Meta Analysis and Meta Regression of a Measure of Discrimination Used in Prognostic Modeling

In this paper we are interested in predicting death with the underlying cause of coronary heart disease (CHD). There are two prognostic modeling methods used to predict CHD: the logistic model and the proportional hazard model. For this paper we consider the logistic model. The dataset used is the Diverse Populations Collaboration (DPC) dataset which includes 28 studies. The DPC dataset has epidemiological results from investigation conducted in different populations around the world. For our analysis we include those individuals who are 17 years old or older. The predictors are: age, diabetes, total serum cholesterol (mg/dl), high density lipoprotein (mg/dl), systolic blood pressure (mmHg) and if the participant is a current cigarette smoker. There is a natural grouping within the studies such as gender, rural or urban area and race. Based on these strata we have 84 cohort groups. Our main interest is to evaluate how well the prognostic model discriminates. For this, we used the area under the Receiver Operating Characteristic (ROC) curve. The main idea of the ROC curve is that a set of subject is known to belong to one of two classes (signal or noise group). Then an assignment procedure assigns each object to a class on the basis of information observed. The assignment procedure is not perfect: sometimes an object is misclassified. We want to evaluate the quality of performance of this procedure, for this we used the Area under the ROC curve (AUROC). The AUROC varies from 0.5 (no apparent accuracy) to 1.0 (perfect accuracy). For each logistic model we found the AUROC and its standard error (SE). We used Meta-analysis to summarize the estimated AUROCs and to evaluate if there is heterogeneity in our estimates. To evaluate the existence of significant heterogeneity we used the Q statistic. Since heterogeneity was found in our study we compare seven different methods for estimating τ2 (between study variance). We conclude by examining whether differences in study characteristics explained the heterogeneity in the values of the AUROC.