estimated using the zero-inflated Poisson regression model, thus it is attractive for meta-analysis when individual participant-level data are not available in some studies. Simulation studies and real data analyses showed that the ZIBC method performed well in correcting zero-inflation bias in most situations.

Original languageEnglish
Pages (from-to)5894-5909
Number of pages16
JournalStatistics in Medicine
Volume40
Issue number26
DOIs
StatePublished - 20 Nov 2021

Keywords

  • aggregate data
  • individual participant data
  • meta-analysis
  • randomized clinical trial
  • zero-inflated outcome

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