Weighted kappa statistic for clustered matched-pair ordinal data

As an important extension of the regular kappa statistic, the weighted kappa statistic has been widely used to assess the agreement between two procedures for independent matched-pair ordinal data. For clustered matched-pair ordinal data, based on the delta method and sampling techniques, a non-parametric variance estimator for the weighted kappa statistic is proposed without within-cluster correlation structure or distributional assumptions. The results of an extensive Monte Carlo simulation study demonstrate that the proposed weighted kappa statistic provides consistent estimation, and the proposed variance estimator behaves reasonably well for at least a moderately large number of clusters (e.g., K≥50). Compared with the variance estimator ignoring dependence within a cluster, the proposed variance estimator performs better in maintaining the nominal coverage probability when the intra-cluster correlation is fair (ρ≥0.3), with more pronounced improvement when ρ is further increased. Moreover, under the general analysis of variance setting with systematic variability between procedures and clusters being included as a component of total variation, the equivalence between weighted kappa statistic and intraclass correlation coefficient is established. To illustrate the practical application of the proposed estimator, two real medical research data examples of clustered matched-pair ordinal data are analyzed, including an agreement study to compare two methods for assessing cervical ectopy, and a physician–patients data example from the Enhancing Communication and HIV Outcomes study.