Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker.
A marker strongly associated with outcome (or disease) is often assumed to be effective for classifying persons according to their current or future outcome. However, for this assumption to be true, the associated odds ratio must be of a magnitude rarely seen in epidemiologic studies. In this paper, an illustration of the relation between odds ratios and receiver operating characteristic curves shows, for example, that a marker with an odds ratio of as high as 3 is in fact a very poor classification tool. If a marker identifies 10% of controls as positive (false positives) and has an odds ratio of 3, then it will correctly identify only 25% of cases as positive (true positives). The authors illustrate that a single measure of association such as an odds ratio does not meaningfully describe a marker's ability to classify subjects. Appropriate statistical methods for assessing and reporting the classification power of a marker are described. In addition, the serious pitfalls of using more traditional methods based on parameters in logistic regression models are illustrated.
Pepe
Margaret Sullivan
MS
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. mspepe@u.washington.edu
Janes
Holly
H
Longton
Gary
G
Leisenring
Wendy
W
Newcomb
Polly
P
D015415:Biomarkers; D016022:Case-Control Studies; D002965:Classification; D003627:Data Interpretation, Statistical; D016002:Discriminant Analysis; D004812:Epidemiologic Methods; D005189:False Positive Reactions; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors
D015415:Biomarkers