کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5121942 1486850 2016 10 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
The occurrence of Simpson's paradox if site-level effect was ignored in the TREAT Asia HIV Observational Database
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی سیاست های بهداشت و سلامت عمومی
پیش نمایش صفحه اول مقاله
The occurrence of Simpson's paradox if site-level effect was ignored in the TREAT Asia HIV Observational Database
چکیده انگلیسی

ObjectivesIn multisite human immunodeficiency virus (HIV) observational cohorts, clustering of observations often occurs within sites. Ignoring clustering may lead to “Simpson's paradox” (SP) where the trend observed in the aggregated data is reversed when the groups are separated. This study aimed to investigate the SP in an Asian HIV cohort and the effects of site-level adjustment through various Cox regression models.Study Design and SettingSurvival time from combination antiretroviral therapy (cART) initiation was analyzed using four Cox models: (1) no site adjustment; (2) site as a fixed effect; (3) stratification through site; and (4) shared frailty on site.ResultsA total of 6,454 patients were included from 23 sites in Asia. SP was evident in the year of cART initiation variable. Model (1) shows the hazard ratio (HR) for years 2010-2014 was higher than the HR for 2006-2009, compared to 2003-2005 (HR = 0.68 vs. 0.61). Models (2)-(4) consistently implied greater improvement in survival for those who initiated in 2010-2014 than 2006-2009 contrasting findings from model (1). The effects of other significant covariates on survival were similar across four models.ConclusionsIgnoring site can lead to SP causing reversal of treatment effects. Greater emphasis should be made to include site in survival models when possible.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Clinical Epidemiology - Volume 76, August 2016, Pages 183-192
نویسندگان
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