Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 159, Issue 9, Pages 882-890Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwh101
Keywords
biological markers; diagnostic test; logistic regression; odds ratio; ROC curve; screening test
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Funding
- NCI NIH HHS [U01 CA074794, P01 CA18029, U01 CA86368] Funding Source: Medline
- NIGMS NIH HHS [R01 GM54438] Funding Source: Medline
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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.
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