STATISTICS IN
MEDICINE
What is statistics ?
`
Statistics involves
data or information
eg.
Information regarding a country
Information about weather
Information on health status
Information about a patient
Information on normal subjects
WHO
Unesco
CDC
What is statistics ?
Statistics is the science dealing with
analysis, presentationcollection,
& interpretation of data
When is statistics useful in
day-to-day life
weather report
in a shop
in an examination
in match making
in lottery
Weather report
rain will be
expected in the
central area
rest of the
country most
likely will be dry
Likelihood, chance
Colombo
Weather
In a shop
what will you
buy?
how to select?
which one is
good?
how much is
worth?
Previous knowledge
Banana
In an examination
what is the pass
mark?
who has sound
knowledge &
who has poor
knowledge?
half knowledge,
should you
pass?
performance, cut off point
In match making
in matching two
people
previous known
details
details of the
family
based on these a
prediction is
made
does it always
work ???
prediction
In lottery
choice between
number to win
and number to
lose
previous
experience
guesswork
prediction
prediction
Summary
Likelihood
Chance
Previous knowledge
Cut off point
Guesswork
Prediction
Probability
Statistics
When is statistics useful in
medicine ?
decision making on diagnosis
eg. a patient with headache
• does all signs and symptoms fit into
already known diseases
• previous knowledge, experience from
previous patients
• guesswork
• does it work ???
When is statistics useful in
medicine ?
decision making on treatment
eg. a patient with headache
• which drug to be given among A,B,C
analgesics
• previous knowledge, experience of
using them
• guesswork
• does it work ???
When is statistics useful in
medicine ?
acquiring new knowledge
eg. how does blood flow against
gravity
• planning a study
• doing the study
• arriving at conclusions
When is statistics useful in
medicine ?
surveys of diseases in a
population
eg. how far malaria has spread
• planning a study
• doing the study
• arriving at conclusions
Summary
Statistics is useful in medicine
in different areas
Research studies use statistics
in data analysis
Variables
Task: write 3 variables and 1 constant
found in the human body
eg. Height as a variable
almost all biological features show
variation
it is extremely difficult to find a
feature which does not vary???
Variables
What is basis of this ‘variation’ ?
fundamentally genetical
but environmental factors are
always important
Variables
height
weight
blood pressure
pulse rate
body temperature
size of a swelling
social status: income
Variables
response to a question
Do you like to treat a patient with
AIDS? Y / N / undecided
Do you agree with what I say in
this lecture? Y/N/?
Attitudes - Opinions - What we feel
Types of variables
a) nominal
b) ordinal
c) interval
d) ratio
Nominal variables
Qualitative classification
Distinct categories
No ranking
eg: gender, race, color, city
males
females
Ordinal variables
Qualitative classification
Categories have order or rank
eg. Socioeconomic status
• Upper
• Middle (upper & lower)
• Lower
Interval & ratio variables
Quantitative classification
Interval variable has no absolute
zero
eg. T°C
Ratio variable has absolute zero
eg. Kelvin temp, time, space
Methods of collecting data
questionnaire
interview
measurement using special
instrument
BHT studies (Bed Head Ticket)
Postal surveys
Different types of sampling
Simple random sample
Systematic sampling
Stratified sampling
Cluster sampling
Population Sample
Simple random sample
each subject in the population has an equal chance
of getting selected to the sample
each subject is given a number
subjects selected using random
numbers
use random tables or computer
generated random numbers
random table
20 17 42 28 31 17 59 66 38 61 03 51 10 55 92 52 44 25 88
74 49 04 03 08 33 53 70 11 54 48 94 60 49 57 38 65 15 40
Non-random sample
this is a biased sample
certain subjects have more
probability of getting selected to
the sample
certain situations randomisation is
not possible either due to practical
difficulties or difficulty in finding
subjects
Statistical concepts
In order to arrive at conclusions
data are analysed
Conclusions are based on
concepts just like geometric
theorems
Descriptive statistics
Background information
Inferential statistics
Hypothesis testing
Central TendencyCentral Tendency
 A single value representing a datasetA single value representing a dataset
 eg. pulse rateeg. pulse rate
Measures of CentralMeasures of Central
TendencyTendency
 MeanMean (x)(x)
 averageaverage
x =x = ΣΣ xx
nn
 ModeMode
 commonest value or the most frequentcommonest value or the most frequent
valuevalue
 MedianMedian
 central valuecentral value
-
-
exampleexample
 In a datasetIn a dataset
1 2 2 3 3 3 4 4 51 2 2 3 3 3 4 4 5
 mean = 3mean = 3
 mode = 3mode = 3
 median = 3median = 3
VariationVariation
 Central value gives only theCentral value gives only the
representative figurerepresentative figure
 variation of data set is not shownvariation of data set is not shown
Measures of VariationMeasures of Variation
 RangeRange
 from minimum to maximumfrom minimum to maximum
 Charts or graphsCharts or graphs
 bar chartbar chart
 histogramhistogram
Bar chartBar chart
0
5
10
15
20
25
30
35
frequency
males females
Patients with headache
generally used for categorical variables
Pie chartPie chart
Patients with headache
males
females
Multiple bar chartMultiple bar chart
0
50
100
150
200
250
average
income
1986 1987 1988
average income in 3 years
male
female
HistogramHistogram
Ageofemployee
38.0
37.0
36.0
35.0
34.0
33.0
32.0
31.0
30.0
29.0
28.0
27.0
26.0
25.0
24.0
23.0
50
40
30
20
10
0
Std.Dev=3.35
Mean=29.4
N=292.00
for continuous variables
Frequency distribution curveFrequency distribution curve
Standard deviation (SD)Standard deviation (SD)
 This is an accurate measure ofThis is an accurate measure of
variabilityvariability
 Calculated for continuous dataCalculated for continuous data
 Based on deviations of data from theBased on deviations of data from the
meanmean
Standard deviation (SD)Standard deviation (SD)
 If the data set isIf the data set is
1, 2, 2, 3, 3, 3, 4, 4, 51, 2, 2, 3, 3, 3, 4, 4, 5
 mean will be 3mean will be 3
 deviations are calculateddeviations are calculated
(3-1), (3-2), (3-2), (3-3), (3-3), (3-4),(3-1), (3-2), (3-2), (3-3), (3-3), (3-4),
(3-4), (3-5)(3-4), (3-5)
2, 1, 1, 0, 0, 0, -1, -1, -22, 1, 1, 0, 0, 0, -1, -1, -2
 deviations are squareddeviations are squared
4, 1, 1, 0, 0, 0, 1, 1, 44, 1, 1, 0, 0, 0, 1, 1, 4
 mean of squared deviation is calculated= 12/9mean of squared deviation is calculated= 12/9
 square root is taken= root of 12/9square root is taken= root of 12/9
Standard deviation (SD)Standard deviation (SD)
 datadata deviationsdeviations square of deviationssquare of deviations
 11 3-13-1 22 44
 22 3-23-2 11 11
 22 3-23-2 11 11
 33 3-33-3 00 00
 33 3-33-3 00 00
 33 3-33-3 00 00
 44 3-43-4 -1-1 11
 44 3-43-4 -1-1 11
 55 3-53-5 -2-2 44
12/9
variance = 12/9
SD = √12/9
Standard deviation (SD)Standard deviation (SD)
 In the previous example of 292 subjectsIn the previous example of 292 subjects
 meanmean = 29.41 yrs= 29.41 yrs
 SDSD = 3.35 yrs= 3.35 yrs
 minimum = 23.00 yrsminimum = 23.00 yrs
 maximum= 37.83 yrsmaximum= 37.83 yrs
 (n = 292)(n = 292)
Coefficient of variationCoefficient of variation
(COV)(COV)
SDSD
COV = ---------COV = --------- X 100 %X 100 %
meanmean
 COV has no unitsCOV has no units
 Variations between two variables could beVariations between two variables could be
compared using COV (eg. Blood pressure andcompared using COV (eg. Blood pressure and
pulse rate)pulse rate)
Normal distributionNormal distribution
 generally continuous variables in the humangenerally continuous variables in the human
body such as height and weight has a definitebody such as height and weight has a definite
patternpattern
 It is a symmetrical, an inverted bell shapedIt is a symmetrical, an inverted bell shaped
curvecurve
 mean, mode and median are similarmean, mode and median are similar
 this type of distribution is calledthis type of distribution is called “normal“normal
distribution”distribution”
Normal distributionNormal distribution
VAR00001
9.08.07.06.05.04.03.02.01.0
12
10
8
6
4
2
0
Std. Dev = 2.02
Mean = 5.0
N = 50.00
Normal distributionNormal distribution
VAR00001
9.08.07.06.05.04.03.02.01.0
12
10
8
6
4
2
0
Std. Dev = 2.02
Mean = 5.0
N = 50.00
•symmetrical
•bell-shaped
•mean, mode,
median
similar
•also called a
Gaussian
curve
Normal distributionNormal distribution
mean
mode
median

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Statistics introduction

  • 2. What is statistics ? ` Statistics involves data or information eg. Information regarding a country Information about weather Information on health status Information about a patient Information on normal subjects WHO Unesco CDC
  • 3. What is statistics ? Statistics is the science dealing with analysis, presentationcollection, & interpretation of data
  • 4. When is statistics useful in day-to-day life weather report in a shop in an examination in match making in lottery
  • 5. Weather report rain will be expected in the central area rest of the country most likely will be dry Likelihood, chance Colombo Weather
  • 6. In a shop what will you buy? how to select? which one is good? how much is worth? Previous knowledge Banana
  • 7. In an examination what is the pass mark? who has sound knowledge & who has poor knowledge? half knowledge, should you pass? performance, cut off point
  • 8. In match making in matching two people previous known details details of the family based on these a prediction is made does it always work ??? prediction
  • 9. In lottery choice between number to win and number to lose previous experience guesswork prediction prediction
  • 10. Summary Likelihood Chance Previous knowledge Cut off point Guesswork Prediction Probability Statistics
  • 11. When is statistics useful in medicine ? decision making on diagnosis eg. a patient with headache • does all signs and symptoms fit into already known diseases • previous knowledge, experience from previous patients • guesswork • does it work ???
  • 12. When is statistics useful in medicine ? decision making on treatment eg. a patient with headache • which drug to be given among A,B,C analgesics • previous knowledge, experience of using them • guesswork • does it work ???
  • 13. When is statistics useful in medicine ? acquiring new knowledge eg. how does blood flow against gravity • planning a study • doing the study • arriving at conclusions
  • 14. When is statistics useful in medicine ? surveys of diseases in a population eg. how far malaria has spread • planning a study • doing the study • arriving at conclusions
  • 15. Summary Statistics is useful in medicine in different areas Research studies use statistics in data analysis
  • 16. Variables Task: write 3 variables and 1 constant found in the human body eg. Height as a variable almost all biological features show variation it is extremely difficult to find a feature which does not vary???
  • 17. Variables What is basis of this ‘variation’ ? fundamentally genetical but environmental factors are always important
  • 18. Variables height weight blood pressure pulse rate body temperature size of a swelling social status: income
  • 19. Variables response to a question Do you like to treat a patient with AIDS? Y / N / undecided Do you agree with what I say in this lecture? Y/N/? Attitudes - Opinions - What we feel
  • 20. Types of variables a) nominal b) ordinal c) interval d) ratio
  • 21. Nominal variables Qualitative classification Distinct categories No ranking eg: gender, race, color, city males females
  • 22. Ordinal variables Qualitative classification Categories have order or rank eg. Socioeconomic status • Upper • Middle (upper & lower) • Lower
  • 23. Interval & ratio variables Quantitative classification Interval variable has no absolute zero eg. T°C Ratio variable has absolute zero eg. Kelvin temp, time, space
  • 24. Methods of collecting data questionnaire interview measurement using special instrument BHT studies (Bed Head Ticket) Postal surveys
  • 25. Different types of sampling Simple random sample Systematic sampling Stratified sampling Cluster sampling Population Sample
  • 26. Simple random sample each subject in the population has an equal chance of getting selected to the sample each subject is given a number subjects selected using random numbers use random tables or computer generated random numbers random table 20 17 42 28 31 17 59 66 38 61 03 51 10 55 92 52 44 25 88 74 49 04 03 08 33 53 70 11 54 48 94 60 49 57 38 65 15 40
  • 27. Non-random sample this is a biased sample certain subjects have more probability of getting selected to the sample certain situations randomisation is not possible either due to practical difficulties or difficulty in finding subjects
  • 28. Statistical concepts In order to arrive at conclusions data are analysed Conclusions are based on concepts just like geometric theorems
  • 30. Central TendencyCentral Tendency  A single value representing a datasetA single value representing a dataset  eg. pulse rateeg. pulse rate
  • 31. Measures of CentralMeasures of Central TendencyTendency  MeanMean (x)(x)  averageaverage x =x = ΣΣ xx nn  ModeMode  commonest value or the most frequentcommonest value or the most frequent valuevalue  MedianMedian  central valuecentral value - -
  • 32. exampleexample  In a datasetIn a dataset 1 2 2 3 3 3 4 4 51 2 2 3 3 3 4 4 5  mean = 3mean = 3  mode = 3mode = 3  median = 3median = 3
  • 33. VariationVariation  Central value gives only theCentral value gives only the representative figurerepresentative figure  variation of data set is not shownvariation of data set is not shown
  • 34. Measures of VariationMeasures of Variation  RangeRange  from minimum to maximumfrom minimum to maximum  Charts or graphsCharts or graphs  bar chartbar chart  histogramhistogram
  • 35. Bar chartBar chart 0 5 10 15 20 25 30 35 frequency males females Patients with headache generally used for categorical variables
  • 36. Pie chartPie chart Patients with headache males females
  • 37. Multiple bar chartMultiple bar chart 0 50 100 150 200 250 average income 1986 1987 1988 average income in 3 years male female
  • 40. Standard deviation (SD)Standard deviation (SD)  This is an accurate measure ofThis is an accurate measure of variabilityvariability  Calculated for continuous dataCalculated for continuous data  Based on deviations of data from theBased on deviations of data from the meanmean
  • 41. Standard deviation (SD)Standard deviation (SD)  If the data set isIf the data set is 1, 2, 2, 3, 3, 3, 4, 4, 51, 2, 2, 3, 3, 3, 4, 4, 5  mean will be 3mean will be 3  deviations are calculateddeviations are calculated (3-1), (3-2), (3-2), (3-3), (3-3), (3-4),(3-1), (3-2), (3-2), (3-3), (3-3), (3-4), (3-4), (3-5)(3-4), (3-5) 2, 1, 1, 0, 0, 0, -1, -1, -22, 1, 1, 0, 0, 0, -1, -1, -2  deviations are squareddeviations are squared 4, 1, 1, 0, 0, 0, 1, 1, 44, 1, 1, 0, 0, 0, 1, 1, 4  mean of squared deviation is calculated= 12/9mean of squared deviation is calculated= 12/9  square root is taken= root of 12/9square root is taken= root of 12/9
  • 42. Standard deviation (SD)Standard deviation (SD)  datadata deviationsdeviations square of deviationssquare of deviations  11 3-13-1 22 44  22 3-23-2 11 11  22 3-23-2 11 11  33 3-33-3 00 00  33 3-33-3 00 00  33 3-33-3 00 00  44 3-43-4 -1-1 11  44 3-43-4 -1-1 11  55 3-53-5 -2-2 44 12/9 variance = 12/9 SD = √12/9
  • 43. Standard deviation (SD)Standard deviation (SD)  In the previous example of 292 subjectsIn the previous example of 292 subjects  meanmean = 29.41 yrs= 29.41 yrs  SDSD = 3.35 yrs= 3.35 yrs  minimum = 23.00 yrsminimum = 23.00 yrs  maximum= 37.83 yrsmaximum= 37.83 yrs  (n = 292)(n = 292)
  • 44. Coefficient of variationCoefficient of variation (COV)(COV) SDSD COV = ---------COV = --------- X 100 %X 100 % meanmean  COV has no unitsCOV has no units  Variations between two variables could beVariations between two variables could be compared using COV (eg. Blood pressure andcompared using COV (eg. Blood pressure and pulse rate)pulse rate)
  • 45. Normal distributionNormal distribution  generally continuous variables in the humangenerally continuous variables in the human body such as height and weight has a definitebody such as height and weight has a definite patternpattern  It is a symmetrical, an inverted bell shapedIt is a symmetrical, an inverted bell shaped curvecurve  mean, mode and median are similarmean, mode and median are similar  this type of distribution is calledthis type of distribution is called “normal“normal distribution”distribution”
  • 47. Normal distributionNormal distribution VAR00001 9.08.07.06.05.04.03.02.01.0 12 10 8 6 4 2 0 Std. Dev = 2.02 Mean = 5.0 N = 50.00 •symmetrical •bell-shaped •mean, mode, median similar •also called a Gaussian curve