TY - JOUR
T1 - Cross-classified multilevel models improved standard error estimates of covariates in clinical outcomes – a simulation study
AU - Doedens, Paul
AU - ter Riet, Gerben
AU - Boyette, Lindy Lou
AU - Latour, Corine
AU - de Haan, Lieuwe
AU - Twisk, Jos
N1 - Publisher Copyright: © 2022
PY - 2022/5
Y1 - 2022/5
N2 - Objective: To compare estimates of effect and variability resulting from standard linear regression analysis and hierarchical multilevel analysis with cross-classified multilevel analysis under various scenarios. Study design and setting: We performed a simulation study based on a data structure from an observational study in clinical mental health care. We used a Markov chain Monte Carlo approach to simulate 18 scenarios, varying sample sizes, cluster sizes, effect sizes and between group variances. For each scenario, we performed standard linear regression, multilevel regression with random intercept on patient level, multilevel regression with random intercept on nursing team level and cross-classified multilevel analysis. Results: Applying cross-classified multilevel analyses had negligible influence on the effect estimates. However, ignoring cross-classification led to underestimation of the standard errors of the covariates at the two cross-classified levels and to invalidly narrow confidence intervals. This may lead to incorrect statistical inference. Varying sample size, cluster size, effect size and variance had no meaningful influence on these findings. Conclusion: In case of cross-classified data structures, the use of a cross-classified multilevel model helps estimating valid precision of effects, and thereby, support correct inferences.
AB - Objective: To compare estimates of effect and variability resulting from standard linear regression analysis and hierarchical multilevel analysis with cross-classified multilevel analysis under various scenarios. Study design and setting: We performed a simulation study based on a data structure from an observational study in clinical mental health care. We used a Markov chain Monte Carlo approach to simulate 18 scenarios, varying sample sizes, cluster sizes, effect sizes and between group variances. For each scenario, we performed standard linear regression, multilevel regression with random intercept on patient level, multilevel regression with random intercept on nursing team level and cross-classified multilevel analysis. Results: Applying cross-classified multilevel analyses had negligible influence on the effect estimates. However, ignoring cross-classification led to underestimation of the standard errors of the covariates at the two cross-classified levels and to invalidly narrow confidence intervals. This may lead to incorrect statistical inference. Varying sample size, cluster size, effect size and variance had no meaningful influence on these findings. Conclusion: In case of cross-classified data structures, the use of a cross-classified multilevel model helps estimating valid precision of effects, and thereby, support correct inferences.
KW - Cross-classification
KW - Epidemiology
KW - Multilevel modelling
KW - Nursing science
KW - Simulation study
UR - http://www.scopus.com/inward/record.url?scp=85124221995&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2022.01.005
DO - 10.1016/j.jclinepi.2022.01.005
M3 - Article
C2 - 35065230
SN - 0895-4356
VL - 145
SP - 39
EP - 46
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -