title: Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker.
abstract: 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.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. mspepe@u.washington.edu
authors.forename: Margaret Sullivan
authors.initials: MS
authors.lastname: Pepe
authors.forename: Holly
authors.initials: H
authors.lastname: Janes
authors.forename: Gary
authors.initials: G
authors.lastname: Longton
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Polly
authors.initials: P
authors.lastname: Newcomb
mesh_terms: 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
chemical_list: D015415:Biomarkers