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Between-trial heterogeneity in meta-analyses may be partially explained by reported design characteristics

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)45-54
Number of pages10
JournalJournal of Clinical Epidemiology
Early online date5 Dec 2017
DateAccepted/In press - 28 Nov 2017
DateE-pub ahead of print - 5 Dec 2017
DatePublished (current) - Mar 2018


We investigated the associations between risk of bias judgments from Cochrane reviews for sequence generation, allocation concealment and blinding and between-trial heterogeneity.

Study Design and Setting
Bayesian hierarchical models were fitted to binary data from 117 meta-analyses, to estimate the ratio λ by which heterogeneity changes for trials at high/unclear risk of bias, compared to trials at low risk of bias. We estimated the proportion of between-trial heterogeneity in each meta-analysis that could be explained by the bias associated with specific design characteristics.

Univariable analyses showed that heterogeneity variances were, on average, increased among trials at high/unclear risk of bias for sequence generation (Math Eq 1.14, 95% interval: 0.57 to 2.30) and blinding (Math Eq 1.74, 95% interval: 0.85 to 3.47). Trials at high/unclear risk of bias for allocation concealment were on average less heterogeneous (Math Eq 0.75, 95% interval: 0.35 to 1.61). Multivariable analyses showed that a median of 37% (95% interval: 0% to 71%) heterogeneity variance could be explained by trials at high/unclear risk of bias for sequence generation, allocation concealment and/or blinding. All 95% intervals for changes in heterogeneity were wide and included the null of no difference.

Our interpretation of the results is limited by imprecise estimates. There is some indication that between-trial heterogeneity could be partially explained by reported design characteristics, and hence adjustment for bias could potentially improve accuracy of meta-analysis results.

    Research areas

  • Meta-analysis, Heterogeneity, Sequence generation, Allocation concealment, Blinding, Randomized trials

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