Standardised Regression Coefficient-Metaanalysis

Epidemiology Biostatistics and Public Health - 2013, Volume 10, Number 4
Biostatistics
Standardised regression coefficient

as an effect size index in summarising
findings in epidemiological studies
Pentti Nieminen(1), Heli Lehtiniemi(1, 2), Kirsi Vhkangas(3), Antti Huusko(2), Arja Rautio(2)
Background: a major problem in evaluating and reviewing the published findings of studies on the
association between a quantitative explanatory variable and a quantitative dependent variable is
that the results are analysed and reported in many different ways. To achieve an effective review of
different studies, a consistent presentation of the results is necessary. This paper aims to exemplify
the main topics related to summarising and pooling research findings from multivariable models with
a quantitative response variable.
Methods: we outline the complexities involved in synthesising associations. We describe a method
by which it is possible to transform the findings into a common effect size index which is based on
standardised regression coefficients. To describe the approach we searched original research articles
published before January 2012 for findings of the relationship between polychlorinated biphenyls
(PCBs) and birth weight of new-borns. Studies with maternal PCB measurements and birth weight as
a continuous variable were included.
Results: the evaluation of 24 included articles reveled that there was variation in variable
measurement methods, transformations, descriptive statistics and inference methods. Research
syntheses were performed summarizing regression coefficients to estimate the effect of PCBs on birth
weight. A birth weight decline related to increase in PCB level was found.
ConclusionS: the proposed method can be useful in quantitatively reviewing published studies when
different exposure measurement methods are used or differential control of potential confounding
factors is not an issue.
Erratum: the first published version of the study contained an error on page 12 (Appendix A) that was
corrected on February 18, 2014.
Key words: Statistical reporting; Standardised regression coefficient; Health outcomes; Meta-analysis;
Research synthesis
(1) Medical Informatics and Statistics Research Group,

University of Oulu, Finland
(2) Thule Institute, University of Oulu, Finland
(3) Faculty of Health Sciences, University of Eastern Finland, Finland
Corresponding author: Pentti Nieminen, Medical

Informatics and Statistics Research Group, University of Oulu,
P.O. Box 5000, FIN-90014 Oulu, Finland. Tel: +358 29 4485109;
Fax: +358 8 5375111. e-mail: pentti.nieminen@oulu.fi
DOI: 10.2427/8854
Effect size index for epidemiological studies
e8854-1
Biostatistics
Introduction
Summarizing the results of published
studies is an important part of any research and
provides also the essential content for metaanalysis [1]. To achieve an effective review of
different studies, a consistent presentation of
their results is necessary [2]. There are many
different statistical methods to analyse the
relation of an explanatory measure with a
continuous dependent outcome variable. For
a reader this becomes more difficult when
research articles include inadequate reporting
of research methods and basic statistics. Medical
research articles using statistical methods have
always been at risk of poor reporting [3].
Results across repeated studies of the
same phenomena are rarely identical due to
various reasons, for instance size of the study,
differences in the used analytical methods
and genetic differences between the studied
populations [1]. Review of original articles
and research synthesis extends our knowledge
through the combination and comparison of the
original studies. When using systematic literature
review to learn from combined studies, we are
dependent on the research methodology and
reporting of the underlying studies. Although
the principal aim of these studies is identical,
e.g. to measure the relationship between an
explanatory factor and a response variable,
different statistical methods are used in different
publications. Some studies use correlation
coefficients, some apply multivariable regression
methods and some studies compare mean
values. Often the explanatory factors in original
studies are measured with different methods and
units of measurement. The quality of reporting
also varies: detailed descriptive statistics of the
variables under study are not given in all articles,
and standard error for regression coefficients or
the mean differences are not always available.
The task of summarizing these studies in a
consistent manner thus appears challenging.
The measure used to represent study
findings in meta-analysis is called an effect size
statistic. Which statistic is appropriate depends
upon the nature of the research findings, the
statistical forms in which they are reported,
and the hypotheses being tested by the metaanalysis [4]. The effect size statistic to evaluate
association between the explanatory and
e8854-2
dependent variable should embody information

about the magnitude of association between
these variables with possible adjustment of
covariates. Multivariable relationships present
special challenges to meta-analysis because
effect size statistics of interest depend on
what other variables are included in the
multivariable analysis. Also, the omission of the
full correlation matrix from most reports makes
it impossible for the reader to evaluate the
dependence between the explanatory variables.
As an example, we examine maternal
exposure to polychlorinated biphenyls (PCBs)
and birth weight of new-borns. Low birth
weight is considered to be associated with a
variety of adverse effects in childhood and
beyond, including poor school performance,
high blood pressure, cardiovascular disease,
stroke, obesity and depression [5-8]. Therefore
even a small increased risk of low birth weight
has important public health implications and
any knowledge of such an effect on potential
reasons is important.
Several factors have been proven to be
associated with an increased risk of giving
birth to low birth weight babies: mothers age,
smoking, race, nutritional status and weight
before pregnancy, infections, socioeconomic
status and educational level [6, 9, 10]. Premature
birth is by far the most common cause of low
birth weight. It has been also speculated that
exposure to environmental contaminants may
have an effect on birth weight [6, 11, 12]. PCBs
are persistent organic pollutants ubiquitously
present in ecosystems. Associations of exposure
to PCBs with low birth weight have been
observed in several studies, while other studies
have found no convincing evidence of such
associations [11-15].
The main purposes of this paper are
to point out the complexities and potential
problems in a critical review of association
between a quantitative response variable and
one primary quantitative explanatory variable,
and to present an effect size approach based
on standardised regression coefficients. To
exemplify this we carried out a systematic
literature review to ensure a comprehensive
summary of the available evidence about the
effect of maternal exposure to PCBs on the
birth weight of their children.
Biostatistics
METHODS
Standardised regression coefficient as an effect
size index
When synthesizing the multivariable
associations between quantitative variables the
regression coefficients are natural measures of
interest. Because exposure is often measured
using different methods and metrics across
the studies, the direct pooling of regression
coefficients is not meaningful. In such a case
standardised regression coefficients may offer
a solution. They are the estimates resulting
from an analysis carried out on variables that
have been standardized so that their variances
are equal to one [16]. Therefore, standardised
coefficients refer to how many standard
deviations the response or outcome variable
will change per a standard deviation increase
in the exposure variable. Thus standardised
coefficient can be used as an effect size estimate
when the exposure levels in original studies are
measured in different units of measurement.
Procedures to convert test statistics into effect
size index (with SE)
In systematic reviews studies addressing the
same research question are selected to be included
in one research synthesis (or meta-analysis). Often
reviewers refer to the problem of different statistical
methods and strategies being used to analyse the
relationship between the response and exposure
variables [4, 17]. In the following, we will show how
the results expressed as correlation coefficients,
linear regression coefficients or mean differences
can be re-expressed as a standardized effect size
index measuring the association between response
and exposure level. The derivation of standard
errors is also described. The different approaches
are summarized in Appendix A (Supplementary
Materials).
Several formulas in Appendix A require
the standard deviation (SD) for response
and exposure variables. In most of the
evaluated articles these are not given.
In those articles we can estimate these
statistics using various methods depending
on the data available in the article. The
different approaches are summarized in
Appendix B (Supplementary Materials).
Observed
standardised
regression
coefficient is an easily interpretable effect size
measure. It has the following interpretation:
An effect size value not significantly
different from zero supports the null
hypothesis that there is no association
between the exposure level and
response variable.
A negative value supports the
hypothesis that high exposure level
decreases the response. If the upper
limit of confidence interval is below
zero then the association is considered
statistically significant.
A positive value supports the
hypothesis that high exposure level
increases the response. If the lower
limit of confidence interval is above
zero then the association is considered
statistically significant.
Pooled estimate of effect size index
In meta-analysis one combines the findings
(and effect sizes) from reviewed studies. The
problem is that every observed effect size is
not equal with regard to the reliability of the
information it carries. The way this is handled
is to weigh each effect size value by a term that
represents its precision. An optimal approach is
to weigh each effect size by the inverse of the
squared standard error of the effect size value.
Thus the formula for computing the associated
standard error must also be identified. To
obtain the summary effect of all reviewed
studies, we computed the weighted average
effect size using the following formula
where k=number studies, wi is the standard

regression coefficient from study i, wi is the
inverse of (SE(i))2. The variance (SE(i))2 could
be calculated using fixed effects or random
effects model [17, 18]. The software package
Comprehensive Meta-analysis [17] software was
used in this study for the meta-analysis.
Identification of articles for an example
We systematically searched Medline, Scopus
e8854-3
Biostatistics
and Web of Science (from inception to January

2012), with no language restrictions, for studies
in humans of the association between birth
weight and maternal PCB levels. The literature
was searched using the terms polychlorinated
biphenyls and birth weight, either as
thesaurus terms or in title or as abstract terms
with synonyms and closely related words which
are available upon request from the authors.
In the next step, relevant articles (as judged
on basis of the article type, title and abstract)
were retrieved for more detailed evaluation.
Only original research articles were included.
Finally, all retrieved articles were screened
to determine which met any of the following
criteria for exclusion: 1=birth weight was not an
outcome, 2=PCBs were not reported as exposure
variables, 3=data about birth weight or PCBs
was insufficient, 4=there was overlap with other
studies or a repetition of a previous study. From
the overlapping studies the most recent with the
highest number of cases was included because
it had the most comprehensive data. The main
outcome measure was birth weight of the newborns measured as a continuous variable.
A total of 140 articles were identified in
the first screen, for which titles and abstracts
were reviewed. In the second step, 51 original
articles were considered as relevant studies
and they were retrieved for detailed evaluation.
After full review, 27 articles met at least one of
the exclusion criteria, and thus were excluded.
Finally, 24 studies were included in our review.
Evaluation of statistical procedures and reporting
across studies
All 24 included papers were manually
reviewed for their content. Two independent
reviewers (PN and HL) performed the extraction
of data from the full articles. Disagreements
were resolved by discussion and consensus. The
following study information was collected: place of
the study, years of the study, measure of exposure,
PCB compounds and characteristics of the parents
and adjusted covariates. Types and frequencies
of statistical methods were also systematically
recorded and classified. Especially, we reviewed
whether the effect of several explanatory variables
on the outcome variable (birth weight) was
simultaneously analysed and which confounding
factors were controlled using regression models.
e8854-4
To evaluate the quality of reporting,

the following information was recorded for
each study: (1) whether sample size and data
analysis procedures were completely described
in the reports methods section, (2) whether
mean value and standard deviation of birth
weight were reported, (3) whether location and
variation of PCB distribution were reported,
and (4) whether the exact P-value was reported.
RESULTS
Baseline characteristics of the included
studies are reported in Table 1. Note that PCBs
were measured using different methods and
metrics across the studies.
In the evaluated papers several different
statistical methods were applied to analyse the
identical research question of the relationship
between a quantitative response variable (birth
weight) and a quantitative exposure variable
(maternal PCB level). These included correlation
coefficient methods (Pearson correlation and nonparametric correlation coefficients) and linear
regression models where the full information
from continuous variables is utilized. In almost
half of the studies (11 of 24 studies) the PCB
levels were categorized to two or more groups,
and mean values of the birth weight between
exposure groups were compared using t-test,
analysis of variance or analysis of covariance.
However, categorizing continuous explanatory
variables is not recommended in statistical
literature [19, 20]. The statistical methods used
in the articles were as follows: correlation
coefficient in 6 articles (25.0%), univariate
linear regression (2 articles, 8.3%), multivariate
linear regression (16 articles, 66.7%), analysis
of covariance (5 articles, 20.8%), comparison
of mean values (8 articles, 33.3%) and nonparametric methods for comparing groups (6
articles, 25.0 %). Note that in some articles more
than one method was used.
In 18 of the publications included
in this review, information was collected
on potential confounding variables and
the reported regression coefficients were
adjusted for these confounding factors. Table
2 provides information about the covariates
and adjusted factors included in the estimated
regression models of the evaluated articles.
Biostatistics
TABLE 1
Baseline characteristics of the included studies
Study
Year of
data
collection
Place of
study
Population
PCB
assessment
Reported
PCB
variable
Bergonzi
[28]
2006
Province of
Brescia, Italy
Caucasian women, resident for >15

years in Brescia, undergoing planned
caesarean section at the University
Hospital of Brescia
Maternal serum
Sum of
30 PCB
congeners
Nice area, France
86 mothers delivering healthy boys

(gestational age 34 weeks) at two
maternity wards in Southern France
Mothers milk
Sum of
seven PCB
congeners
(28, 52, 101,
118, 138, 153,
180)
Mothers milk
Sum of
six PCB
congeners
(28, 52, 101,
138, 153,
180)
BruckerDavis [34]
2002-2005
Chao [35]
2001
Taichung, Taiwan
30 primipara mothers without clinical

complications between the ages 2035 in Chung Shan Medical University
Hospital
Fein [36]
1980-1981
Lake Michigan,
USA
Newly delivered mothers in four

hospitals located near Lake Michigan,
who were asked to report their
consumption of Lake Michigan fish
Cord serum
PCBs based
on Aroclor
1260
Maternal serum
PCBs based
on Aroclor
1254
Givens [37]
1976-1998
Michigan, USA
450 mothers from cohort of 4000

men, women and children who
had consumed contaminated food
products. These mothers conceived
and gave birth from 1973 to 1997 to
infants who were potentially exposed
in utero
Gladen [38]
1993-1994
Kyiv and
Dniprodzerzhinsk,
Ukraine
197 singleton infants drawn from the

general population born in two cities
(participants in Children of
Ukraine study)
Mothers milk
Sum of PCB
congeners
153 and 132
Faroe Islands
182 pregnant women with

spontaneous singleton term births
at the National Hospital in Trshavn.
The cohort was based on the primary
catchment area away from the capital
area of Trshavn
Maternal serum
Sum of 28
detectable
PCB
congeners
Denmark
100 nulliparous women who gave birth

to singleton full-term infants, aged 2535 years with normal pre-pregnancy
BMI were selected according to their
intake of fatty fish from the Danish
National Birth Cohort
Maternal serum
Sum of
six PCB
congeners
(105, 118,
138, 153,
156, 180)
1964-1967
San Francisco Bay

Area, USA
Subset of the Child Health and

Development study, a cohort of
about 20000 pregnant women either
attending prenatal clinics or giving
birth at Kaiser Foundation Health Plan
Medical Centers
Maternal serum
Sum of
nine PCB
congeners
Jackson [42]
1996-1999
16 New York
State Counties
surrounding Lakes
Erie and Ontario,
USA
Women enrolled in the Prospective

Pregnancy Study of the New York
State Angler Cohort Study prior to
attempting pregnancy
Maternal serum
Sum of
74 PCB
congeners
Karmaus [5]
1973-1991
Michigan, USA
Births that occurred after 1968 in

cohort of Michigan anglers (Great
Lakes Fish Eater Study)
Maternal serum
PCBs based
on Aroclor
1260
Grandjean
[39]
Halldorsson
[40]
HertzPicciotto [41]
1994-1995
1998-2002
e8854-5
Biostatistics
TABLE 1 (CONTINUED)
Baseline characteristics of the included studies
Study
Year of
data
collection
Place of
study
Population
PCB
assessment
Reported
PCB
variable
Maternal serum
Sum of
12 dioxinlike PCB
congeners
Maternal serum
Sum of
11 PCB
congeners
Cord serum
Sum of
14 PCB
congeners
Maternal serum
Sum of
76 PCB
congeners
Cord serum
Sum of
four PCB
congeners
(118, 138,
153, 180)
Konishi [43]
2002-2005
Sapporo,
Hokkaido, Japan
Inborn Infants delivered at the

Sapporo Toho Hospital. Mothers
were approached if they were 23rd35th weeks of gestation, and no
serious illness or any other medical
complications
Longnecker
[11]
1959-1965
12 U.S. study
centres
Pregnant women, delivery of a live-born

singleton and availability of a 3 mL
aliquot of third-trimester maternal serum
Lucas [44]
1993-1996
Nunavik, Canada
Murphy [12]
1995-1996
New York, USA
1990-1992
Rotterdam, The
Netherlands
Patandin
[45]
The population under study is

represented by Inuit women who
lived in 14 coastal villages of Nunavik
as well as their infants born at
the Tulattavik Health Centre and
Inuulitsivik Health Centre
A population-based prospective
cohort of preconception enrollment of
women. Eligibility criteria included age
18-34 years, no physician-diagnosed
infertility. Of the eligible women, 69
became pregnant and 55 of these
pregnancies resulted in live births
Infants born at term 37-42 weeks
of gestation, without congenital
anomalies or diseases. Participants
lived in Rotterdam or its immediate
surroundings
Ribas-Fito
[46]
1997-1999
Flix, Spain
All children born in the main hospital

of the study area
Cord serum
Sum of
seven PCB
congeners
(28, 52, 101,
118, 138, 153,
180)
Sagiv [13]
1993-1998
New Bedford,
Massachusetts,
USA
A cohort of 722 infants born to mothers

residing near a PCB-contaminated
harbor and Superfund site
Cord serum
Sum of
51 PCB
congeners
Maternal serum
Sum of
six PCB
congeners
(118, 138,
153, 156,
170, 180)
Sonneborn
[47]
2002-2004
Eastern Slovakia
Mother-child pairs recruited from

two districts: one with high PCB
contamination in the environment and
one with low levels of PCBs. Mothers
were enrolled at the time they came to
the hospital for delivery
Tajimi [24]
1999-2000
Tokyo, Japan
Pregnant 240 mothers aged 25-34

years who had resided in Tokyo for
more than 5 years
Mothers milk
Sum of 12
coplanar PCB
congeners
Tan [48]
2006
Singapore
41 native Singaporean mothers

admitted to the National Hospital of
Singapore for cesarean section
Cord serum
Sum of PCBs
132 and 153
Vartiainen
[49]
1987
Helsinki and
Kuopio, Finland
All consecutive women from one of the

maternity clinics in Helsinki and one
clinic in Kuopio, a total of 167 mothers
Mothers milk
No details
Weisskopf
[50]
1993-1995
Great Lakes
region, USA
Mothers consuming sport-caught fish
Maternal serum
No details
1998-2002
New York City,

USA
Ethnically diverse cohort of motherinfant pairs enrolled at Mount Sinai

Hospital during pregnancy, n=404
Maternal serum
Sum of
four PCB
congeners
(118, 138,
153, 180)
Wolff [29]
e8854-6
Biostatistics
A total of 6 articles reported only a bivariate

association between PCB exposure and birth
weight. These studies did not adjust the
association by other potential factors. In
12 studies gestational age was included as
a covariate in the regression model. Other
common analysed confounding variables
were gender, parity and the following
maternal characteristics: smoking, age,
height and body mass index (BMI).
A complete description of data analysis
procedures was not presented in 7 papers
(29.2%). Failure to describe the distribution of
the primary outcome variable was common;
of the 24 evaluated articles, mean value of
birth weight was not reported in five articles
(20,8%) and standard deviation was missing in
9 articles (37.5%). Location statistics of the PCB
level were missing in 3 articles and information
about the variation of PCB level was missing in
four articles. Furthermore, the exact p-value of
the main outcome was not reported in ten of
the 24 articles (41.7%).
We applied the formulas presented
in Appendix A (Supplementary Materials)
to transform the reported findings of the
reviewed PCB studies to standardized
regression coefficients. Table 3 presents the
estimated effect size of interest, namely
(standardized regression coefficient) with its
standard error for each study. We calculated
both unadjusted and adjusted regression
coefficients if the required data was reported
in the original study. In some studies basic
data was not shown and it was impossible to
calculate the effect size index. A random-effect
meta-analysis was performed to estimate
the overall effect sizes for unadjusted and
adjusted studies.
Figure 1 shows the results of meta-analysis
when standardized unadjusted regression
coefficient was used as an effect size. The
pooled estimate of regression coefficient was
-0.046 (95% CI: -0.095, 0.004). Figure 2 shows
the meta-analysis of standardized adjusted
regression coefficients. The pooled estimate for
the adjusted studies is similar to the unadjusted
cases: -0.039 (95% CI: -0.076, -0.001). The metaanalyses showed that the high maternal PCB
concentration seems to be related with low
birth weight.
DISCUSSION
Because many original studies for various
reasons are relatively small and differ in
their statistical content, it is important to
have practicable research methods to combine
findings from different studies to describe
the relationships between exposures and
outcomes. Such information is important for
policy-makers and authorities when they
make recommendations and guidelines for the
population. This article presents an approach
for the synthesis of an association between
a quantitative dependent variable and one
main explanatory factor when the exposure
measurement methods and controlling of
other potential covariates varies between the
reviewed studies. We described a method on
how it is possible to develop a workable effect
size statistic that can be applied to the research
findings of interest. We applied this method in
a systematic review of studies that evaluated
the effect of PCB exposure on infant birth
weight. In this meta-analysis we found a weak
negative correlation between these variables.
Our findings are in line with a recent
meta-analysis report within 12 European birth
cohorts [15]. In their study, Govarts et al.
[15] had access to the original data from the
cohorts and used PCB-153 congener as a
biomarker of PCB exposure. Using identical
exposure variable definitions or conversation
factors they estimated for each cohort linear
regression model of birth weight on cord
serum concentration of PCB-153 adjusted for
selected covariates. Meta-analysis produced a
combined regression coefficient -0.15 (95% CI:
-0.24, -0-05) of cord serum PCB-153 (ug/L),
corresponding to a weight decline of 150 g
per 1 g/L increase in cord serum PCB-153. If
we apply our estimated regression coefficient
(-0.039) to the combined data of Govarts
et al. [15] where the standard deviation of
combined cord serum PCB-153 was 0.16 g/L
and estimated (given by supplemental material)
standard deviation of birth weight was 556 gr
then we get a weight decline of 22 g per 0.16
g/L and a decline of 6.25*22 g = 137.5 g per 1
g/L. We conclude that our method to combine
findings across different published studies with
different statistical content support the findings
from combined cohorts with identical variables
and methods.
e8854-7
Biostatistics
TABLE 2
Covariates and adjusted factors used in the evaluated 24 articles
Study
Birth outcomes
Maternal factors
Birth
GA Gender
Parity Smoking Age Education Height Weight BMI Race
year
Other
Bergonzi [28]
Unadjusted
BruckerDavis [34]
Unadjusted
Chao [35]
Unadjusted
Fein [36]
Givens [37]
X
X
Gladen [38]
Halldorsson
[40]
X
X
HertzPicciotto [41]
Grandjean
[39]
Type of delivery, maternal

weight gain during
pregnancy
X
X
X
X
City
Plasma lipid
concentration
Prenatal care,
hypertension, preeclampsia, childs race,
specimen characteristics,
medication
Jackson [42]
Unadjusted
Karmaus [5]
Konishi [43]
Longnecker
[11]
X
X
DDE
Inshore fish intake, blood
sampling period
Lucas [44]
Unadjusted
Murphy [12]
Patandin [45]
Ribas-Fito
[46]
Sagiv [13]
Sonneborn
[47]
Tajimi [24]
Tan [48]
X
X
X
Alcohol use, predicted
height
X
X
Local fish consumption
Inter-pregnancy interval
Dietary, meat, milk,

post pregnancy weight
and BMI, previous
breastfeeding
Vartiainen
[49]
Unadjusted
Weisskopf
[50]
Wolff [29]
e8854-8
Study center, serum level

of triglycerides, cholesterol,
oxychlordane, DDE
X
X
Alcohol use during

pregnancy, weeks of
breastfeeding
X
X
Pregnancy weight gain
Biostatistics
TABLE 3
Number of study subjects (n), mean value of birth weight (g) (Mean BW) by gender, estimated
standard deviation of birth weight (BW SD), statistical method used, unadjusted and adjusted
standardized regression coefficient with standard deviation SE() for each evaluated study
Study
Mean BW
Estimated
Multiple
Bivariate Comparison Unadjusted
Boys Girls All
BW SD
Bergonzi [28]
70
3385 3021 3245
466
Brucker-Davis [34]
65
3275
3275
423
-0.240 0.122
Chao [35]
30
3140
278
- 0.214 0.185
Fein [36]
241
3520
552
regression correlation of means
dns
dns
SE()
-0.110 0.103
Adjusted
SE()
na2
na
-0.136 0.063
Givens [37]
814
3636 3442 3551
533
-0.013 0.035 -0.021 0.035
Gladen [38]
162
3433
486
-0.004 0.031 -0.101 0.064
Grandjean [39]
182
3801 3537 3672
484
Halldorsson [40]
100
3580
435
-0.161 0.107 -0.273 0.119
Hertz-Picciotto [41]
399
dns
dns
-0.180 0.150
Jackson [42]
44
3482
565
Karmaus [5]
168
3457
482
-0.067 0.216
-0.035 0.151
-0.104 0.217 -0.444 0.270
Konishi [43]
398
3160 3046 3100
349
-0.087 0.053
Longnecker [11]
1034
3193
531
0.021 0.071 0.112 0.084
Lucas [44]
351
3567 3438 3502
441
0.158 0.102
Murphy [12]
50
3500
580
-0.110 0.103
Patandin [45]
179
3514 3411 3466
437
-0.091 0.041
Ribas-Fito [46]
70
3245
489
Sagiv [13]
722
3416
dns
Sonneborn [47]
1057
3325
497
Tajimi [24]
240
dns
dns
Tan [48]
41
dns
dns
Vartiainen [49]
167
3742 3535 3630
527
Weisskopf [50]
143
3544
561
-0.005 0.031
X
na
na
na
0.010 0.0251
X
-0.141 0.064
na
na
-0.080 0.080
X
-0.095 0.078
0.028 0.069
Wolff [29]
178
dns
dns
X
dns = data not shown in the article, 2 na = not applicable due to incomplete reporting
El Majidi et al. [14] have also evaluated

20 published epidemiological studies of the
relationship between PCBs and birth weight.
The reviewed papers were mainly the same
as in our study. To facilitate comparisons of
results from different papers, El Majidi et al.
[14] applied conversion factors to standardize
the reported exposure data. Their review of the
relationship is more narrative as the authors
categorize the studies to those with an observed
effect and to ones with non-observed effect
on birth weight. They provide no statistical
mechanism for synthesizing the data. They
conclude that there is a low probability of
PCB-related effects on birth weight. However,
decisions based on simple counting statistically
significant and non-significant studies can be
na
na
na
misleading, especially as the number of studies

increases [17, 21]. Approach proposed in our
paper allows reviewers to assess the magnitude
of the effect, even when direct comparison of
studies is difficult.
There are some forms of research findings
that cannot readily be combined in a metaanalysis using established effect size statistics
[4]. These include findings generated by
multivariable analysis, e.g. multiple regression,
discriminant analysis, factor analysis and
structural equation models. Their complexity
and diversity across studies with regard
to the selection of variables and reporting
practices has made it difficult to develop effect
size statistics for these forms of research.
e8854-9
Biostatistics
FIGURE 1
Observed 95% confidence intervals of the unadjusted standardized regression coefficients
from 12 studies estimating the relationship between PCB exposure and infant birth weight
Study name
Statistics for each study
Point estimate and 95% CI
Point
estimate
Lower limit
Upper limit
p-Value
Bergonzi
-0.110
-0.311
0.091
0.283
Brucker-Davis
-0.240
-0.480
-0.000
0.050
Chao
-0.214
-0.576
0.148
0.246
Givens
-0.013
-0.082
0.055
0.704
Gladen
-0.004
-0.065
0.056
0.894
Halldorsson
-0.161
-0.371
0.048
0.132
Jackson
-0.035
-0.330
0.260
0.816
Karmaus
-0.104
-0.528
0.321
0.632
Longnecker
0.021
-0.118
0.160
0.765
Lucas
0.158
-0.041
0.357
0.120
Tajimi
-0.141
-0.267
-0.015
0.028
Vartiainen
-0.095
-0.248
0.057
0.220
Combined effect
-0.046
-0.095
0.004
0.070
FIGURE 2
Observed 95% confidence intervals of the adjusted standardized regression coefficients from 15
studies estimating the relationship between PCB exposure and infant birth weight.
The adjusted covariates are reported in Table 2
Study name
Statistics for each study
Point estimate and 95% CI
Point
estimate
Lower limit
Upper limit
Fein
-0.136
-0.259
-0.013
0.031
Givens
-0.021
-0.090
0.048
0.546
p-Value
Gladen
0.010
-0.116
0.136
0.875
Grandjean
-0.070
-0.511
0.371
0.756
Halldorsson
-0.273
-0.507
-0.040
0.022
Hertz-Picciotto
-0.088
-0.382
0.206
0.559
Karmaus
-0.444
-0.973
0.085
0.100
Konishi
-0.087
-0.192
0.018
0.105
Longnecker
0.112
-0.054
0.277
0.185
Murphy
-0.110
-0.311
0.092
0.285
Patandin
-0.091
-0.171
-0.011
0.026
Ritas-Fito
-0.005
-0.066
0.056
0.876
Sonneborn
0.010
-0.039
0.059
0.690
Tan
-0.080
-0.237
0.077
0.317
Weiskopf
0.028
-0.107
0.163
0.682
Combined effect
-0.039
-0.076
-0.001
0.042
e8854-10
Biostatistics
Multivariable regression is a flexible method

of data analysis that may be appropriate
whenever a quantitative dependent variable is
to be examined in relationship with any other
predictor variables [16, 22]. The synthesis of
regression coefficients has received increased
attention in recent years due to increased
use of multivariable methods in medicine
[23]. Becker and Wu [23] present a review
of existing methods for the synthesis of
regression coefficients and summarizes the
main strengths and weaknesses of these
methods. According to Becker and Wu [23] the
main problems with these methods include
different measurement scales of explanatory
variables across studies and lack of required
information in the study reports.
To estimate the independent effect of
PCBs on birth weight, the effect of these other
covariates should be controlled or adjusted
for [16]. Our review revealed differences in
the choice of adjusted factors. This is partly
understandable because many factors related
to the mother modify human foetal growth
process in different ways [9, 10]. However,
two covariates could be of crucial importance
for the interpretation of findings, namely
gestational age affecting birth weight and
mothers consumption of fish affecting personal
PCB level and possibly also birth weight.
While results from most of the studies were
routinely adjusted for gestational age, two
studies decided not to adjust for gestational age
because gestational age is in the causal pathway
and not a confounder [12, 24]. Schisterman et
al. [25] discussed also this issue and argued that
adjustment by gestational age is unnecessary
or even potential source of bias, because
adjustment by gestational age does not alter
the expectation of the causal effect between
PCB level and birth weight but may affect the
precision of the estimated effect.
Statistical
methods
naturally
play
a significant role in the studies pursuing
associations between explanatory variables
and health outcomes [22, 26]. Unfortunately,
medical research articles have included poor
reporting of statistical methods [3, 27]. The
existence of this problem was evident in the
set of articles evaluated for this review. In some
cases [13, 24, 28, 29] incomplete reporting of
statistics in the studies limited or prevented the
use of these studies in this systematic review.

Most of the shortcomings in reporting of
statistical information in the articles reviewed
here were related to basic fundamental topics
that are covered in basic introductory books of
medical statistics. The main outward reporting
of an original research paper should consist
of statistical expressions, which summarize
the raw data used in the research, including
location and variability statistics. The reporting
of estimated multivariable regression models
needs attachments such as tables and
figures reporting descriptive statistics about
the distributions of response variables and
explanatory variables. This would help other
researchers to utilize the results in their
approaches to summarize and meta-analyse the
magnitude of the effects.
A standard method of reporting would
certainly improve the ability to compare
different studies. There are initiatives which
provide guidance on how to appropriately
report observational research. One of them is
the STROBE Statement aimed to establish a
checklist of items that should be included in
articles reporting such observational studies
[30]. Authors should follow these guidelines.
Statistical methods used in studies should
not be the basis for inclusion of the studies
in meta-analysis [31]. Statistical text books
note that the same research question can be
analysed with different statistical methods [32,
33]. Our evaluation revealed that this applies
also to the association between two quantitative
variables (birth weight and PCB level) with
potential confounding factors involved. There
was variation in variable measurement methods,
transformations, descriptive statistics and
inference methods. We included studies with
various designs, analyses or methodological
quality. This resulted in variability among the
studies, but also reflects the reality when trying
to summarize the findings from observational
studies. Comparison of the effect sizes produced
by different statistical techniques is a challenge
for readers, reviewers and especially those
wanting to carry out a meta-analysis. Our
approach based on standardized regression
coefficients provides a workable effect size index
when inference about the size and strength of
effects in published studies are sought.
e8854-11
Biostatistics
Acknowledgments and grant information:

the research leading to these results has received funding
from the European Communitys Seventh Framework
Programme FP7/2007-2013 - Environment (including
Climate Change) FP7-ENV-2008-1 - under grant
agreement number 226534-ArcRisk.
appendix a
In this appendix we describe how to
calculate
the
standardised
regression
coefficient effect size and its standard error
SE() in different research approaches of the
original studies.
1. If value, the standardized regression
coefficient, is reported from the estimated
linear regression model, it is used as the effect
size. Standard error is obtained from model
output (if reported), from reported confidence
interval, or from test statistic to test the
hypotheses: = 0.
response Y and exposure X. We obtained the

effect size statistic by applying the same
formula as in previous item 3 when b was the
adjusted regression coefficient [16].
5. In some articles mean values of the
response variable are compared between low
and high exposure groups. We can first calculate
the (Cohens or Hedges) mean difference effect
size statistic
where y1 is the mean response value

in the low exposure group, y2 is the mean
response value in the high exposure group
and SD(within) is the within-groups standard
deviation, pooled across groups [4, 17].
Then we can convert from mean difference
(d) to correlation coefficient r using the formula
2. If in an unadjusted analysis, Pearson or

Spearman correlation coefficient r is reported,
equals to r and
where a is a correction factor for cases
n1 n2,
[4, 17].
3. If a study reports the results of a simple
linear regression Y = a + b X, value can be
obtained by applying formula
where SD(Y) is the standard deviation of

response variable in the study and SD(X) is the
standard deviation of exposure measure used
in the study [51, 52].
The standard error for beta is obtained as
follows:
4. Several articles have estimated

multivariable linear regression model to report
the adjusted regression coefficient b between
e8854-12
[17]. If n1 n2 then a = 4 [17, 53].

standard error for r is given by
The
where SE(d) is the standard error of mean

difference d.
6. In some articles the authors have
used analysis of variance to compare the
mean response values between more than two
groups with different ordered exposure levels.
We applied the linear trend test (by performing
linear regression analysis with the group
means as dependent variable and contrast as
explanatory variable)[54]. We obtained the
with SE() as follows:
Biostatistics
SD(between) is the between groups mean sum

of squares (standard deviation) and n=total
number of subjects [55].
where SD(contrast) is the SD for explanatory

contrast values and SD(X) is standard deviation
of the exposure variable X and b is the effect
size for trend.
2. If minimum and maximum (or lower and

upper quartile) value of response variable was
given, we estimated SD by applying formulas
appendix b
We have used the following procedures:
1. If SD of response variable was given in
k different sub-groups, SD was obtained using
formula
where SD(pooled) is the within-groups

standard deviation pooled across groups,
[56, 57]
3. If standard error of response Y or
confidence interval for mean value of response
Y were reported, we obtained SD(Y) by
applying the formulas
If SE(Y) was not given, we obtained it from

the confidence interval.
References
[1] Cooper H, Hedges LV. Research synthesis as a
scientific enterprise. In: Cooper H, Hedges LV,
editors. The handbook of research synthesis. New
York: Russell Sage Foundation; 1994: 3-14
[2] Chene G, Thompson SG. Methods for summarizing
the risk associations of quantitative variables in
epidemiologic studies in a consistent form. Am J
Epidemiol 1996; 144(6): 610-21
[3] Nieminen P, Carpenter J, Rucker G, Schumacher M. The
relationship between quality of research and citation
frequency. BMC Med Res Methodol 2006; 6: 42
[4] Lipsey MW, Wilson DB. Practical meta-analysis.
London: SAGE Publications, 2001
[5] Karmaus W, Zhu X. Maternal concentration of
polychlorinated biphenyls and dichlorodiphenyl
dichlorethylene and birth weight in Michigan fish
eaters: a cohort study. Environ Health 2004; 3(1): 1
[6] Baibergenova A, Kudyakov R, Zdeb M, Carpenter
DO. Low birth weight and residential proximity
to PCB-contaminated waste sites. Environ Health
Perspect 2003; 111(10): 1352-7
[7] Maiorana A, Del BC, Cianfarani S. Adipose Tissue:
[8]
[9]
[10]
[11]
[12]
[13]
A Metabolic Regulator. Potential Implications for

the Metabolic Outcome of Subjects Born Small for
Gestational Age (SGA). Rev Diabet Stud 2007; 4(3):
134-46
Miles HL, Hofman PL, Cutfield WS. Fetal origins of
adult disease: a paediatric perspective. Rev Endocr
Metab Disord 2005; 6(4): 261-8
Murphy VE, Smith R, Giles WB, Clifton VL. Endocrine
regulation of human fetal growth: the role of the mother,
placenta, and fetus. Endocr Rev 2006; 27(2): 141-69
Muthayya S. Maternal nutrition & low birth weight
- what is really important? Indian J Med Res 2009;
130(5): 600-8
Longnecker MP, Klebanoff MA, Brock JW, Guo X.
Maternal levels of polychlorinated biphenyls in
relation to preterm and small-for-gestational-age
birth. Epidemiology 2005; 16(5): 641-7
Murphy LE, Gollenberg AL, Buck Louis GM, et al.
Maternal serum preconception polychlorinated
biphenyl concentrations and infant birth weight.
Environ Health Perspect 2010; 118(2): 297-302
Sagiv SK, Tolbert PE, Altshul LM, Korrick SA.
e8854-13
Biostatistics
Organochlorine exposures during pregnancy and

infant size at birth. Epidemiology 2007; 18(1): 120-9
[14] El Majidi N, Bouchard M, Gosselin NH, Carrier
G. Relationship between prenatal exposure to
polychlorinated biphenyls and birth weight: a
systematic analysis of published epidemiological
studies through a standardization of biomonitoring
data. Regul Toxicol Pharmacol 2012; 64(1): 161-76
[15] Govarts E, Nieuwenhuijsen M, Schoeters G,
et al. Birth Weight and Prenatal Exposure
to Polychlorinated Biphenyls (PCBs) and
Dichlorodiphenyldichloroethylene (DDE): A Metaanalysis within 12 European Birth Cohorts. Environ
Health Perspect 2012; 120(2): 162-70
[16] Vittinghoff E, Glidden DV, Shiboski SC, McCulloch
CE. Regression methods in biostatistics: linear,
logistic, survival and repeated measures models.
Springer, 2005
[17] Borenstein M, Hedges LV, Higgins JPT, Rothstein HR.
Introduction to Meta-Analysis. Chichester: Wiley, 2009
[18] Shadish WR, Haddock CK. Combining estimates
of effect size. In: Cooper H, Hedges LV, editors.
Handbook of research synthesis. New York: Russell
Sage Foundation; 1994: 261-81
[19] Royston P, Altman DG, Sauerbrei W. Dichotomizing
continuous predictors in multiple regression: a bad
idea. Stat Med 2006; 25(1): 127-41
[20] Sauerbrei W, Royston P, Binder H. Selection of
important variables and determination of functional
form for continuous predictors in multivariable model
building. Stat Med 2007; 26(30): 5512-28
[21] Becker BJ. Combining significance levels. In: Cooper H,
Hedges LV, editors. The handbook of research synthesis.
New York: Russell Sage Foundation; 1994: 215-30
[22] Nieminen P, Miettunen J, Koponen H, Isohanni M. Statistical
methodologies in psychopharmacology: a review. Hum
Psychopharmacol Clin Exp 2006; 21(3): 195-203
[23] Becker BJ, Wu M-J. The synthesis of regression slopes
in meta-analysis. Statistical Science 2007; 22(3): 414-29
[24] Tajimi M, Uehara R, Watanabe M, et al. Relationship
of PCDD/F and Co-PCB concentrations in breast
milk with infant birthweights in Tokyo, Japan.
Chemosphere 2005; 61(3): 383-8
[25] Schisterman EF, Cole SR, Platt RW. Overadjustment
bias and unnecessary adjustment in epidemiologic
studies. Epidemiology 2009; 20(4): 488-95
[26] Horton NJ, Switzer SS. Statistical methods in the
journal. N Engl J Med 2005; 353(18): 1977-9
[27] Altman DG. Statistical reviewing for medical journals.
Stat Med 1998; 17(23): 2661-74
[28] Bergonzi R, De PG, Specchia C, et al. Persistent
organochlorine compounds in fetal and maternal
e8854-14
[29]
[30]
[32]
[33]
[34]
[35]
[36]
[37]
[38]
[39]
[40]
[41]
tissues: evaluation of their potential influence on

several indicators of fetal growth and health. Sci
Total Environ 2011; 409(15): 2888-93
Wolff MS, Engel S, Berkowitz G, et al. Prenatal
pesticide and PCB exposures and birth outcomes.
Pediatr Res 2007; 61(2): 243-50
von Elm E, Altman DG, Egger M, et al. The
Strengthening the Reporting of Observational Studies
in Epidemiology (STROBE) statement: guidelines
for reporting observational studies. J Clin Epidemiol
2008; 61(4): 344-9 [31] Blair A, Burg J, Foran J,
et al. Guidelines for application of meta-analysis
in environmental epidemiology. ISLI Risk Science
Institute. Regul Toxicol Pharmacol 1995; 22(2): 189-97
Lang T, Secic M. How to report statistics in medicine.
Philadelphia: American College of Physicians, 1997
Royston P, Sauerbrei W. Multivariable modelbuilding: A Pragmatic Approach to Regression
Anaylsis based on Fractional Polynomials for
Modelling Continuous Variables. Chichester: John
Wiley & Sons, 2008
Brucker-Davis F, Wagner-Mahler K, Bornebusch L,
et al. Exposure to selected endocrine disruptors and
neonatal outcome of 86 healthy boys from Nice area
(France). Chemosphere 2010; 81(2): 169-76
Chao HR, Wang SL, Lin LY, et al. Polychlorinated
biphenyls in taiwanese primipara human milk and
associated factors. Bull Environ Contam Toxicol 2003;
70(6): 1097-103
Fein GG, Jacobson JL, Jacobson SW, et al. Prenatal
exposure to polychlorinated biphenyls: effects on birth
size and gestational age. J Pediatr 1984; 105(2): 315-20
Givens ML, Small CM, Terrell ML, et al. Maternal
exposure to polybrominated and polychlorinated
biphenyls: infant birth weight and gestational age.
Chemosphere 2007; 69(8): 1295-304
Gladen BC, Shkiryak-Nyzhnyk ZA, et al. Persistent
organochlorine compounds and birth weight. Ann
Epidemiol 2003; 13(3): 151-7
Grandjean P, Bjerve KS, Weihe P, Steuerwald U.
Birthweight in a fishing community: significance of
essential fatty acids and marine food contaminants.
Int J Epidemiol 2001; 30(6): 1272-8
Halldorsson TI, Thorsdottir I, Meltzer HM, et al.
Linking exposure to polychlorinated biphenyls with
fatty fish consumption and reduced fetal growth
among Danish pregnant women: a cause for concern?
Am J Epidemiol 2008; 168(8): 958-65
Hertz-Picciotto I, Charles MJ, James RA, et al. In utero
polychlorinated biphenyl exposures in relation to
fetal and early childhood growth. Epidemiology 2005;
16(5): 648-56
Biostatistics
[42] Jackson LW, Lynch CD, Kostyniak PJ, et al. Prenatal

and postnatal exposure to polychlorinated biphenyls
and child size at 24 months of age. Reprod Toxicol
2010; 29(1): 25-31
[43] Konishi K, Sasaki S, Kato S, et al. Prenatal exposure
to PCDDs/PCDFs and dioxin-like PCBs in relation to
birth weight. Environ Res 2009; 109(7): 906-13
[44] Lucas M, Dewailly E, Muckle G, et al. Gestational age
and birth weight in relation to n-3 fatty acids among
Inuit (Canada). Lipids 2004; 39(7): 617-26
[45] Patandin S, Koopman-Esseboom C, de Ridder MA, et al.
Effects of environmental exposure to polychlorinated
biphenyls and dioxins on birth size and growth in
Dutch children. Pediatr Res 1998; 44(4): 538-45
[46] Ribas-Fito N, Sala M, Cardo E, et al. Association
of hexachlorobenzene and other organochlorine
compounds with anthropometric measures at birth.
Pediatr Res 2002; 52(2): 163-7
[47] Sonneborn D, Park HY, Petrik J, et al. Prenatal
polychlorinated biphenyl exposures in eastern Slovakia
modify effects of social factors on birthweight.
Paediatr Perinat Epidemiol 2008; 22(3): 202-13
[48] Tan J, Loganath A, Chong YS, Obbard JP. Exposure
to persistent organic pollutants in utero and related
maternal characteristics on birth outcomes: a
multivariate data analysis approach. Chemosphere
2009; 74(3): 428-33
[49] Vartiainen T, Jaakkola JJ, Saarikoski S, Tuomisto J.
[50]
[51]
[52]
[53]
[54]
[55]
[56]
[57]
Birth weight and sex of children and the correlation

to the body burden of PCDDs/PCDFs and PCBs of the
mother. Environ Health Perspect 1998; 106(2): 61-6
Weisskopf MG, Anderson HA, Hanrahan LP, et al.
Maternal exposure to Great Lakes sport-caught fish
and dichlorodiphenyl dichloroethylene, but not
polychlorinated biphenyls, is associated with reduced
birth weight. Environ Res 2005; 97(2): 149-62
DeCoster J. Meta-analysis notes. Statistical notes 2009.
Available from: http://www.stat-help.com/notes.html
[Accessed May 7, 2012]
Draper NR, Smith H. Applied regression analysis.
Third edition . New York: John Wiley & Sons, 1998
Rosenthal R. Parametric measures of effect size.
In: Cooper H, Hedges LV, editors. The handbook
of research synthesis. New York: Russell Sage
Foundation; 1994
Altman DG. Practical statistics for medical research.
London: Chapman and Hall, 1991
Armitage P, Berry G, Matthews JNS. Statistical
methods in medical research. Fourth edition. Oxford:
Blackwell Science, 2002
Higgins JPT, Green S. Cochrane handbook for
systematic reviews of interventions. Chichester:
Wiley-Blackwell, 2009
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean
and variance from the median, range, and the size of
a sample. BMC Med Res Methodol 2005; 5: 13
e8854-15

Standardised Regression Coefficient-Metaanalysis

Uploaded by

Copyright:

Available Formats

Standardised Regression Coefficient-Metaanalysis

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Standardised Regression Coefficient-Metaanalysis

Uploaded by

Copyright:

Available Formats

Epidemiology Biostatistics and Public Health - 2013, Volume 10, Number 4