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      Comparing performance between log-binomial and robust Poisson regression models for estimating risk ratios under model misspecification

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          Abstract

          Background

          Log-binomial and robust (modified) Poisson regression models are popular approaches to estimate risk ratios for binary response variables. Previous studies have shown that comparatively they produce similar point estimates and standard errors. However, their performance under model misspecification is poorly understood.

          Methods

          In this simulation study, the statistical performance of the two models was compared when the log link function was misspecified or the response depended on predictors through a non-linear relationship (i.e. truncated response).

          Results

          Point estimates from log-binomial models were biased when the link function was misspecified or when the probability distribution of the response variable was truncated at the right tail. The percentage of truncated observations was positively associated with the presence of bias, and the bias was larger if the observations came from a population with a lower response rate given that the other parameters being examined were fixed. In contrast, point estimates from the robust Poisson models were unbiased.

          Conclusion

          Under model misspecification, the robust Poisson model was generally preferable because it provided unbiased estimates of risk ratios.

          Electronic supplementary material

          The online version of this article (10.1186/s12874-018-0519-5) contains supplementary material, which is available to authorized users.

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          Most cited references29

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          A modified poisson regression approach to prospective studies with binary data.

          G Zou (2004)
          Relative risk is usually the parameter of interest in epidemiologic and medical studies. In this paper, the author proposes a modified Poisson regression approach (i.e., Poisson regression with a robust error variance) to estimate this effect measure directly. A simple 2-by-2 table is used to justify the validity of this approach. Results from a limited simulation study indicate that this approach is very reliable even with total sample sizes as small as 100. The method is illustrated with two data sets.
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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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              Generalized Linear Models

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                Author and article information

                Contributors
                (626) 564-3475 , Wansu.Chen@KP.org
                Lei.X.Qian@kp.org
                Jiaxiao.M.Shi@kp.org
                Meredith.Franklin@usc.edu
                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central (London )
                1471-2288
                22 June 2018
                22 June 2018
                2018
                : 18
                : 63
                Affiliations
                [1 ]ISNI 0000 0000 9957 7758, GRID grid.280062.e, Kaiser Permanente Southern California, Department of Research and Evaluation, ; 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA 91101 USA
                [2 ]ISNI 0000 0001 2156 6853, GRID grid.42505.36, Department of Preventive Medicine, Keck School of Medicine, , University of Southern California, ; 1975 Zonal Ave, Los Angeles, CA 90033 USA
                Article
                519
                10.1186/s12874-018-0519-5
                6013902
                29929477
                e1aa2525-7b28-496c-a878-e7c0bc80d9fa
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 August 2017
                : 8 June 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Medicine
                log-binomial regression,robust (modified) poisson regression,model misspecification,risk ratio,link function misspecification

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