Firth's logistic regression with rare events: accurate effect estimates AND predictions?

Firth-type logistic regression has become a standard approach for the analysis of binary outcomes with small samples. Whereas it reduces the bias in maximum likelihood estimates of coefficients, bias towards 1/2 is introduced in the predicted probabilities. The stronger the imbalance of the outcome, the more severe is the bias in the predicted probabilities. We propose two simple modifications of Firth-type logistic regression resulting in unbiased predicted probabilities. The first corrects the predicted probabilities by a post-hoc adjustment of the intercept. The other is based on an alternative formulation of Firth-types estimation as an iterative data augmentation procedure. Our suggested modification consists in introducing an indicator variable which distinguishes between original and pseudo observations in the augmented data. In a comprehensive simulation study these approaches are compared to other attempts to improve predictions based on Firth-type penalization and to other published penalization strategies intended for routine use. For instance, we consider a recently suggested compromise between maximum likelihood and Firth-type logistic regression. Simulation results are scrutinized both with regard to prediction and regression coefficients. Finally, the methods considered are illustrated and compared for a study on arterial closure devices in minimally invasive cardiac surgery.