Calculating Ordinal Regression Models in SAS and S-Plus

Although a number of regression models for ordinal responses have been proposed, these models are not widely known and applied in epidemiology and biomedical research. Overviews of these models are either highly technical or consider only a small part of this class of models so that it is difficult to understand the features of the models and to recognize important relations between them. In this paper we give an overview of logistic regression models for ordinal data based upon cumulative and conditional probabilities. We show how the most popular ordinal regression models, namely the proportional odds model and the continuation ratio model, are embedded in the framework of generalized linear models. We describe the characteristics and interpretations of these models and show how the calculations can be performed by means of SAS and S-Plus. We illustrate and compare the methods by applying them to data of a study investigating the effect of several risk factors on diabetic retinopathy. A special aspect is the violation of the usual assumption of equal slopes which makes the correct application of standard models impossible. We show how to use extensions of the standard models to work adequately with this situation.