Journal Article

Limitations of the Odds Ratio in Gauging the Performance of a Diagnostic, Prognostic, or Screening Marker

Margaret Sullivan Pepe, Holly Janes, Gary Longton, Wendy Leisenring and Polly Newcomb

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 159, issue 9, pages 882-890
Published in print May 2004 | ISSN: 0002-9262
Published online May 2004 | e-ISSN: 1476-6256 | DOI:
Limitations of the Odds Ratio in Gauging the Performance of a Diagnostic, Prognostic, or Screening Marker

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A marker strongly associated with outcome (or disease) is often assumed to be effective for classifying persons according to their current or future outcome. However, for this assumption to be true, the associated odds ratio must be of a magnitude rarely seen in epidemiologic studies. In this paper, an illustration of the relation between odds ratios and receiver operating characteristic curves shows, for example, that a marker with an odds ratio of as high as 3 is in fact a very poor classification tool. If a marker identifies 10% of controls as positive (false positives) and has an odds ratio of 3, then it will correctly identify only 25% of cases as positive (true positives). The authors illustrate that a single measure of association such as an odds ratio does not meaningfully describe a marker’s ability to classify subjects. Appropriate statistical methods for assessing and reporting the classification power of a marker are described. In addition, the serious pitfalls of using more traditional methods based on parameters in logistic regression models are illustrated.

Keywords: biological markers; diagnostic test; logistic regression; odds ratio; ROC curve; screening test; Abbreviations: FPF, false-positive fraction; ROC, receiver operating characteristic; TPF, true-positive fraction.

Journal Article.  5452 words.  Illustrated.

Subjects: Public Health and Epidemiology

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