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When studies reported relative risks with different degrees of statistical adjustment for confounding, we used the most adjusted estimate.
Wherever possible, we used the most adjusted estimate available.
For each study, we have plotted the most adjusted estimate of relative risk of breast cancer for women with high levels of oestradiol in that study compared with women with low oestradiol, together with a weighted average of the results from all the studies.
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If several estimates for one study outcome were reported, the most fully adjusted estimate was abstracted.
The sensitivity analysis in which the most fully adjusted estimates were used resulted in a relationship similar to that found in the main analysis.
Most studies (68) presented adjusted estimates, but eight reported only unadjusted estimates and another eight adjusted only for basic demographic information.
The estimates are again little affected by preferring least, rather than most, adjusted RRs, with the estimates now 3.41 (3.00-3.87) for COPD, 3.43 (3.12-3.77) for CB and 4.32 (2.40-7.78) for emphysema.
Individual study estimates of risk (e.g. hazard ratio) can be influenced by which adjustment factors are used (Rushton and Jones, 1992), and so there may be an additional reporting bias concern if researchers specifically only report those adjusted estimates with the most statistically significant result.
Alternatively, using RRs selected as most adjusted for other aspects of smoking, the overall estimate was 1.34 (1.16-1.56, n = 14).
Data from 15 studies providing adjusted estimates were extracted.
Inverse probability weighting (IPW) adjusted estimates.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com