04B Hme 712 Week 3 Audio Chi Square And 95% Ci For Epidemiological Tables

In part B of this video, we now turn our attention to the analysis of data when we
have, when we performed a matched case control study. People use matching, for
example, when they have a small number, a relatively small number of cases and a
large number of confounders, and they wish to improve the power of the study. Here
is the plan for the video. What do we mean by matching? An explanation of what we,
the difference between one-to-one matching and n to one matching, then the two-by-
two table, it's not set out the same way as before and finally, we analyze the data
using McNemar's test. And we'll show you the Stata output.
If there is one to one matching, it means for each case, you find a person who
matches the case, in every respect, except that the person does not have the
disease. Remember the cases are the people with the disease. If you want to match
for sex and age, for example, then the buddy who you match with the case will be
somebody of the same sex, and with the same age or age group. If you want to
match for many items, such as smoking, using contraception, and so on, then you're
going to have to match for all those additional items as well. Now the unit of analysis
is the pair. So, you're, you're analyzing the pairs, not at an individual level. Each
case is matched. And if you have 50 pairs of cases, then the numbers in your table
will add up to 50. But remember, they represent a 100 people. Because each of
those numbers is actually a pair, it's a case with its buddy control. So, the number,
the unit of analysis is the pair. And the actual number of participants is double the
number of pairs.
Now, when we analyze these data, we use a test called McNemar's test. With a
matched study, matched case control study, the data that you're going to analyze
involve whether or not the case was exposed, and whether or not the control was
exposed. So, you'll see here on this table, the first pair, pair ID number one, the case
was exposed, but the control was not. So, if you're looking at the association
between Depo Provera use and cancer of the uterus, in this case, the in this pair
rather, the case was using Depo but the control that was matched with this case,
turns out was not using Depo. So that's a zero. The first thing to note when doing this
manually is that your case exposure is on the side, and your control exposure is on
the top. It's very important to get the order right.
Now we have numbers there 320 136. But these refer to pairs, not to individuals. In
blue three, there were three pairs where both the case and its buddy control were
exposed. Blue six indicates that there were six pairs where the case was not
exposed, and the cases' buddy also was not exposed. We have 21 where case was
exposed, but the buddy control not. That makes us suspicious of an association, that
red 21. And we have red 3 where the case was not exposed but the control was.
Those count against an association. So, when we work out the odds ratio, we're only
interested in the two red numbers red 21 over red 3, because the other two numbers
the blue numbers don't help us to decide whether there's an association or not. So,
the McNemar's odds ratio in this case is simply red 21 over red 3, which equals
seven.
Here we have the Stata command. This is appropriate when we have the pair data
individually entered as shown in the earlier slide of the slideshow. The control is
simply MCC which stands for matched case control. Then you put in a case exposed
variable and then the control exposed variable. The order is very important; case
first, control second. And this is the output, and you'll see that the odds ratio again
the McNemar's odds ratio comes to seven and they give you a 95% confidence
04B Hme 712 Week 3 Audio Chi Square And 95% Ci For Epidemiological Tables

interval for that, the exact one. Now if you want the immediate command because
let's say you only have tables of data and you don't have individual pairs of
information then we use mcci and again the order is very important. You go a b c d.
If you have n to one matching meaning that you've got more than two controls
matched to each case, then you need to do something more tricky.
It's not possible to do a McNemar's test because that was for one to one for pairs
and we only have two dimensions available. So now we have to resort to regression
analysis. If you've had loose matching where you've only matched, for example for
sex and age perhaps, then you can get away with simple logistic regression,
unconditional logistic regression which we're going to learn about at the end of this
module. However, if you've got tight matching where you've matched for quite a few
confounding characteristics then you need to resort to something called conditional
logistic regression. In either case at this stage, you would need to seek biostatistician
assistance.