Letter to the editor: Beyond the odds ratios: Why risk ratios offer clearer clinical insight in comparative surgical meta-analyses

jpedsurg.org

The odds ratio (OR) and the risk ratio (RR) are valid measures of association but differ substantially in interpretability and magnitude when outcomes are common. The RR compares event probabilities directly, whereas the OR compares odds, diverging from risks as event frequency increases. When events are rare, both measures approximate each other; however, with higher incidences, ORs increasingly overestimate RRs, potentially exaggerating the apparent effect size (Cochrane Handbook, Chapter 6.4.1.3) (“Problems may arise if the odds ratio is misinterpreted as a risk ratio.

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Article · Aug 2025 · 1 min read

In brief

This letter clarifies the critical distinction between odds ratios and risk ratios in surgical meta-analyses, emphasizing that risk ratios provide more intuitive clinical interpretation. When outcomes are common, odds ratios can substantially overestimate effect sizes compared to risk ratios, potentially misleading clinical decision-making.

Odds ratios (OR) and risk ratios (RR) diverge substantially when outcomes are common, with ORs overestimating effect size.
Risk ratios compare event probabilities directly, making them more clinically interpretable than odds ratios.
When event rates are high, misinterpreting an OR as an RR can exaggerate the apparent treatment effect.
For rare outcomes, OR and RR approximate each other; for common outcomes, prefer RR for clearer clinical communication.

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