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The origins and uses of regression analysis

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Statistical techniques are tools that enable us to answer questions about possible patterns in empirical data. It is not surprising, then, to learn that many important techniques of statistical analysis were developed by scientists who were interested in answering very specific empirical questions. So it was with regression analysis. The history of this particular statistical technique can be traced back to late nineteenth-century England and the pursuits of a gentleman scientist, Francis Galton. Galton was born into a wealthy family that produced more than its share of geniuses; he and Charles Darwin, the famous biologist, were first cousins. During his lifetime, Galton studied everything from fingerprint classification to meteorology, but he gained widespread recognition primarily for his work on inheritance. His most important insight came to him while he was studying the inheritance of one of the most obvious of all human characteristics: height. In order to understand how the characteristic of height was passed from one generation to the next, Galton collected data on the heights of individuals and the heights of their parents. After constructing frequency tables that classified these individuals both by their height and by the average height of their parents, Galton came to the unremarkable conclusion that tall people usually had tall parents and short people usually had short parents.

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(1997). The origins and uses of regression analysis. In: Understanding Regression Analysis. Springer, Boston, MA. https://doi.org/10.1007/978-0-585-25657-3_1

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• Published: 31 January 2022

The clinician’s guide to interpreting a regression analysis

• Sofia Bzovsky 1 ,
• Mark R. Phillips   ORCID: orcid.org/0000-0003-0923-261X 2 ,
• Robyn H. Guymer   ORCID: orcid.org/0000-0002-9441-4356 3 , 4 ,
• Charles C. Wykoff 5 , 6 ,
• Lehana Thabane   ORCID: orcid.org/0000-0003-0355-9734 2 , 7 ,
• Mohit Bhandari   ORCID: orcid.org/0000-0001-9608-4808 1 , 2 &
• Varun Chaudhary   ORCID: orcid.org/0000-0002-9988-4146 1 , 2

on behalf of the R.E.T.I.N.A. study group

Eye volume  36 ,  pages 1715–1717 ( 2022 ) Cite this article

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• Outcomes research

Introduction

When researchers are conducting clinical studies to investigate factors associated with, or treatments for disease and conditions to improve patient care and clinical practice, statistical evaluation of the data is often necessary. Regression analysis is an important statistical method that is commonly used to determine the relationship between several factors and disease outcomes or to identify relevant prognostic factors for diseases [ 1 ].

This editorial will acquaint readers with the basic principles of and an approach to interpreting results from two types of regression analyses widely used in ophthalmology: linear, and logistic regression.

Linear regression analysis

Linear regression is used to quantify a linear relationship or association between a continuous response/outcome variable or dependent variable with at least one independent or explanatory variable by fitting a linear equation to observed data [ 1 ]. The variable that the equation solves for, which is the outcome or response of interest, is called the dependent variable [ 1 ]. The variable that is used to explain the value of the dependent variable is called the predictor, explanatory, or independent variable [ 1 ].

In a linear regression model, the dependent variable must be continuous (e.g. intraocular pressure or visual acuity), whereas, the independent variable may be either continuous (e.g. age), binary (e.g. sex), categorical (e.g. age-related macular degeneration stage or diabetic retinopathy severity scale score), or a combination of these [ 1 ].

When investigating the effect or association of a single independent variable on a continuous dependent variable, this type of analysis is called a simple linear regression [ 2 ]. In many circumstances though, a single independent variable may not be enough to adequately explain the dependent variable. Often it is necessary to control for confounders and in these situations, one can perform a multivariable linear regression to study the effect or association with multiple independent variables on the dependent variable [ 1 , 2 ]. When incorporating numerous independent variables, the regression model estimates the effect or contribution of each independent variable while holding the values of all other independent variables constant [ 3 ].

When interpreting the results of a linear regression, there are a few key outputs for each independent variable included in the model:

Estimated regression coefficient—The estimated regression coefficient indicates the direction and strength of the relationship or association between the independent and dependent variables [ 4 ]. Specifically, the regression coefficient describes the change in the dependent variable for each one-unit change in the independent variable, if continuous [ 4 ]. For instance, if examining the relationship between a continuous predictor variable and intra-ocular pressure (dependent variable), a regression coefficient of 2 means that for every one-unit increase in the predictor, there is a two-unit increase in intra-ocular pressure. If the independent variable is binary or categorical, then the one-unit change represents switching from one category to the reference category [ 4 ]. For instance, if examining the relationship between a binary predictor variable, such as sex, where ‘female’ is set as the reference category, and intra-ocular pressure (dependent variable), a regression coefficient of 2 means that, on average, males have an intra-ocular pressure that is 2 mm Hg higher than females.

Confidence Interval (CI)—The CI, typically set at 95%, is a measure of the precision of the coefficient estimate of the independent variable [ 4 ]. A large CI indicates a low level of precision, whereas a small CI indicates a higher precision [ 5 ].

P value—The p value for the regression coefficient indicates whether the relationship between the independent and dependent variables is statistically significant [ 6 ].

Logistic regression analysis

As with linear regression, logistic regression is used to estimate the association between one or more independent variables with a dependent variable [ 7 ]. However, the distinguishing feature in logistic regression is that the dependent variable (outcome) must be binary (or dichotomous), meaning that the variable can only take two different values or levels, such as ‘1 versus 0’ or ‘yes versus no’ [ 2 , 7 ]. The effect size of predictor variables on the dependent variable is best explained using an odds ratio (OR) [ 2 ]. ORs are used to compare the relative odds of the occurrence of the outcome of interest, given exposure to the variable of interest [ 5 ]. An OR equal to 1 means that the odds of the event in one group are the same as the odds of the event in another group; there is no difference [ 8 ]. An OR > 1 implies that one group has a higher odds of having the event compared with the reference group, whereas an OR < 1 means that one group has a lower odds of having an event compared with the reference group [ 8 ]. When interpreting the results of a logistic regression, the key outputs include the OR, CI, and p-value for each independent variable included in the model.

Clinical example

Sen et al. investigated the association between several factors (independent variables) and visual acuity outcomes (dependent variable) in patients receiving anti-vascular endothelial growth factor therapy for macular oedema (DMO) by means of both linear and logistic regression [ 9 ]. Multivariable linear regression demonstrated that age (Estimate −0.33, 95% CI − 0.48 to −0.19, p  < 0.001) was significantly associated with best-corrected visual acuity (BCVA) at 100 weeks at alpha = 0.05 significance level [ 9 ]. The regression coefficient of −0.33 means that the BCVA at 100 weeks decreases by 0.33 with each additional year of older age.

Multivariable logistic regression also demonstrated that age and ellipsoid zone status were statistically significant associated with achieving a BCVA letter score >70 letters at 100 weeks at the alpha = 0.05 significance level. Patients ≥75 years of age were at a decreased odds of achieving a BCVA letter score >70 letters at 100 weeks compared to those <50 years of age, since the OR is less than 1 (OR 0.96, 95% CI 0.94 to 0.98, p  = 0.001) [ 9 ]. Similarly, patients between the ages of 50–74 years were also at a decreased odds of achieving a BCVA letter score >70 letters at 100 weeks compared to those <50 years of age, since the OR is less than 1 (OR 0.15, 95% CI 0.04 to 0.48, p  = 0.001) [ 9 ]. As well, those with a not intact ellipsoid zone were at a decreased odds of achieving a BCVA letter score >70 letters at 100 weeks compared to those with an intact ellipsoid zone (OR 0.20, 95% CI 0.07 to 0.56; p  = 0.002). On the other hand, patients with an ungradable/questionable ellipsoid zone were at an increased odds of achieving a BCVA letter score >70 letters at 100 weeks compared to those with an intact ellipsoid zone, since the OR is greater than 1 (OR 2.26, 95% CI 1.14 to 4.48; p  = 0.02) [ 9 ].

The narrower the CI, the more precise the estimate is; and the smaller the p value (relative to alpha = 0.05), the greater the evidence against the null hypothesis of no effect or association.

Simply put, linear and logistic regression are useful tools for appreciating the relationship between predictor/explanatory and outcome variables for continuous and dichotomous outcomes, respectively, that can be applied in clinical practice, such as to gain an understanding of risk factors associated with a disease of interest.

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R.E.T.I.N.A. study group

Varun Chaudhary 1,2 , Mohit Bhandari 1,2 , Charles C. Wykoff 5,6 , Sobha Sivaprasad 8 , Lehana Thabane 2,7 , Peter Kaiser 9 , David Sarraf 10 , Sophie J. Bakri 11 , Sunir J. Garg 12 , Rishi P. Singh 13,14 , Frank G. Holz 15 , Tien Y. Wong 16,17 , and Robyn H. Guymer 3,4

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Department of Surgery, McMaster University, Hamilton, ON, Canada

Sofia Bzovsky, Mohit Bhandari & Varun Chaudhary

Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada

Mark R. Phillips, Lehana Thabane, Mohit Bhandari & Varun Chaudhary

Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia

Robyn H. Guymer

Department of Surgery, (Ophthalmology), The University of Melbourne, Melbourne, VIC, Australia

Retina Consultants of Texas (Retina Consultants of America), Houston, TX, USA

Charles C. Wykoff

Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

Biostatistics Unit, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

Lehana Thabane

NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK

Sobha Sivaprasad

Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

Peter Kaiser

Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California, Los Angeles, CA, USA

David Sarraf

Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA

Sophie J. Bakri

The Retina Service at Wills Eye Hospital, Philadelphia, PA, USA

Sunir J. Garg

Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

Rishi P. Singh

Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

Department of Ophthalmology, University of Bonn, Bonn, Germany

Frank G. Holz

Singapore Eye Research Institute, Singapore, Singapore

Tien Y. Wong

Singapore National Eye Centre, Duke-NUD Medical School, Singapore, Singapore

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• Varun Chaudhary
• , Mohit Bhandari
• , Charles C. Wykoff
• , Sobha Sivaprasad
• , Lehana Thabane
• , Peter Kaiser
• , David Sarraf
• , Sophie J. Bakri
• , Sunir J. Garg
• , Rishi P. Singh
• , Frank G. Holz
• , Tien Y. Wong
•  & Robyn H. Guymer

Contributions

SB was responsible for writing, critical review and feedback on manuscript. MRP was responsible for conception of idea, critical review and feedback on manuscript. RHG was responsible for critical review and feedback on manuscript. CCW was responsible for critical review and feedback on manuscript. LT was responsible for critical review and feedback on manuscript. MB was responsible for conception of idea, critical review and feedback on manuscript. VC was responsible for conception of idea, critical review and feedback on manuscript.

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Correspondence to Varun Chaudhary .

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Competing interests.

SB: Nothing to disclose. MRP: Nothing to disclose. RHG: Advisory boards: Bayer, Novartis, Apellis, Roche, Genentech Inc.—unrelated to this study. CCW: Consultant: Acuela, Adverum Biotechnologies, Inc, Aerpio, Alimera Sciences, Allegro Ophthalmics, LLC, Allergan, Apellis Pharmaceuticals, Bayer AG, Chengdu Kanghong Pharmaceuticals Group Co, Ltd, Clearside Biomedical, DORC (Dutch Ophthalmic Research Center), EyePoint Pharmaceuticals, Gentech/Roche, GyroscopeTx, IVERIC bio, Kodiak Sciences Inc, Novartis AG, ONL Therapeutics, Oxurion NV, PolyPhotonix, Recens Medical, Regeron Pharmaceuticals, Inc, REGENXBIO Inc, Santen Pharmaceutical Co, Ltd, and Takeda Pharmaceutical Company Limited; Research funds: Adverum Biotechnologies, Inc, Aerie Pharmaceuticals, Inc, Aerpio, Alimera Sciences, Allergan, Apellis Pharmaceuticals, Chengdu Kanghong Pharmaceutical Group Co, Ltd, Clearside Biomedical, Gemini Therapeutics, Genentech/Roche, Graybug Vision, Inc, GyroscopeTx, Ionis Pharmaceuticals, IVERIC bio, Kodiak Sciences Inc, Neurotech LLC, Novartis AG, Opthea, Outlook Therapeutics, Inc, Recens Medical, Regeneron Pharmaceuticals, Inc, REGENXBIO Inc, Samsung Pharm Co, Ltd, Santen Pharmaceutical Co, Ltd, and Xbrane Biopharma AB—unrelated to this study. LT: Nothing to disclose. MB: Research funds: Pendopharm, Bioventus, Acumed—unrelated to this study. VC: Advisory Board Member: Alcon, Roche, Bayer, Novartis; Grants: Bayer, Novartis—unrelated to this study.

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Bzovsky, S., Phillips, M.R., Guymer, R.H. et al. The clinician’s guide to interpreting a regression analysis. Eye 36 , 1715–1717 (2022). https://doi.org/10.1038/s41433-022-01949-z

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DOI : https://doi.org/10.1038/s41433-022-01949-z

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• Understanding and interpreting regression analysis
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• http://orcid.org/0000-0002-7839-8130 Parveen Ali 1 , 2 ,
• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 3 , 4
• 1 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 2 Sheffiled University Interpersonal Violence Research Group , The University of Sheffiled SEAS , Sheffield , UK
• 3 Faculty of Nursing , Memorial University of Newfoundland , St. John's , Newfoundland and Labrador , Canada
• 4 Swat College of Nursing , Mingora, Swat , Pakistan
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St. John's, NL A1C 5S7, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103425

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• statistics & research methods

Introduction

A nurse educator is interested in finding out the academic and non-academic predictors of success in nursing students. Given the complexity of educational and clinical learning environments, demographic, clinical and academic factors (age, gender, previous educational training, personal stressors, learning demands, motivation, assignment workload, etc) influencing nursing students’ success, she was able to list various potential factors contributing towards success relatively easily. Nevertheless, not all of the identified factors will be plausible predictors of increased success. Therefore, she could use a powerful statistical procedure called regression analysis to identify whether the likelihood of increased success is influenced by factors such as age, stressors, learning demands, motivation and education.

What is regression?

Purposes of regression analysis.

Regression analysis has four primary purposes: description, estimation, prediction and control. 1 , 2 By description, regression can explain the relationship between dependent and independent variables. Estimation means that by using the observed values of independent variables, the value of dependent variable can be estimated. 2 Regression analysis can be useful for predicting the outcomes and changes in dependent variables based on the relationships of dependent and independent variables. Finally, regression enables in controlling the effect of one or more independent variables while investigating the relationship of one independent variable with the dependent variable. 1

Types of regression analyses

There are commonly three types of regression analyses, namely, linear, logistic and multiple regression. The differences among these types are outlined in table 1 in terms of their purpose, nature of dependent and independent variables, underlying assumptions, and nature of curve. 1 , 3 However, more detailed discussion for linear regression is presented as follows.

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Comparison of linear, logistic and multiple regression

Linear regression and interpretation

Linear regression analysis involves examining the relationship between one independent and dependent variable. Statistically, the relationship between one independent variable (x) and a dependent variable (y) is expressed as: y= β 0 + β 1 x+ε. In this equation, β 0 is the y intercept and refers to the estimated value of y when x is equal to 0. The coefficient β 1 is the regression coefficient and denotes that the estimated increase in the dependent variable for every unit increase in the independent variable. The symbol ε is a random error component and signifies imprecision of regression indicating that, in actual practice, the independent variables are cannot perfectly predict the change in any dependent variable. 1 Multiple linear regression follows the same logic as univariate linear regression except (a) multiple regression, there are more than one independent variable and (b) there should be non-collinearity among the independent variables.

Factors affecting regression

Linear and multiple regression analyses are affected by factors, namely, sample size, missing data and the nature of sample. 2

Small sample size may only demonstrate connections among variables with strong relationship. Therefore, sample size must be chosen based on the number of independent variables and expect strength of relationship.

Many missing values in the data set may affect the sample size. Therefore, all the missing values should be adequately dealt with before conducting regression analyses.

The subsamples within the larger sample may mask the actual effect of independent and dependent variables. Therefore, if subsamples are predefined, a regression within the sample could be used to detect true relationships. Otherwise, the analysis should be undertaken on the whole sample.

Building on her research interest mentioned in the beginning, let us consider a study by Ali and Naylor. 4 They were interested in identifying the academic and non-academic factors which predict the academic success of nursing diploma students. This purpose is consistent with one of the above-mentioned purposes of regression analysis (ie, prediction). Ali and Naylor’s chosen academic independent variables were preadmission qualification, previous academic performance and school type and the non-academic variables were age, gender, marital status and time gap. To achieve their purpose, they collected data from 628 nursing students between the age range of 15–34 years. They used both linear and multiple regression analyses to identify the predictors of student success. For analysis, they examined the relationship of academic and non-academic variables across different years of study and noted that academic factors accounted for 36.6%, 44.3% and 50.4% variability in academic success of students in year 1, year 2 and year 3, respectively. 4

Ali and Naylor presented the relationship among these variables using scatter plots, which are commonly used graphs for data display in regression analysis—see examples of various scatter plots in figure 1 . 4 In a scatter plot, the clustering of the dots denoted the strength of relationship, whereas the direction indicates the nature of relationships among variables as positive (ie, increase in one variable results in an increase in the other) and negative (ie, increase in one variable results in decrease in the other).

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An Example of Scatter Plot for Regression.

Table 2 presents the results of regression analysis for academic and non-academic variables for year 4 students’ success. The significant predictors of student success are denoted with a significant p value. For every, significant predictor, the beta value indicates the percentage increase in students’ academic success with one unit increase in the variable.

Regression model for the final year students (N=343)

Conclusions

Regression analysis is a powerful and useful statistical procedure with many implications for nursing research. It enables researchers to describe, predict and estimate the relationships and draw plausible conclusions about the interrelated variables in relation to any studied phenomena. Regression also allows for controlling one or more variables when researchers are interested in examining the relationship among specific variables. Some of the key considerations are presented that may be useful for researchers undertaking regression analysis. While planning and conducting regression analysis, researchers should consider the type and number of dependent and independent variables as well as the nature and size of sample. Choosing a wrong type of regression analysis with small sample may result in erroneous conclusions about the studied phenomenon.

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• Montgomery DC ,
• Schneider A ,

Twitter @parveenazamali, @@Ahtisham04

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Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Regression Analysis

Regression analysis is a quantitative research method which is used when the study involves modelling and analysing several variables, where the relationship includes a dependent variable and one or more independent variables. In simple terms, regression analysis is a quantitative method used to test the nature of relationships between a dependent variable and one or more independent variables.

The basic form of regression models includes unknown parameters (β), independent variables (X), and the dependent variable (Y).

Regression model, basically, specifies the relation of dependent variable (Y) to a function combination of independent variables (X) and unknown parameters (β)

                                    Y  ≈  f (X, β)   

Regression equation can be used to predict the values of ‘y’, if the value of ‘x’ is given, and both ‘y’ and ‘x’ are the two sets of measures of a sample size of ‘n’. The formulae for regression equation would be

Do not be intimidated by visual complexity of correlation and regression formulae above. You don’t have to apply the formula manually, and correlation and regression analyses can be run with the application of popular analytical software such as Microsoft Excel, Microsoft Access, SPSS and others.

Linear regression analysis is based on the following set of assumptions:

1. Assumption of linearity . There is a linear relationship between dependent and independent variables.

2. Assumption of homoscedasticity . Data values for dependent and independent variables have equal variances.

3. Assumption of absence of collinearity or multicollinearity . There is no correlation between two or more independent variables.

4. Assumption of normal distribution . The data for the independent variables and dependent variable are normally distributed

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