Testing the agreement of medical instruments: Overestimation of bias in the Bland–Altman analysis |
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| Institution: | 1. Julius Centre University of Malaya, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;2. Department of Applied Statistics, Faculty of Economics & Administration, University of Malaya, 50603, Kuala Lumpur, Malaysia;1. Department of Computer and Information Technology Engineering, Amirkabir University of Technology, Tehran, Iran;2. Division of Electronics and Electrical Engineering, Department of Engineering, Salman Farsi University of Kazeroon, Kazeroon, Iran;1. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;2. Department of Biostatistics, School of Public Health, Shandong University, Jinan, China;3. Department of Endocrinology and Metabolism, the First Hospital of Xiamen, Xiamen University, Xiamen, China;1. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;2. Departments of Pathology and Laboratory Medicine and Biochemistry, Western University, London, ON N6A 3K7, Canada;3. Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON N6A 5W9, Canada;4. Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada;5. Escarpment Cancer Research Institute, Hamilton, ON L8V 5C2, Canada;1. Department of Burn Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China;2. Department of Orthopedics, Second Affiliated Hospital of Zhejiang University School of Medicine (Binjiang Branch), Hangzhou, China;2. Centre Universitaire d''Ophtalmologie, Centre Hospitalier de Quebec, Quebec, Ont.;3. Case Western Reserve University, Cleveland, OH |
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| Abstract: | ObjectivesThe Bland–Altman method is the most popular method used to assess the agreement of medical instruments. The main concern about this method is the presence of proportional bias. The slope of the regression line fitted to the Bland–Altman plot should be tested to exclude proportional bias. The aim of this study was to determine whether the overestimation of bias in the Bland–Altman analysis is still present even when the proportional bias has been excluded.MethodsData were collected from participants attending a workplace health screening program in a public university in Malaysia between 2009 and 2010. Variables collected were blood glucose level, body weight and systolic blood pressure (n = 300 per variable). Readings from the original clinical dataset were compared with twenty randomly generated datasets for each variable. The Bland–Altman limits of agreement was used to determine the agreement. The presence of proportional bias was excluded for all datasets using the recommended method.ResultsThe range of predicted bias was higher than the simulated bias for all datasets. The overestimation of bias increased as the range of actual bias increased.ConclusionTesting the slope of regression line of the Bland–Altman plot does not remove the artifactual bias in the prediction. |
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