학술논문
The association of sensitivity and specificity with disease prevalence: analysis of 6909 studies of diagnostic test accuracy.
Document Type
Academic Journal
Author
Murad MH; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan. Murad.mohammad@mayo.edu.; Lin L; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Chu H; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Hasan B; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Alsibai RA; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Abbas AS; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Mustafa RA; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.; Wang Z; Evidence-Based Practice Center (Murad, Hasan, Alsibai, Abbas, Wang), Mayo Clinic, Rochester, Minn.; Department of Epidemiology and Biostatistics (Lin), University of Arizona, Tucson, Ariz.; Statistical Research and Data Science Center (Chu), Pfizer, New York, NY; Department of Internal Medicine (Mustafa), University of Kansas Health System, Kansas City, Kan.
Source
Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 9711805 Publication Model: Print Cited Medium: Internet ISSN: 1488-2329 (Electronic) Linking ISSN: 08203946 NLM ISO Abbreviation: CMAJ Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Sensitivity and specificity are characteristics of a diagnostic test and are not expected to change as the prevalence of the target condition changes. We sought to evaluate the association between prevalence and changes in sensitivity and specificity.
Methods: We retrieved data from meta-analyses of diagnostic test accuracy published in the Cochrane Database of Systematic Reviews (2003-2020). We used mixed-effects random-intercept linear regression models to evaluate the association between prevalence and logit-transformed sensitivity and specificity. The model evaluated all meta-analyses as nested within each systematic review.
Results: We analyzed 6909 diagnostic test accuracy studies from 552 meta-analyses that were included in 92 systematic reviews. For sensitivity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly higher odds of identifying a true positive case (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.26; OR 1.32, 95% CI 1.23-1.41; OR 1.47, 95% CI 1.37-1.58; respectively). For specificity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly lower odds of identifying a true negative case (OR 0.74, 95% CI 0.69-0.80; OR 0.65, 95% CI 0.60-0.70; OR 0.47, 95% CI 0.44-0.51; respectively). Pooled regression coefficients from bivariate models conducted within each meta-analysis showed that prevalence was positively associated with sensitivity and negatively associated with specificity. Findings were consistent across subgroups.
Interpretation: In this large sample of diagnostic studies, higher prevalence was associated with higher estimated sensitivity and lower estimated specificity. Clinicians should consider the implications of disease prevalence and spectrum when interpreting the results from studies of diagnostic test accuracy.
Competing Interests: Competing interests: Haitao Chu is employed by Pfizer and owns stock in the company. No other competing interests were declared.
(© 2023 CMA Impact Inc. or its licensors.)
Methods: We retrieved data from meta-analyses of diagnostic test accuracy published in the Cochrane Database of Systematic Reviews (2003-2020). We used mixed-effects random-intercept linear regression models to evaluate the association between prevalence and logit-transformed sensitivity and specificity. The model evaluated all meta-analyses as nested within each systematic review.
Results: We analyzed 6909 diagnostic test accuracy studies from 552 meta-analyses that were included in 92 systematic reviews. For sensitivity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly higher odds of identifying a true positive case (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.26; OR 1.32, 95% CI 1.23-1.41; OR 1.47, 95% CI 1.37-1.58; respectively). For specificity, compared with the lowest quartile of prevalence, the second, third and fourth quartiles were associated with significantly lower odds of identifying a true negative case (OR 0.74, 95% CI 0.69-0.80; OR 0.65, 95% CI 0.60-0.70; OR 0.47, 95% CI 0.44-0.51; respectively). Pooled regression coefficients from bivariate models conducted within each meta-analysis showed that prevalence was positively associated with sensitivity and negatively associated with specificity. Findings were consistent across subgroups.
Interpretation: In this large sample of diagnostic studies, higher prevalence was associated with higher estimated sensitivity and lower estimated specificity. Clinicians should consider the implications of disease prevalence and spectrum when interpreting the results from studies of diagnostic test accuracy.
Competing Interests: Competing interests: Haitao Chu is employed by Pfizer and owns stock in the company. No other competing interests were declared.
(© 2023 CMA Impact Inc. or its licensors.)