Interpretation of statistical values

&
fundamentals of epidemiology
Dr.Asma Rahim
Dr.Bindhu vasudevan

Dept. of Community Medicine

What you are expected to Know?
Mean
What is SD ?
What is SE?
What is Confidence limits as noted
in many journals?
 What is P value ?How to interpret it?

Which are the different statistical tests to be

applied on different situations?

Study designs in Medical research.

Measurements of risk in clinical research

What is sensitivity ,Specificity, Predictive

value of a test?
 Dilemma of a PG Student!!!
DNB exams more stress on Original work.

Methodology of your work is important.

Look ahead for statistical queries.

Examiners familiar with research designs

OSCE stations have questions on

Statistics.
 Types of variables
Qualitative
Dichotomous
Nominal
Ordinal
Quantitative
Discrete
Continuous
1. Which is a qualitative variable
a) BMI
b) S. bilirubin
c) Name of residing place
d) Blood urea
 2. Which is a quantitative variable

Causes of deaths
Religious distribution
Age group distribution
Age distribution
 4. Which is an ordinal variable

A)Blood pressure
B)Name of residing place
C)Grading of carcinoma
D) temperature
 5. Which is not a nominal scale
variable
A)Causes of death
B) religion
C)diagnosis
D)visual analogue scale
Quantitative data Qualitative data

Hb in gm% Anemic/non anemic

Height in cm Tall/short

B.P in mm of Hg Hypo/normo/
hypertensives
 In a group of 100 under five children
attending IMCH O.P the mean weight is
15kg. The standard deviation is 2.

1.In what range 95% of childrens weight

will lie in the sample?

2. In what range the mean weight of all

children who are attending IMCH OP
will lie?
Range in which 95% childrens weight in the
sample will lie:
95% reference range =
mean +/- 2SD = 13-17Kg

Range in which 95% childrens weight

attending IMCH O.P will lie:
95% Confidence interval =
mean +/- 2SE( Standard error)-
 Standard Error

17
19

16

17kg
18

15
 Central limit Theorem
Central limit theorem states that
The random sampling distribution of
sample means will be normal distribution
Means of random sample means will be
equal to population mean
The standard deviation of sample means
from population mean is the standard error
 The PEFR of 100, 11 year old girls follow a
normal distribution with a mean of 300 1/min,
standard deviation 20 l/min and standrd error of
2 l/min

What will be the range in which 95% of the girls

PEFR will lie in the sample?

What will be the range in which mean of the

population will lie from which the sample was
taken?
Range in which 95% of girls PEFR in the
sample will lie:
mean +/- 2SD = 260 - 340

Range in which mean PEFR Value will lie:

mean +/- 2SE( Standard error)- 95%
Confidence interval = 298-304
 Normal distribution curve

 Sample size
Calculate the sample size to find out the
prevalence of a disease after implementing
a control programme with 10% allowable
error. Prevalence of the disease before
implementing the programme was 80 %
 Sample size
Qualitative data N = 4pq/L2
P = positive factor /prevalence/proportion
Q = 100 p
L = allowable error or precision or
variability
Quantitative data N = 4SD2/L2
 N= 4 x 80 x 20/8 x 8 = 100
 Determine the sample size to find out the Vitamin A
requirement in the under five children of Calicut
district . From the existing literature the mean daily
requirement of the same was documented as 930 I.U
with a SD of 90 I.U. Consider the precision as 9.
 N = 4SD2/L2

4 x 90 x 90 /9 x9 = 400
 Determine the sample size to prove that
drug A is better than drug B in reducing the
S.Cholesterol. The findings from a previous
study is given
Drug Mean SD

A 215 20

B 240 30
 Quantitative data N =
(Z + Z )2 x S2 x 2 /d2
Z = Z value for level = 1.96 at 0.05
Z = Z value for level =1.28 for at 10%
S = average SD
d = difference between the two means
 Qualitative data N =
(Z + Z )2 p x q /d2
Z = Z value for level = 1.96 at 0.5
Z = Z value for level =1.28 for at 10%
P = average prevalence
d = difference between the prevalence
 Reject Accept
Null hypothesis Null hypothesis

Null hypothesis Type 1 error Correct

true (alpha error) decision

Null hypothesis Correct Type 2 error

false decision (Beta error)
 Alpha = 1.96.
Beta = 0.1 to 0.2 or 10 to 20%.
Power of the study = 1- beta error
Strength at which we conclude there is no
difference between the two groups.
 Statistical test chosen depends on----

Whether comparison is between

independent or related groups.

Whether proportions or means are being

compared.

Whether more than 2 groups are compared.

 Deciding statistical tests?
In a clinical trial of a micronutrient on
growth, the weight was measured before
and after giving the micronutrient.. Which
test will you use for comparison?
paired t test
F test
T test
Chi square test
Parametric and Nonparametric tests

Parametric: When the data is normally

distributed.

Nonparametric : When data is not normally

distributed,usually with small sample size.
 Common statistical tests
Design Nature of variable Statistical test Statistic derived

Two independent Qualitative (nominal) Chi square Chi square

Groups Quantitative (continous) Student t test t

Two related
groups Qualitative (nominal) Chi square Chi square

Quantitative (continous) Paired t test t

More than 2 Qualitative (nominal Chi square Chi square

Independent Quantitative (continous) Anova F

groups
Difference in proportion Chi-square test, Z test,

Difference in mean(Before Paired t test

and after comparison-same
group)
Difference in mean (two Unpaired t test, If sample
independent groups) > 30-Z test
More than 2 means(> 2 Anova
groups)
Association Spearman correlation
Prediction regression
 Non parametric tests
Chi-square test
Fishers test,
Mc Nemar test
Wilcoxon Signed rank test Paired t test
Wilcoxon test , Mann- independent t test
Whitney U , Kolmogrov

Kruskal-wallis test Anova

 The most appropriate test for
comparing Hb values in the adult
women in two different population of
size 150 and 200 is
A) t test
B) Anova
C) Z test
D) Chi square test
 Answer

C
Two groups
>30
Continuous variable
Comparing mean
 The most appropriate test to
compare birth weight in 3
different regions is
A) t test
B) Anova
C) Z test
D) Chi square test
 Answer

B
Continuous variable
Compare means
> 2 groups
 The most appropriate test to
compare BMI in two different
adult population of size 24 and
30 is
A) Two sampled t test
B) Paired t test
C) Z test
D) Chi square test
 Answer

A
Two different groups
Continuous variable
Size <30
 The association between smoking
status and MI is tested by
A) t test
B) Anova
C) F test
D) Chi square test
Standard drug used 40% of patients responded
and a new drug when used 60% of patients
responded. Which of the following tests of
parametric significance is most useful in this
study?
A) Fishers t Test
B) Independent sample t test
C) Paired t test
D) Chi square test.
 A consumer group would like to evaluate
the success of three different commercial
weight loss programmes. Subjects are
assigned to one of three programmes
(Group A , Group B ,GROUP C) . Each
group follows different diet regimen. At
first time and at the end of 6 weeks subjects
are weighed an their BP measurements
recorded.
Test to detect mean difference in
body weight between Group A &
Group B

T-TEST

Difference between means of two samples

 Is there a significant difference in body
weight in Group A at Time 1 and Time
2?
Paired T Test

Same people sampled on two Occasions.

Is the difference in body weight of subjects in
Group A,GROUP b ,group C significantly
different at Time 2
Analysis of variance
 Is there any relation between blood pressure
and body weight of these subjects?

Correlation
 Correlation coefficient
Shows the relation between two quantitative
variable
Shows the rate of change of one variable as
the other variable change
The value lies between 1 to + 1
Correlation coefficient of zero means that
there is no relationship
No.of deaths in 8 villages due to
water borne diseases before &
after installation of water supply
system
Villages: 1 2 3 4 5 6 7 8
Before :13 6 12 13 4 13 9 10
After :15 4 10 9 1 11 8 13
 Did the Installation of water
supply system significantly
reduce deaths

Small sample size

Distribution is not normal
Non parametric test
Wilcoxon signed rank test
 For treatment of Hepatitis A 7
patients treated with herbal
medicines& 7 patients treated with
Allopathic symptomatic management.
S.Br values after 10 days of treatment
is given below
Herbal :9 6 10 3 6 3 2

Allopathy: 6 3 5 6 2 4 8
 Is herbal treatment is better than
allopathic treatment?
Small sample size
Distribution is not normal
Non parametric test
Mann- Whitney test
 After applying a statistical test an
investigator get the p value as
0.01. It means that
A)The probability of finding a significant
difference is 1%
B) The probability of finding a significant
difference when there is no difference is 1%
C) The difference is not significant 1%
times and significant 99% times
D) The power of the test used is 99%
 Answer
B
Null hypothesis states there is no difference,If
there is any difference it is due to chance
P value = If the null hypothesis is true the
probability of the sample variation to occur by
chance
P value 0.05= probability of the sample variation
by chance is only 5% if null hypothesis was true
95% the sample variation is not due to chance,&
there is a difference. So we will reject NH
 P = 0.01 - probability of the sample
variation by chance is only 1% if null
hypothesis was true
99 % the sample variation is not due to
chance,& there is a difference. So we will
reject NH
As p value decreases the difference become
more significant
For practical purpose p value < 0.05 ; the
difference is significant
 In assessing the association between
maternal nutritional status and Birth
weight of the newborns two investigators
A and B studied separately and found
significant results with p values 0.02 &
0.04 respectively. From this what can you
infer about the magnitude of association
found by the
two investigators
Type of study Alternative Unit of study
name
Descriptive Case series Prevalence
Cross sectional study Individual
Longitudinal Incidence study

Correlational
Analytical Ecological Case reference Populations
studies Case control Follow up Individuals
(observational Cohort Individuals

Analytical studies Randomised Clinical trial Patients

(interventional) controlled trial Community Healthy people
Field trial intervention
Community Community Healthy people
trials
 Study questions and appropriate designs

Type of question Appropriate study design

Burden of illness Cross sectional survey
Longitudinal survey
Causation, risk and Case control study, Cohort study
prognosis
Occupational risk, Ecological studies
environmental risk
Treatment efficacy RCT
Diagnostic test Paired comparative study
evaluation
Cost effectiveness RCT
 Odds ratio
In a study conducted by Gireesh G N etal
about the Prevalence of Worm infestation
in children,50 children in anganwadi were
examined. Out of this 5 had worm
infestation. 2 out of this 5 have a history of
pet animals at home while 21 out of the 45
non infested has a history of pet animals at
home. Is there any association between pet
animals and worm infestations?
 Study design Case control
Measure of risk Odds ratio
 Set up a 2x2 table Worm infestation
+ -

a b
+ 2 21
Pet animals

- c d
3 24
 Odds ratio = ad /bc

2 x 24 = 0.76
21 x3
 Interpretation
OR =1,RISK FACTOR NOT RELATED
TO DISEASE

OR <1 ,RISK FACTOR PROTECTIVE

OR >1 RISK FACTOR POSITIVELY

ASSOCIATED WITH DISEASE
 Relative risk
In a study to find the effect of Birth weight
on subsequent growth of children , 300
children with birth weight 2kg to 2.5 kg
were followed till age 1 . A similar number
of children with birth weight greater 2.5 kg
were followed up too. Anthropometric
measurements done in both groups. Results
are shown below
 Low birth weight Normal

No.children studied 300 300

No.malnourished
At age one 102 51
 Study design Cohort study
Measure of risk Relative risk ,Attributable
risk.
Relative risk Incidence among exposed
Incidence among nonexposed
= 102/300 = 0.34 = 2
51/ 300 0.17
Inference ?
 An out break of Pediculosis capitis being
investigated in a girls school with 291
pupils.Of 130 Children who live in a nearby
housing estate 18 were infested and of 161
who live elsewhere 37 were infested. The
Chi square value was found to be 3.93 .
P value = 0.04
Is there a significant difference in the
infestation rates between the two groups?
 Results of a screening test
Disease
Positive Negative
Positive TP(a) FP(b)

Test

Negative FN TN(d)
Features of a screening test
Sensitivity = a/ a+c

Specificity = d/b+d

Positive predictive value = a/a+b

Negative predictive value = d/c+d
False positive rate = b\b+d
False negative rate = c/a+c
In a group of patients presenting to a hospital emergency
with abdominal pain, 30% of patients have acute
appendicitis, 70% of patients with appendicitis have a
temperature greater than 37.50c and 40% of patients
without appendictis have a temperature greater than
37.50c. Considering these findings which of the
following statement is correct ?
a) Sensitivity of temperature greater than 37.50c as a
marker for appendicitis is 21/49
b) Specificity of temperature grater than 37.50c as a
marker for appendicitis is 42/70
c) The positive predictive value of temperature greater
than 37.50c as marker for appendicitis is 21/30
d) Specificity of the test will depend upon the
prevalence of appendicitis in the population to which it
is applied.
 Sensitivity and Specificity
Appendicitis+ -
21a 28b
Fever > 37.50c +
- 9c 42d

30a+c 70b+d
 Sensitivity = a/a+c - 21/30=70%
Specificity = d/b+d = 42/70=60%
Positive predictive value = a/a+b =
21/49=43%
Negative predictive value = d/c+d = 42/51
 Exercise 11
Disease prevalence in a population of
10,000 was 5%. A urine sugar test with
sensitivity of 70% and specificity of 80%
was done on the population. The positive
predictive value will be :
a)15.55% b) 70.08% c) 84.4%
d)98.06%
 Total population = 10,000
Disease prevalence = 5%
No diseased = 500
Applying this to a 2x2 table :
 2x2 table
+ -

+ TEST 350 a 1900 b 2250

- 150c 7600d 7750

500 9500 10000
All the Best!!1