Abstract
Leucht [ [1] Leucht S. Let us not rush back to odds ratios without a recommendation to convert them to interpretable measures. J Clin Epidemiol. 2021; : S0895-4356-4358https://doi.org/10.1016/j.jclinepi.2021.02.017 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ] responds to our paper [ [2] Doi SA Furuya-Kanamori L Xu C Lin L Chivese T Thalib L. Questionable utility of the relative risk in clinical research: a call for change to practice. J Clin Epidemiol. 2020; (S0895-4356(20)31171-9) Abstract Full Text Full Text PDF Scopus (23) Google Scholar ] and raises the point that odds ratios (OR) are less intuitive and suggests that we should temper the recommendation that ORs should be preferred over relative risks (RRs) in meta-analyses. Leucht suggests that even if meta-analysts were to derive RRs from ORs, since they use average baseline risks from the included trials, the RR calculated directly will usually be similar to that derived from an OR. While it may be possible (as in the example cited by Leucht) for the RR and OR to numerically coincide, there are two reasons why this cannot be recommended. First, the RRs across studies at different baseline risks are not comparable and therefore should not be synthesized [ [2] Doi SA Furuya-Kanamori L Xu C Lin L Chivese T Thalib L. Questionable utility of the relative risk in clinical research: a call for change to practice. J Clin Epidemiol. 2020; (S0895-4356(20)31171-9) Abstract Full Text Full Text PDF Scopus (23) Google Scholar ]. Second, the synthesized RR (had the baseline risks across studies been similar) cannot be applied beyond the baseline risk observed. For example a RR of 2 at a baseline risk of 40% does not apply to a baseline risk of 60% [ [2] Doi SA Furuya-Kanamori L Xu C Lin L Chivese T Thalib L. Questionable utility of the relative risk in clinical research: a call for change to practice. J Clin Epidemiol. 2020; (S0895-4356(20)31171-9) Abstract Full Text Full Text PDF Scopus (23) Google Scholar , [3] Llewelyn H. The scope and conventions of evidence-based medicine need to be widened to deal with ``too much medicine''. J Eval Clin Pract. 2018; 24: 1026-1032 Crossref PubMed Scopus (7) Google Scholar . Thus RRs lack transportability across clinical settings and patient risk profiles and therefore should not be the effect size of interest in meta-analysis.
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