Absolute risk reductions, relative risks, relative risk reductions, and numbers needed to treat can be obtained from a logistic regression model.

OBJECTIVE Logistic regression models are frequently used in cohort studies to determine the association between treatment and dichotomous outcomes in the presence of confounding variables. In a logistic regression model, the association between exposure and outcome is measured using the odds ratio (OR). The OR can be difficult to interpret and only approximates the relative risk (RR) in certain restrictive settings. Several authors have suggested that for dichotomous outcomes, RRs, RR reductions, absolute risk reductions, and the number needed to treat (NNT) are more clinically meaningful measures of treatment effect. STUDY DESIGN AND SETTING We describe a method for deriving clinically meaningful measures of treatment effect from a logistic regression model. This method involves determining the probability of the outcome if each subject in the cohort was treated and if each subject was untreated. These probabilities are then averaged across the study cohort to determine the average probability of the outcome in the population if all subjects were treated and if they were untreated. RESULTS Risk differences, RRs, and NNTs were derived using a logistic regression model. CONCLUSIONS Clinically meaningful measures of effect can be derived from a logistic regression model in a cohort study. These methods can also be used in randomized controlled trials when logistic regression is used to adjust for possible imbalance in prognostically important baseline covariates.

[1]  Roger W. Johnson,et al.  An Introduction to the Bootstrap , 2001 .

[2]  S J Senn,et al.  Covariate imbalance and random allocation in clinical trials. , 1989, Statistics in medicine.

[3]  Peter C Austin,et al.  A critical appraisal of propensity‐score matching in the medical literature between 1996 and 2003 , 2008, Statistics in medicine.

[4]  Xiaonan Xue,et al.  Estimating the relative risk in cohort studies and clinical trials of common outcomes. , 2003, American journal of epidemiology.

[5]  N Heddle,et al.  Basic statistics for clinicians: 3. Assessing the effects of treatment: measures of association. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[6]  Baseline comparisons in randomized clinical trials. , 1991 .

[7]  P. Austin A comparison of classification and regression trees, logistic regression, generalized additive models, and multivariate adaptive regression splines for predicting AMI mortality , 2007 .

[8]  M. Bracken,et al.  Clinically useful measures of effect in binary analyses of randomized trials. , 1994, Journal of clinical epidemiology.

[9]  S. Senn Testing for baseline balance in clinical trials. , 1994, Statistics in medicine.

[10]  Edna Schechtman,et al.  Odds ratio, relative risk, absolute risk reduction, and the number needed to treat--which of these should we use? , 2002, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[11]  Peter C Austin,et al.  A comparison of propensity score methods: a case‐study estimating the effectiveness of post‐AMI statin use , 2006, Statistics in medicine.

[12]  Peter C Austin,et al.  Propensity-score matching in the cardiovascular surgery literature from 2004 to 2006: a systematic review and suggestions for improvement. , 2007, The Journal of thoracic and cardiovascular surgery.

[13]  J. Zhang,et al.  What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. , 1998, JAMA.

[14]  P. Lavori,et al.  Designs for experiments--parallel comparisons of treatment. , 1983, The New England journal of medicine.

[15]  Peter C. Austin,et al.  A critical appraisal of propensity score matching in the medical literature from 1996 to 2003 , 2008 .

[16]  S Greenland,et al.  Interpretation and choice of effect measures in epidemiologic analyses. , 1987, American journal of epidemiology.

[17]  James Stafford,et al.  The Performance of Two Data-Generation Processes for Data with Specified Marginal Treatment Odds Ratios , 2008, Commun. Stat. Simul. Comput..

[18]  P. Austin Comparing Clinical Data with Administrative Data for Producing AMI Report Cards , 2006 .

[19]  Peter C Austin,et al.  The performance of different propensity-score methods for estimating relative risks. , 2008, Journal of clinical epidemiology.

[20]  D. Sackett,et al.  The number needed to treat: a clinically useful measure of treatment effect , 1995, BMJ.

[21]  Peter C Austin,et al.  A comparison of regression trees, logistic regression, generalized additive models, and multivariate adaptive regression splines for predicting AMI mortality , 2007, Statistics in medicine.

[22]  Peter C. Austin,et al.  Comparing clinical data with administrative data for producing acute myocardial infarction report cards , 2006 .

[23]  M. Gail,et al.  Biased estimates of treatment effect in randomized experiments with nonlinear regressions and omitted covariates , 1984 .

[24]  R. Newcombe,et al.  A deficiency of the odds ratio as a measure of effect size , 2006, Statistics in medicine.