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Network meta-analysis: application and practice using R software
Sung Ryul Shim, Seong-Jang Kim, Jonghoo Lee, Gerta Rücker
Epidemiol Health. 2019;41:e2019013.   Published online April 8, 2019
DOI: https://doi.org/10.4178/epih.e2019013
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
The objective of this study is to describe the general approaches to network meta-analysis that are available for quantitative data synthesis using R software. We conducted a network meta-analysis using two approaches: Bayesian and frequentist methods. The corresponding R packages were “gemtc” for the Bayesian approach and “netmeta” for the frequentist approach. In estimating a network meta-analysis model using a Bayesian framework, the “rjags” package is a common tool. “rjags” implements Markov chain Monte Carlo simulation with a graphical output. The estimated overall effect sizes, test for heterogeneity, moderator effects, and publication bias were reported using R software. The authors focus on two flexible models, Bayesian and frequentist, to determine overall effect sizes in network meta-analysis. This study focused on the practical methods of network meta-analysis rather than theoretical concepts, making the material easy to understand for Korean researchers who did not major in statistics. The authors hope that this study will help many Korean researchers to perform network meta-analyses and conduct related research more easily with R software.
Summary
Korean summary
통계프로그램으로서의 R이 대세인 연구환경에서 R을 활용한 체계적인 메타분석 안내서가 요구되어지며 본 연구는 이에 대한 좋은 해답이 될 것이다. 더욱이 본 연구는 네트워크 메타분석 (Network meta-analysis)의 이론과 더불어 R을 활용한 실습위주의 내용으로 구성되어져 있어 누구나 쉽게 실행할 수 있을 것이다. 본 연구를 통하여 많은 연구자들이 보다 쉽게 본인의 연구분야에 적용하여 관련 연구가 활성화되기를 바란다.

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Original Article
Comparison of estimates and time series stability of Korea Community Health Survey and Korea National Health and Nutrition Examination Survey
Ji Son Ki, Ho Kim
Epidemiol Health. 2019;41:e2019012.   Published online April 7, 2019
DOI: https://doi.org/10.4178/epih.e2019012
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In South Korea, there are two nationwide health surveys conducted by the Korea Centers for Disease Control and Prevention: the Korea Community Health Survey (KCHS) and Korea National Health and Nutrition Examination Survey (KNHANES). The two surveys are directly comparable, as they have the same target population with some common items, and because both surveys are used in various analyses, identifying the similarities and disparities between the two surveys would promote their appropriate use. Therefore, this study aimed to compare the estimates of six variables in KCHS and eight variables in KNHANES over a six-year period and compare time series stability of region-specific and sex- and age-specific subgroup estimates.
METHODS
Data from adults aged 19 years or older in the 2010-2015 KCHS and KNHANES were examined to analyze the differences of estimates and 95% confidence interval for self-rated health, current smoking rate, monthly drinking rate, hypertension diagnosis rate, diabetes diagnosis rate, obesity prevalence, hypertension prevalence, and diabetes prevalence. The variables were then clustered into subgroups by city as well as sex and age to assess the time series stability of the estimates based on mean square error.
RESULTS
With the exception of self-rated health, the estimates taken based on questionnaires, namely current smoking rate, monthly drinking rate, hypertension diagnosis rate, and diabetes diagnosis rate, only differed by less than 1.0%p for both KCHS and KNHANES. However, for KNHANES, estimates taken from physical examination data, namely obesity prevalence, hypertension prevalence, and diabetes prevalence, differed by 1.9-8.4%p, which was greater than the gap in the estimates taken from questionnaires. KCHS had a greater time series stability for subgroup estimates than KNHANES.
CONCLUSIONS
When using the data from KCHS and KNHANES, the data should be selected and used based on the purpose of analysis and policy and in consideration of the various differences between the two data.
Summary
Korean summary
본 연구는 지역사회건강조사와 국민건강영양조사의 2010년부터 2015년까지 6년간의 자료로 각각 6개, 8개 변수의 추정치를 비교하였다. 설문변수 간의 추정치 차이보다 설문변수와 검진변수간의 추정치의 더 차이가 컸고 하위그룹별 시계열 변동은 지역사회건강조사가 더 안정적이었다.

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Methods
Network meta-analysis: application and practice using Stata
Sungryul Shim, Byung-Ho Yoon, In-Soo Shin, Jong-Myon Bae
Epidemiol Health. 2017;39:e2017047.   Published online October 27, 2017
DOI: https://doi.org/10.4178/epih.e2017047
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This review aimed to arrange the concepts of a network meta-analysis (NMA) and to demonstrate the analytical process of NMA using Stata software under frequentist framework. The NMA tries to synthesize evidences for a decision making by evaluating the comparative effectiveness of more than two alternative interventions for the same condition. Before conducting a NMA, 3 major assumptions—similarity, transitivity, and consistency—should be checked. The statistical analysis consists of 5 steps. The first step is to draw a network geometry to provide an overview of the network relationship. The second step checks the assumption of consistency. The third step is to make the network forest plot or interval plot in order to illustrate the summary size of comparative effectiveness among various interventions. The fourth step calculates cumulative rankings for identifying superiority among interventions. The last step evaluates publication bias or effect modifiers for a valid inference from results. The synthesized evidences through five steps would be very useful to evidence-based decision-making in healthcare. Thus, NMA should be activated in order to guarantee the quality of healthcare system.
Summary
Korean summary
같은 치료 목적을 가진 여러 치료법들 간의 효과를 상호 비교한 결과들을 통합하기 위해 개발된 네트워크 메타분석 (NMA) 결과는 의사결정의 우선순위를 정하는데 있어 가장 상위의 과학적 설득력을 갖는다. STATA 통계프로그램에서 제공하는 빈도주의 틀에 기반한 NMA를 수행하는데 점검해야 할 가정들과 실제 적용 과정을 소개한다.

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Original Article
A Comparison of Occupation, Education, and Cause of Death from National Death Certificates and Deaths Data Due to Workplace Injuries from WELCO in Korea.
Mia Son
Korean J Epidemiol. 2001;23(2):44-51.
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AbstractAbstract PDF
Abstract
PURPOSE
The variables (occupation, education, cause of death, age, and sex) on death certificates can be used for health related studies, however, there has been little research on health related studies using death certificates in Korea. Also, the validity of the values of these variables on death certificates is questionable in Korea. Therefore, we compared occupation, data obtained from WELCO(Korea Labour Welfare Corporation) between 1995 and 1997.
METHODS
WELCO data on deaths due to workplace injury between 1995-1997 were merged with data from NSO on deaths occurring during the same period, using social security numbers. Out of a total of 7,698 deaths due to workplace injury reported to WELCO between 1995 and 1997, final study population are linked to 6,513 deaths among aged 20-64 between 1995 and 1997. On linking the data sets, two different sources of data are cross-tabulated to determine the percentage of agreement. Expected agreement and Kappa index are also calculated.
RESULTS
The results are as follows : Some manual workers are promoted into the non-manual group in the national death data from the National Statistics Office. Educational groups are promoted or demoted between NSO and WELCO death data. The Kappa index for occupational group is 0.49 when the occupational groups are categorised as manual and non-manual workers. The Kappa index is 0.50 in the two-category classification for education : beyond and below university levels; 0.32 in the three-category classification : university, high-school and less than middle-school; 0.25 in the four category classification : university, high-school, middle-school and less than elementary school. The Kappa index is 0.69 for the three-category disease classification : injury, poisoning and certain other consequences of external causes (S00-T98, ICD10), disease of the circulatory system(I00-I99, ICD10) and other disease categories except the two-category classification. The Kappa index for the 5-year age band is 0.99. There is no disagreement for the sex.
CONCLUSIONS
The comparison between national workplace injury data and national death data and tells us that occupational and educational variables are not in the range of 'excellent agreement' suggested by Koch(1997). Our comparison study suggests strong prediction of random errors as well as systemic errors. As for the cause of death, injury and cardiovascular disease from the NSO data are well-matched with those from the WELCO workplace injury death data. However, this comparison may have a limitation as the present study is confined to comparing only the categories of infury and cardiovascular disease. This study suggests that national death data as well as workplace injury data need to be improved for use as health indicators in studies relating socio-economic factors and working conditions to mortality in Korea.
Summary

Epidemiol Health : Epidemiology and Health