Abstract:
OBJECTIVE:Adding risk factors to a prediction model often increases the area under the receiver operating characteristic curve (AUC) only slightly, particularly when the AUC of the model was already high. We investigated whether a risk factor that minimally improves the AUC may nevertheless improve the predictive ability of the model, assessed by integrated discrimination improvement (IDI). STUDY DESIGN AND SETTING:We simulated data sets with risk factors and event status for 100,000 hypothetical individuals and created prediction models with AUCs between 0.50 and 0.95. We added a single risk factor for which the effect was modeled as a certain odds ratio (OR 2, 4, 8) or AUC increment (ΔAUC 0.01, 0.02, 0.03). RESULTS:Across all AUC values of the baseline model, for a risk factor with the same OR, both ΔAUC and IDI were lower when the AUC of the baseline model was higher. When the increment in AUC was small (ΔAUC 0.01), the IDI was also small, except when the AUC of the baseline model was >0.90. CONCLUSION:When the addition of a risk factor shows minimal improvement in AUC, predicted risks generally show minimal changes too. Updating risk models with strong risk factors may be informative for a subgroup of individuals, but not at the population level. The AUC may not be as insensitive as is frequently argued.
journal_name
J Clin Epidemioljournal_title
Journal of clinical epidemiologyauthors
Martens FK,Tonk EC,Kers JG,Janssens ACdoi
10.1016/j.jclinepi.2016.07.002subject
Has Abstractpub_date
2016-11-01 00:00:00pages
159-164eissn
0895-4356issn
1878-5921pii
S0895-4356(16)30194-9journal_volume
79pub_type
杂志文章abstract::We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), ob...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(92)90204-z
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVES:This study compares three major elements of evidence-based medicine (EBM) practices, namely evidence synthesis, clinical practice guidelines (CPGs), and real-world prescriptions in the United States, regarding antidepressant treatments of major depression over the past 3 decades. STUDY DESIGN AND SETTING:We...
journal_title:Journal of clinical epidemiology
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doi:10.1016/j.jclinepi.2020.12.023
更新日期:2021-01-06 00:00:00
abstract::The aim of the study was to determine coronary events in a defined Sudanese population. All coronary events occurring in Khartoum, the capital of Sudan, were registered during the calendar year 1989. The cold pursuit method of identifying coronary events by surveillance of routinely collected data was adopted. A total...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(96)00116-3
更新日期:1996-09-01 00:00:00
abstract::The effect of age, sex, diabetes, hypertension, pulse rate and cigarette smoking on extracranial carotid artery plaque thickness evaluated by B-mode ultrasonography was investigated in a cross-sectional study of 698 white men, 730 white women, 77 black men and 76 black women as part of a clinical ultrasound registry. ...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(89)90151-0
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVES:The objective of this study was to identify and describe critical appraisal tools designed for assessing the quality of evidence (QoE) and/or strength of recommendations (SoRs) related to health care-related tests and diagnostic strategies (HCTDSs). STUDY DESIGN AND SETTING:We conducted a systematic review ...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,评审
doi:10.1016/j.jclinepi.2017.09.007
更新日期:2017-12-01 00:00:00
abstract::The importance of using risk-adjusted mortality rates to measure quality of care is well-established. However, mortality rates may be an insensitive measure of quality for surgical patients since death is a relatively rare outcome. This study used Medicare files to identify, through chart abstraction, clinical postope...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(94)00165-m
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:Clinical trials are unlikely to ever be launched for many comparative effectiveness research (CER) questions. Inferences from hypothetical randomized trials may however be emulated with marginal structural modeling (MSM) using observational data, but success in adjusting for time-dependent confounding and sel...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2013.01.016
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To assess whether nominally statistically significant effects in meta-analyses of clinical trials are true and whether their magnitude is inflated. STUDY DESIGN AND SETTING:Data from the Cochrane Database of Systematic Reviews 2005 (issue 4) and 2010 (issue 1) were used. We considered meta-analyses with bina...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,评审
doi:10.1016/j.jclinepi.2010.12.012
更新日期:2011-10-01 00:00:00
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journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinepi.2014.03.007
更新日期:2014-08-01 00:00:00
abstract::To assess the accuracy of Bayesian probability analysis for the prediction of coronary artery disease, post-test probabilities were generated by the application of three Bayesian algorithms to the clinical and noninvasive test results of 199 patients undergoing angiography in a veterans' hospital. All assumed conditio...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(88)90065-0
更新日期:1988-01-01 00:00:00
abstract::Individual energy expenditure (kcal/kg/day) was calculated from a detailed set of questions from the Health Promotion and Disease Prevention Supplement of the 1985 National Health Interview Survey. Responses to three single-item, self-assessment questions were compared to the energy expenditure variable to test criter...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(90)90013-f
更新日期:1990-01-01 00:00:00
abstract::Whether or not to treat patients with non-rheumatic atrial fibrillation with anticoagulants to prevent embolic stroke is a dilemma for physicians. If randomized trials, currently underway, demonstrate a beneficial effect, the dilemma will not be solved because not all of the relevant factors can be addressed by trials...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(91)90219-y
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVES:Accurately predicting hospital mortality is necessary to measure and compare patient care. External validation of predictive models is required to truly prove their utility. This study assessed the Kaiser Permanente inpatient risk adjustment methodology for hospital mortality in a patient population distinct...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jclinepi.2009.08.020
更新日期:2010-07-01 00:00:00
abstract::To investigate reproductive maternal risk factors of intrapartum fetal asphyxia, we analyzed 556 women with singleton pregnancies complicated by intrapartum fetal asphyxia who gave birth at Kuopio University Hospital from January 1990 to December 1998. The general obstetric population (N=21746) was selected as the ref...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/s0895-4356(00)00329-2
更新日期:2001-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To comprehensively examine comorbidity in unselected cohorts of patients with depression, stroke, multiple sclerosis (MS), Parkinson's disease/parkinsonism (PD/PKM), dementia, migraine, and epilepsy. METHODS:This cross-sectional study used morbidity data recorded by Dutch general practitioners...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2006.01.005
更新日期:2006-12-01 00:00:00
abstract:OBJECTIVE:The uptake of research findings into routine health care is a haphazard and unpredictable process. The usefulness of the results of implementation studies is limited, due in part to the lack of an underlying framework of the important dimensions of research studies in this area and the healthcare settings wit...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2004.09.002
更新日期:2005-02-01 00:00:00
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journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2016.05.003
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:We aimed to generate evidence on patients' values and preferences to inform the development of the German national Evidence-based Anal Cancer Guideline. STUDY DESIGN AND SETTING:We developed a list of health outcomes based on a systematic search. We then asked anal cancer patients and experts of the guidelin...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2020.09.026
更新日期:2021-01-01 00:00:00
abstract::The incidence and mortality due to the major cancers such as lung, breast, colon-rectum, prostate, and ovary have changed very little over the past 20-30 years, in spite of the introduction of important new treatments and apparent prolongation of survival of patients with these cancers. The new strategies focus on ear...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/0895-4356(94)90205-4
更新日期:1994-06-01 00:00:00
abstract:OBJECTIVE:Treatments may be more effective in some patients than others, and individual participant data (IPD) meta-analysis of randomized trials provides perhaps the best method of investigating treatment-covariate interactions. Various methods are used; we provide a comprehensive critique and develop guidance on meth...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,评审
doi:10.1016/j.jclinepi.2010.11.016
更新日期:2011-09-01 00:00:00
abstract::This article (Part II) and the preceding article (Part I) report the development of two clinical staging systems for HIV-infected individuals. The objective of the research reported here (Part II) was to construct a clinical staging system to predict survival in patients with AIDS. We analyzed data from VA Cooperative...
journal_title:Journal of clinical epidemiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:1997-11-01 00:00:00
abstract:OBJECTIVES:This study assesses the properties of the Mini-Mental State Examination (MMSE) with the purpose of improving the efficiencies of the methods of screening for cognitive impairment and dementia. A specific purpose was to determine whether an abbreviated version would be as accurate as the original MMSE in pred...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2006.06.008
更新日期:2007-03-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to reanalyze and reinterpret data obtained in Paracetamol in Acute Low Back Pain (PACE), the first large randomized controlled trial evaluating the efficacy of paracetamol in acute low back pain, to assess the inferential reproducibility of the original conclusions. STUDY DESIGN AN...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jclinepi.2020.01.010
更新日期:2020-05-01 00:00:00
abstract::We analyzed data from outpatients with chronic low back pain (LBP) in the Veterans Health Study (n = 563) to examine the relationship between localized LBP intensity and radiating leg pain in assessing patient functional status, low back disability, and use of diagnostic imaging. Based on the localized LBP intensity, ...
journal_title:Journal of clinical epidemiology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0895-4356(99)00094-3
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:Mendelian randomization is a popular technique for assessing and estimating the causal effects of risk factors. If genetic variants which are instrumental variables for a risk factor are shown to be additionally associated with a disease outcome, then the risk factor is a cause of the disease. However, in man...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2015.08.001
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVES:The aim of the study was to describe the research environment of scientists in health services and policy research in China. STUDY DESIGN:Study was conducted during the 2016 Westlake Youth Forum with grantees of China Medical Board and key informants. Mixed methods used anonymous, survey of grantees, semist...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2019.05.004
更新日期:2019-08-01 00:00:00
abstract::To examine the effect of cancer histopathology on the relationship between estrogen-replacement therapy (ERT) use and breast cancer risk, we performed a case-control study of 109 postmenopausal women 45 years or older with in situ or invasive breast cancer matched to 545 controls. When in situ and invasive tumors were...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/s0895-4356(98)00116-4
更新日期:1998-12-01 00:00:00
abstract::The "iatrotropic stimulus" is a typical example of Alvan Feinstein's terminology and his clinical way of thinking about medical research. Feinstein specified "interiatric referral" as an additional important factor affecting "the likelihood that patients will appear at the particular setting in which research is being...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/s0895-4356(02)00528-0
更新日期:2002-12-01 00:00:00
abstract::The objective of this study was to construct a prediction model for predicting stroke in an elderly U.S. population, and to assess the accuracy in this population of other previously published prediction models. The subjects were participants in the Cardiovascular Health Study: 2,495 men and 3,393 women age 65 years a...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/s0895-4356(01)00434-6
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:Statistical interaction between a single, instantaneous exposure and attained age (age during follow-up; attained age = age at exposure + time since exposure) is used in risk analyses to assess potential effect modification by unmeasured factors correlated with age. However, the impact of such interaction on ...
journal_title:Journal of clinical epidemiology
pub_type: 杂志文章
doi:10.1016/j.jclinepi.2015.10.004
更新日期:2016-03-01 00:00:00