Using binary logistic regression models for ordinal data with non-proportional odds

The proportional odds model (POM) is the most popular logistic regression model for analyzing ordinal response variables. However, violation of the main model assumption can lead to invalid results. This is demonstrated by application of this method to data of a study investigating the effect of smoking on diabetic retinopathy. Since the proportional odds assumption is not fulfilled, separate binary logistic regression models are used for dichotomized response variables based upon cumulative probabilities. This approach is compared with polytomous logistic regression and the partial proportional odds model. The separate binary logistic regression approach is slightly less efficient than a joint model for the ordinal response. However, model building, investigating goodness-of-fit, and interpretation of the results is much easier for binary responses. The careful application of separate binary logistic regressions represents a simple and adequate tool to analyze ordinal data with non-proportional odds.