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      Primer on binary logistic regression

      research-article
      Family Medicine and Community Health
      BMJ Publishing Group
      education, epidemiology, public health

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          Abstract

          Family medicine has traditionally prioritised patient care over research. However, recent recommendations to strengthen family medicine include calls to focus more on research including improving research methods used in the field. Binary logistic regression is one method frequently used in family medicine research to classify, explain or predict the values of some characteristic, behaviour or outcome. The binary logistic regression model relies on assumptions including independent observations, no perfect multicollinearity and linearity. The model produces ORs, which suggest increased, decreased or no change in odds of being in one category of the outcome with an increase in the value of the predictor. Model significance quantifies whether the model is better than the baseline value (ie, the percentage of people with the outcome) at explaining or predicting whether the observed cases in the data set have the outcome. One model fit measure is the count- R 2 , which is the percentage of observations where the model correctly predicted the outcome variable value. Related to the count- R 2 are model sensitivity—the percentage of those with the outcome who were correctly predicted to have the outcome—and specificity—the percentage of those without the outcome who were correctly predicted to not have the outcome. Complete model reporting for binary logistic regression includes descriptive statistics, a statement on whether assumptions were checked and met, ORs and CIs for each predictor, overall model significance and overall model fit.

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            Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio

            Background Cross-sectional studies with binary outcomes analyzed by logistic regression are frequent in the epidemiological literature. However, the odds ratio can importantly overestimate the prevalence ratio, the measure of choice in these studies. Also, controlling for confounding is not equivalent for the two measures. In this paper we explore alternatives for modeling data of such studies with techniques that directly estimate the prevalence ratio. Methods We compared Cox regression with constant time at risk, Poisson regression and log-binomial regression against the standard Mantel-Haenszel estimators. Models with robust variance estimators in Cox and Poisson regressions and variance corrected by the scale parameter in Poisson regression were also evaluated. Results Three outcomes, from a cross-sectional study carried out in Pelotas, Brazil, with different levels of prevalence were explored: weight-for-age deficit (4%), asthma (31%) and mother in a paid job (52%). Unadjusted Cox/Poisson regression and Poisson regression with scale parameter adjusted by deviance performed worst in terms of interval estimates. Poisson regression with scale parameter adjusted by χ2 showed variable performance depending on the outcome prevalence. Cox/Poisson regression with robust variance, and log-binomial regression performed equally well when the model was correctly specified. Conclusions Cox or Poisson regression with robust variance and log-binomial regression provide correct estimates and are a better alternative for the analysis of cross-sectional studies with binary outcomes than logistic regression, since the prevalence ratio is more interpretable and easier to communicate to non-specialists than the odds ratio. However, precautions are needed to avoid estimation problems in specific situations.
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              R: a Lenguage and Environment for Statistical Computing

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                Author and article information

                Journal
                Fam Med Community Health
                Fam Med Community Health
                fmch
                fmch
                Family Medicine and Community Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2305-6983
                2009-8774
                2021
                23 December 2021
                : 9
                : Suppl 1
                : e001290
                Affiliations
                [1]departmentBrown School , Washington University in St Louis , St Louis, Missouri, USA
                Author notes
                [Correspondence to ] Dr Jenine K Harris; harrisj@ 123456wustl.edu
                Author information
                http://orcid.org/0000-0002-3576-5906
                Article
                fmch-2021-001290
                10.1136/fmch-2021-001290
                8710907
                34952854
                13cccffd-8a1b-447f-847c-a63a1e9b0806
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

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                Methodology and Research Methods
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                education,epidemiology,public health
                education, epidemiology, public health

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