Funnel plot
Encyclopedia
A funnel plot is a useful graph designed to check the existence of publication bias
Publication bias
Publication bias is the tendency of researchers, editors, and pharmaceutical companies to handle the reporting of experimental results that are positive differently from results that are negative or inconclusive, leading to bias in the overall published literature...

 in systematic review
Systematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

s and meta-analyses
Meta-analysis
In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses. In its simplest form, this is normally by identification of a common measure of effect size, for which a weighted average might be the output of a meta-analyses. Here the...

. It assumes that the largest studies will be near the average, and small studies will be spread on both sides of the average. Variation from this assumption can indicate publication bias.

Quotation

Funnel plots, introduced by Light and Pillemer in 1984
and discussed in detail by Egger and colleagues,
are useful adjuncts to meta-analyses. A funnel plot is a scatterplot
Scatterplot
A scatter plot or scattergraph is a type of mathematical diagram using Cartesian coordinates to display values for two variables for a set of data....

 of treatment effect against a measure of study size. It is used primarily as a visual aid to detecting bias or systematic heterogeneity
Study heterogeneity
In statistics, study heterogeneity is a problem that can arise when attempting to undertake a meta-analysis. Ideally, the studies whose results are being combined in the meta-analysis should all be undertaken in the same way and to the same experimental protocols: study heterogeneity is a term used...

. A symmetric
Symmetry
Symmetry generally conveys two primary meanings. The first is an imprecise sense of harmonious or aesthetically pleasing proportionality and balance; such that it reflects beauty or perfection...

 inverted funnel shape arises from a ‘well-behaved’ data set, in which publication bias is unlikely. An asymmetric funnel indicates a relationship between treatment effect and study size. This suggests the possibility of either publication bias
Publication bias
Publication bias is the tendency of researchers, editors, and pharmaceutical companies to handle the reporting of experimental results that are positive differently from results that are negative or inconclusive, leading to bias in the overall published literature...

 or a systematic difference between smaller and larger studies (‘small study effects’). Asymmetry can also arise from use of an inappropriate effect measure. Whatever the cause, an asymmetric funnel plot leads to doubts over the appropriateness of a simple meta-analysis and suggests that there needs to be investigation of possible causes.

A variety of choices of measures of ‘study size’ is available, including total sample size, standard error
Standard error (statistics)
The standard error is the standard deviation of the sampling distribution of a statistic. The term may also be used to refer to an estimate of that standard deviation, derived from a particular sample used to compute the estimate....

 of the treatment effect, and inverse variance
Variance
In probability theory and statistics, the variance is a measure of how far a set of numbers is spread out. It is one of several descriptors of a probability distribution, describing how far the numbers lie from the mean . In particular, the variance is one of the moments of a distribution...

 of the treatment effect (weight
Weight function
A weight function is a mathematical device used when performing a sum, integral, or average in order to give some elements more "weight" or influence on the result than other elements in the same set. They occur frequently in statistics and analysis, and are closely related to the concept of a...

). Sterne and Egger have compared these with others, and conclude that the standard error is to be recommended.
When the standard error is used, straight lines may be drawn to define a region within which 95% of points might lie in the absence of both heterogeneity and publication bias.

In common with confidence interval
Confidence interval
In statistics, a confidence interval is a particular kind of interval estimate of a population parameter and is used to indicate the reliability of an estimate. It is an observed interval , in principle different from sample to sample, that frequently includes the parameter of interest, if the...

 plots, funnel plots are conventionally drawn with the treatment effect measure on the horizontal axis
Cartesian coordinate system
A Cartesian coordinate system specifies each point uniquely in a plane by a pair of numerical coordinates, which are the signed distances from the point to two fixed perpendicular directed lines, measured in the same unit of length...

, so that study size appears on the vertical axis, breaking with the general rule. Since funnel plots are principally visual aids for detecting asymmetry along the treatment effect axis, this makes them considerably easier to interpret.

Criticism

The funnel plot is not without problems.
If high precision studies really are different than low precision studies with respect to effect size
Effect size
In statistics, an effect size is a measure of the strength of the relationship between two variables in a statistical population, or a sample-based estimate of that quantity...

 (e.g., due different populations examined) a funnel plot may give a wrong impression of publication bias.
The appearance of the funnel plot can change quite dramatically depending on the scale on the y-axis — whether it is the inverse square error or the trial size.

Further reading

  • Adapted from Cochrane
    Cochrane Collaboration
    The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...

     Handbook for Systematic Reviews
    Systematic review
    A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...

    of Interventions
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