Developing more generalizable prediction models from pooled studies and large clustered data sets

de Jong, Valentijn M. T.; Moons, Karel G. M.; Eijkemans, Marinus J. C.; Riley, Richard D.; Debray, Thomas P. A.

Abstract

Prediction models often yield inaccurate predictions for new individuals. Large data sets from pooled studies or electronic healthcare records may alleviate this with an increased sample size and variability in sample characteristics. However, existing strategies for prediction model development generally do not account for heterogeneity in predictor-outcome associations between different settings and populations. This limits the generalizability of developed models (even from large, combined, clustered data sets) and necessitates local revisions. We aim to develop methodology for producing prediction models that require less tailoring to different settings and populations. We adopt internal-external cross-validation to assess and reduce heterogeneity in models' predictive performance during the development. We propose a predictor selection algorithm that optimizes the (weighted) average performance while minimizing its variability across the hold-out clusters (or studies). Predictors are added iteratively until the estimated generalizability is optimized. We illustrate this by developing a model for predicting the risk of atrial fibrillation and updating an existing one for diagnosing deep vein thrombosis, using individual participant data from 20 cohorts (N = 10 873) and 11 diagnostic studies (N = 10 014), respectively. Meta-analysis of calibration and discrimination performance in each hold-out cluster shows that trade-offs between average and heterogeneity of performance occurred. Our methodology enables the assessment of heterogeneity of prediction model performance during model development in multiple or clustered data sets, thereby informing researchers on predictor selection to improve the generalizability to different settings and populations, and reduce the need for model tailoring. Our methodology has been implemented in the R package metamisc.

Citation

de Jong, V. M. T., Moons, K. G. M., Eijkemans, M. J. C., Riley, R. D., & Debray, T. P. A. (2021). Developing more generalizable prediction models from pooled studies and large clustered data sets. Statistics in Medicine, 40(15), 3533-3559. https://doi.org/10.1002/sim.8981

• Journal Article Type: Article
• Acceptance Date: Mar 22, 2021
• Online Publication Date: May 5, 2021
• Publication Date: Jul 10, 2021
• Publicly Available Date: May 30, 2023
• Journal: STATISTICS IN MEDICINE
• Print ISSN: 0277-6715
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 15
• Pages: 3533-3559
• DOI: https://doi.org/10.1002/sim.8981
• Keywords: heterogeneity; individual participant data; internal‐ external cross‐ validation; prediction
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1002/sim.8981