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Table 3 Summary of findings table using the GRADE approach

From: Association between inflammatory bowel disease and chronic obstructive pulmonary disease: a systematic review and meta-analysis

Association between IBD and COPD

Patient or population: COPD

Setting:

Intervention: IBD

Comparison: Control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence (GRADE)

Comments

Risk with Control

Risk with Airways disease

Risk of IBD in COPD patients (IBD-COPD)

128 per 100,000

355 per 100,000 (263 to 481)

RR 2.02 (1.56 to 2.63)

660,463 (4 observational studies)

Low a,b,c

Despite association between IBD and COPD was consistently elevated. Lack of confounding analysis by tobacco exposure would suggest a spurious effect

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence

High certainty: We are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect

Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

  1. RR: Relative ratio, CI: Confidence interval. IBD: Inflammatory Bowel Disease, COPD: Chronic Obstructive Pulmonary Disease. CD: Crohn’s Disease; UC: Ulcerative colitis
  2. Explanations
  3. a. Risk of bias due to confounding variables, selection of participants (unclear diagnosis or ICD-9 criteria without a confirmation test) and selection of reported results
  4. b. Type of IBD (CD or UC) was the main explanation for heterogeneity. However, residual heterogeneity was low for CD and high for UC
  5. c. Serious publication bias after funnel plot inspection