Empirical comparison of univariate and multivariate meta-analyses in Cochrane Pregnancy and Childbirth reviews with multiple binary outcomes.

Publisher: Wiley Blackwell Country of Publication: England NLM ID: 101543738 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1759-2887 (Electronic) Linking ISSN: 17592879 NLM ISO Abbreviation: Res Synth Methods Subsets: MEDLINE

Publication: : Chichester : Wiley Blackwell
Original Publication: Malden, MA : John Wiley & Sons, 2010-

Labor, Obstetric* ; Meta-Analysis as Topic* ; Parturition* ; Research Design* ; Review Literature as Topic*; Anesthesia, Conduction ; Anesthesiology/methods ; Cesarean Section/methods ; Female ; Humans ; Likelihood Functions ; Models, Theoretical ; Multivariate Analysis ; Odds Ratio ; Pregnancy ; Serotonin Antagonists/chemistry ; Treatment Outcome

Background: Multivariate meta-analysis (MVMA) jointly synthesizes effects for multiple correlated outcomes. The MVMA model is potentially more difficult and time-consuming to apply than univariate models, so if its use makes little difference to parameter estimates, it could be argued that it is redundant.
Methods: We assessed the applicability and impact of MVMA in Cochrane Pregnancy and Childbirth (CPCB) systematic reviews. We applied MVMA to CPCB reviews published between 2011 and 2013 with two or more binary outcomes with at least three studies and compared findings with results of univariate meta-analyses. Univariate random effects meta-analysis models were fitted using restricted maximum likelihood estimation (REML).
Results: Eighty CPCB reviews were published. MVMA could not be applied in 70 of these reviews. MVMA was not feasible in three of the remaining 10 reviews because the appropriate models failed to converge. Estimates from MVMA agreed with those of univariate analyses in most of the other seven reviews. Statistical significance changed in two reviews: In one, this was due to a very small change in P value; in the other, the MVMA result for one outcome suggested that previous univariate results may be vulnerable to small-study effects and that the certainty of clinical conclusions needs consideration.
Conclusions: MVMA methods can be applied only in a minority of reviews of interventions in pregnancy and childbirth and can be difficult to apply because of missing correlations or lack of convergence. Nevertheless, clinical and/or statistical conclusions from MVMA may occasionally differ from those from univariate analyses.
(© 2019 The Authors Research Synthesis Methods Published by John Wiley & Sons Ltd.)

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MC_UU_12023/21 United Kingdom MRC_ Medical Research Council; MR/J013595/1 United Kingdom MRC_ Medical Research Council; NIHR CLAHRC West Midlands+

Keywords: comparison; evidence synthesis; multivariate meta-analysis; univariate meta-analysis

0 (Serotonin Antagonists)

Date Created: 20190507 Date Completed: 20200428 Latest Revision: 20220409

20240628

PMC6771837

10.1002/jrsm.1353

31058440