239 Meta-analysis female sex and mortality in SAB 10 eAppendix 3. Description of EPC approach. We used the Evidence-based Practice Center (EPC) model from the U.S. Agency for Healthcare Research and Quality (AHRQ) to grade the overall strength of evidence [20]. The EPC approach evaluates the following domains: study limitations/risk of bias, consistency, directness, precision, and reporting bias. In brief, the EPC classification system applies an overall strength of evidence grade rating to an estimate effect from a body of evidence: high (we are very confident that the estimate of effect lies close to the true effect for this outcome), moderate (we are moderately confident that the estimate of effect lies close to the true effect for this outcome), low (we have limited confidence that the estimate of effect lies close to the true effect for this outcome), or insufficient (we have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome). The initial strength of evidence grade was moderate given that the included observational studies in the primary adjusted analysis reduced bias from confounding through matching or statistical adjustment [20]. This baseline category could be rated down if the included studies demonstrated high risk of bias, imprecision, inconsistency, indirectness, or reporting bias. eTable 1 (next page). Newcastle-Ottawa quality assessment of individual studies The Newcastle-Ottawa Quality Assessment Scale determines a study’s risk of bias through nine questions (detailed in Appendix 2). For each study, the grades for the nine questions are shown below. Grades that receive a star are highlighted in green, while those that do not are highlighted in red. Based on the grades from each question in the Newcastle-Ottawa Scale, an overall risk of bias (high, medium, low) can be assigned (detailed in Appendix 2).
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