## 6.3 Influence Analyses

We have now showed you how you can detect and remove extreme effect sizes (outliers) in your meta-analysis.

As we’ve mentioned before in Chapter, however, it is not only statistical outliers which may cause concerns regarding the robustness of our pooled effect. It is also possible that some studies in a meta-analysis exert a very high influence on our overall results. For example, it could be the case that we find that an overall effect is not significant, when in fact, a highly significant effect is consistently found once we remove one particular study in our analysis. Such information is highly important once we want to communicate the results of our meta-analysis to the public.

Here, we present techniques which dig a little deeper than simple outlier removal. To some extent, they are based on the Leave-One-Out-method, in which we recalculate the results of our meta-analysis $$K-1$$ times, each times leaving out one study. This way, we can more easily detect studies which influence the overall estimate of our meta-analysis the most, and lets us better assess if this influence may distort our pooled effect (Viechtbauer and Cheung 2010). Thus, such analyses are called Influence Analyses.

We have created the function influence.analysis for you through which influences can be conducted all in one. For this function to work, you need to have the meta and metafor packages installed and loaded in your library.

Again, R doesn’t know this function yet, so we have to let R learn it by copying and pasting the code underneath in its entirety into the console on the bottom left pane of RStudio, and then hit Enter ⏎.

influence.analysis<-function(data,method.tau,hakn){

influence.data<-data
TE<-data$TE seTE<-data$seTE
method.tau<-method.tau
hakn<-hakn

if(hakn == TRUE){
res <- rma(yi=TE, sei=seTE, measure="ZCOR",
data=influence.data,
method = paste(method.tau),
test="knha")
res
inf <- influence(res)
influence.data<-metainf(data)
influence.data$I2<-format(round(influence.data$I2,2),nsmall=2)
plot(inf)
baujat(data)
forest(influence.data,
sortvar=I2,
rightcols = c("TE","ci","I2"),
smlab = "Sorted by I-squared")
forest(influence.data,
sortvar=TE,
rightcols = c("TE","ci","I2"),
smlab = "Sorted by Effect size")

} else {

res <- rma(yi=TE, sei=seTE, measure="ZCOR",
data=influence.data,
method = paste(method.tau))
res
inf <- influence(res)
influence.data<-metainf(data)
influence.data$I2<-format(round(influence.data$I2,2),nsmall=2)
plot(inf)
baujat(data)
forest(influence.data,
sortvar=I2,
rightcols = c("TE","ci","I2"),
smlab = "Sorted by I-squared")
forest(influence.data,
sortvar=TE,
rightcols = c("TE","ci","I2"),
smlab = "Sorted by Effect size")
}}  

The influence.analysis function has three parameters which we have to define in the function.

Code Description
data The output object from our meta-analysis. In my case, this is ‘data=m.hksj’
method.tau The method we used to estimate tau-squared (see Chapter 4.2.1). If you haven’t set the estimator ‘method.tau’ in your analysis, use ‘DL’ because the DerSimonian-Laird estimator is the default in meta
hakn Weather we used the Knapp-Hartung-Sidik-Jonkman adjustments. If yes, use hakn=TRUE. If not, use hakn=FALSE

This is how the function code looks for my m.hksj data:

influence.analysis(data=m.hksj,method.tau = "SJ", hakn = TRUE)

Now, let’s have a look at the output.

As you can see, the influence.analysis function gives us various types of plots as output. Let’s interpret them one by one.

Influence Analyses

In the first analysis, you can see different influence measures, for which we can see graphs including each individual study of our meta-analysis. This type of influence analysis has been proposed by Viechtbauer and Cheung (Viechtbauer and Cheung 2010). We’ll discuss the most important ones here:

• dffits: The DIFFITS value of a study indicates in standard deviations how much the predicted pooled effect changes after excluding this study
• cook.d: The Cook’s distance resembles the Mahalanobis distance you may know from outlier detection in conventional multivariate statistics. It is the distance between the value once the study is included compared to when it is excluded
• cov.r: The covariance ratio is the determinant of the variance-covariance matrix of the parameter estimates when the study is removed, divided by the determinant of the variance-covariance matrix of the parameter estimates when the full dataset is considered. Importantly, values of cov.r < 1 indicate that removing the study will lead to a more precise effect size estimation (i.e., less heterogeneity).

Usually, however, you don’t have to dig this deep into the calculations of the individual measures. As a rule of thumb, influential cases are studies with very extreme values in the graphs. Viechtbauer and Cheung have also proposed cut-offs when to define a a study as an influential case, for example (with $$p$$ being the number of model coefficients and $$k$$ the number of studies):

$DFFITS > 3\times\sqrt{\frac{p}{k-p}}$ $hat > 3\times\frac{p}{k}$

If a case was determined being an influential case using these cut-offs, its value will be displayed in red (in our example, this is the case for study number 3).

Please note, as Viechtbauer & Cheung emphasize, that these cut-offs are set on somewhat arbitrary thresholds. Therefore, you should never only have a look on the color of the study, but the general structure of the graph, and interpret results in context.

In our example, we see that while only Study 3 is defined as an influential case, there are actually two spiked in most plots, while the other studies all quite have the same value. Given this structure, we could also decide to define Study 16 as an influential case too, because its values are very extreme too.

Let’s have a look what the 3rd and 16th study in our m.hksj meta-analysis output were.

m.hksj\$studlab[c(3,16)]
## [1] "DanitzOrsillo"  "Shapiro et al."

This is an interesting finding, as we detected the same studies when only looking at statistical outliers. This further corroborates that these two studies could maybe have distorted our pooled effect estimate, and might cause parts of the between-group heterogeneity we found in our meta-analysis.

Baujat Plot

The Baujat Plot (Baujat et al. 2002) is a diagnostic plot to detect studies overly contributing to the heterogeneity of a meta-analysis. The plot shows the contribution of each study to the overall heterogeneity as measured by Cochran’s Q on the horizontal axis, and its influence on the pooled effect size on the vertical axis. As we want to assess heterogeneity and studies contributing to it, all studies on the right side of the plot are important to look at, as this means that they cause much of the heterogeneity we observe. This is even more important when a study contributes much to the overall heterogeneity, while at the same time being not very influential concerning the overall pooled effect (e.g., because the study had a very small sample size). Therefore, all studies on the right side of the Baujat plot, especially in the lower part, are important for us.

As you might have already recognized, the only two studies we find in those regions of the plot are the two studies we already detected before (Danitz & Orsillo, Shapiro et al.). These studies don’t have a large impact on the overall results (presumably because they are very small), but they do add substantially to the heterogeneity we found in the meta-analysis.

Leave-One-Out Analyses

In these to forest plots, we see the pooled effect recalculated, with one study omitted each time. There are two plots, which provide the same data, but are ordered by different values.

The first plot is ordered by heterogeneity (low to high), as measured by I2 . We see in the plot that the lowest I2 heterogeneity is reached (as we’ve seen before) by omitting the studies Danitz & Orsillo and Shapiro et al.. This again corroborates our finding that these two studies were the main “culprits” for the between-study heterogeneity we found in the meta-analysis.

The second plot is ordered by effect size (low to high). Here, we see how the overall effect estimate changes with one study removed. Again, as the two outlying studies have very high effect sizes, we find that the overall effect is smallest when they are removed.

All in all, the results of our outlier and influence analysis in this example point in the same direction. The two studies are probably outliers which may distort the effect size estimate, as well as its precision. We should therefore also conduct and report a sensitivity analysis in which these studies are excluded.

The influence analysis function for fixed-effect-model meta-analyses

The influence.analysis function we presented above can only be used for random-effect meta-analyses. If you want to perform influence analyses for meta-analyses in which you pooled the effects with a fixed-effect model, you will have to use the influence.analysis.fixed function, which can be found here.

To use this function, you only have to set the parameter data, as method.tau and hakn only apply to random-effect-models.

### References

Viechtbauer, Wolfgang, and Mike W-L Cheung. 2010. “Outlier and Influence Diagnostics for Meta-Analysis.” Research Synthesis Methods 1 (2). Wiley Online Library: 112–25.

Baujat, Bertrand, Cédric Mahé, Jean-Pierre Pignon, and Catherine Hill. 2002. “A Graphical Method for Exploring Heterogeneity in Meta-Analyses: Application to a Meta-Analysis of 65 Trials.” Statistics in Medicine 21 (18). Wiley Online Library: 2641–52.