Study-type module for dose-response meta-analyses. Provides section-by-section guidance for modelling non-linear exposure-outcome relationships using restricted cubic splines, Greenland and Longnecker trend estimation, and two-stage pooling. Follows PRISMA 2020 with dose-response-specific extensions.
This module governs manuscript generation for dose-response meta-analyses. These analyses estimate the shape of the relationship between a quantified exposure (dose, duration, intake, biomarker level) and a health outcome across multiple studies. Because no dedicated reporting guideline exists for dose-response meta-analyses, this module follows PRISMA 2020 with dose-response-specific extensions drawn from the foundational methodological literature.
There is no dedicated PRISMA extension for dose-response meta-analyses. The manuscript should follow the standard PRISMA 2020 statement:
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Supplemented with methodological standards from the foundational dose-response meta-analysis literature:
Berlin JA, Longnecker MP, Greenland S. Meta-analysis of epidemiologic dose-response data. Epidemiology. 1993;4(3):218-228.
Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135(11):1301-1309.
Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6(1):40-57.
When citing the approach in the Methods section, use the following phrasing:
"This systematic review and dose-response meta-analysis was conducted and reported in accordance with PRISMA 2020 (Page et al., BMJ 2021;372:n71), with dose-response modelling following the methods of Greenland and Longnecker (Am J Epidemiol 1992;135:1301-1309) and Orsini et al. (Stata J 2006;6:40-57)."
See references/dose-response-guidelines.md for a summary of the
methodological standards.
State the prospective registration. Template sentences:
"The protocol for this systematic review and dose-response meta-analysis was registered prospectively with PROSPERO (registration number CRD42XXXXXXX). The protocol specified the eligibility criteria, the dose-response modelling strategy including the choice of spline model, and the pre-specified sensitivity analyses."
Specify that eligible studies must report results for at least three quantified exposure categories. Template sentences:
"Studies were eligible if they reported risk estimates (odds ratios, relative risks, or hazard ratios) with 95% confidence intervals for at least three quantified categories of [exposure] in relation to [outcome]. The requirement for three or more categories was necessary to estimate the dose-response trend using the generalised least-squares method of Greenland and Longnecker."
"Studies reporting only dichotomous exposure (exposed vs unexposed) or continuous exposure without category-specific estimates were excluded. Case reports, ecological studies, and cross-sectional studies were excluded. Both cohort studies and case-control studies reporting adjusted estimates were eligible."
List all databases and supplementary sources. Template sentences:
"A systematic search was conducted across MEDLINE (via PubMed), Embase (via Elsevier), and Web of Science from inception to [date]. Reference lists of included studies and published dose-response meta-analyses on [topic] were hand-searched. The full search strategy is provided in the Supplementary Materials (eTable 1)."
Describe the specific data required for dose-response modelling. Template