PRACTICE PROBLEMS

FOR
BIOSTATISTICS

BIOSTATISTICS
DESCRIBING DATA, THE NORMAL DISTRIBUTION
1. The duration of time from first exposure to HIV infection to AIDS diagnosis is called the
incubation period. The incubation periods of a random sample of 7 HIV infected
individuals is given below (in years):
12.0
9.5
13.5
7.2

10.5
6.3
12.5

a.
b.
c.
d.

Calculate the sample mean.

Calculate the sample median.
Calculate the sample standard deviation.
If the number 6.3 above were changed to 1.5, what would happen to the sample mean,
median, and standard deviation? State whether each would increase, decrease, or
remain the same.
e. Suppose instead of 7 individuals, we had 14 individuals. (we added 7 more randomly
selected observations to the original 7)
12.0
9.5
13.5
7.2
8.1

10.5
6.3
12.5
14.9
7.9

5.2
13.1
10.7
6.5

Make an educated guess of whether the sample mean and sample standard deviation for
the 14 observations would increase, decrease, or remain roughly the same compared to
your answer in part (c) based on only 7 observations. Now actually calculate the sample
mean standard deviation to see if you were right. How does your calculation compare to
your educated guess? Why do you think this is?

2. In a random survey of 3,015 boys age 11, the average height was 146 cm, and the standard
deviation (SD) was 8 cm. A histogram suggested the heights were approximately normally
distributed. Fill in the blanks.
a. One boy was 170 cm tall. He was above average by __________ SDs.
b. Another boy was 148 cm tall. He was above average by __________ SDs.
c. A third boy was 1.5 SDs below the average height. He was __________ cm tall.
d. If a boy was within 2.25 SDs of average height, the shortest he could have been is
__________ cm and the tallest is __________ cm.
e. Here are the heights of four boys: 150 cm, 130 cm, 165 cm, 140 cm. Which
description from the list below best fits each of the boys (a description can be used
more than once)? Justify you answer
Unusually short.
About average.
Unusually tall.
3. Assume blood-glucose levels in a population of adult women are normally distributed with
mean 90 mg/dL and standard deviation 38 mg/dL.
a. Suppose the abnormal range were defined to be glucose levels outside of 1 standard
deviation of the mean (i.e., either at least 1 standard deviation above the mean, or at
least 1 standard deviation below mean). Individuals with abnormal levels will be
retested. What percentage of individuals would be called abnormal and need to be
retested? What is the normal range of glucose levels in units of mg/dL?
b. Suppose the abnormal range were defined to be glucose levels outside of 2 standard
deviations of the mean. What percentage of individuals would now be called
abnormal? What is the normal range of glucose levels (mg/dL)?

4.
A sample of 5 body weights (in pounds) is as follows: 116, 168, 124, 132, 110. The
sample median is:
a. 124.
b. 116.
c. 132.
d. 130.
e. None of the above.

5.
Suppose a random sample of 100 12-year-old boys were chosen and the heights of these
100 boys recorded. The sample mean height is 64 inches, and the sample standard deviation is 5
inches. You may assume heights of 12-year-old boys are normally distributed. Which interval
below includes approximately 95% of the heights of 12-year-old boys?
a. 63 to 65 inches.
b. 39 to 89 inches.
c. 54 to 74 inches.
d. 59 to 69 inches.
e. Cannot be determined from the information given.
f. Can be determined from the information given, but none of the above choices is
correct.
6.
Cholesterol levels are measured on a random sample of 1,000 persons, and the sample
standard deviation is calculated. Suppose a second survey were repeated in the same population,
but the sample size tripled to 3,000. Then which of the following is true?
a. The new sample standard deviation would tend to be smaller than the first and
approximately about one-third the size.
b. The new sample standard deviation would tend to be larger than the first and
approximately about three times the size.
c. The new sample standard deviation would tend to be larger than the first, but we
cannot approximate by how much.
d. None of the above is true because there is no reason to believe one standard deviation
would tend to be larger than the other.

BIOSTATISTICS
SAMPLING DISTRIBUTIONS, CONFIDENCE INTERVALS
Investigator A takes a random sample of 100 men age 18-24 in a community. Investigator B
takes a random sample of 1,000 such men.
a. Which investigator will tend to get a bigger standard deviation (SD) for
the heights of the men in his sample? Or, can it not be determined?
b. Which investigator will tend to get a bigger standard error of the mean
height? Or, can it not be determined?
c. Which investigator is likely to get the tallest man? Or are the chances
about the same for both investigators?
d. Which investigator is likely to get the shortest man? Or are the chances
about the same for both investigators?
2.

A study is conducted concerning the blood pressure of 60 year old women

with glaucoma. In the study 200 60-year old women with glaucoma are
randomly selected and the sample mean systolic blood pressure is 140 mm
Hg and the sample standard deviation is 25 mm Hg.
a. Calculate a 95% confidence interval for the true mean systolic blood
pressure among the population of 60 year old women with glaucoma.
b. Suppose the study above was based on 100 women instead of 200 but
the sample mean (140) and standard deviation (25) are the same.
Recalculate the 95% confidence interval. Does the interval get wider
or
narrower? Why?

3.

The post-surgery times to relapse of a sample of 500 patients with a particular disease is a
skewed distribution. The sampling distribution of the sample mean relapse time:
(a)
(b)
(c)

will be approximately normally distributed.

will be skewed
No general statement can be made

4.

A survey is performed to estimate the proportion of 18-year old females who have
had a recent sexually transmitted disease (STD) defined as an STD in the past
year. In a random sample of 300 women, 200 have agreed to participate.
Based on these 200 women, a 95% confidence interval for the proportion who
had a recently sexually transmitted disease was .10 to .21.
Which of the following is true about the proportion who had a recent STD among
the 100 who did not agree to participate in the survey:
(a)
(b)
(c)
(d)

5.

The proportion will definitely be in the interval .10 to .21.

The proportion will definitely not be in the interval .10 to .21.
Proportion will be in the interval .10 to .21 with 95% confidence.
No general statement can be made without additional information.

A random sample of 300 diastolic blood pressure measurements are taken.

Suppose a 99% confidence interval for the population mean diastolic blood
pressure is 68 to 73 mm Hg. If a 95% confidence interval is also calculated, then
(a)
(b)
(c)
(d)

The 95% confidence interval will be wider than the 99%.

The 95% confidence interval will be narrower than the 99%.
95% and 99% confidence interval will be the same.
One cannot make a general statement about whether the
95% confidence interval would be narrower, wider or the
same as the 99%.

You will need the following information to answer questions 6 through 8:

There were over 3.5 million hospital discharges in the year 2000 in the U.S. state of
California. Patient length of stay summary statistics available on all reported year 2000
hospital discharges in California include a median length of stay of 3.0 days, a mean length
of stay of 4.6 days, and a standard deviation of 4.5 days. Below is a histogram that shows
the distribution of the length of stay, measured in days, for all hospital discharges in the year
2000 in California. (the California all discharge data set). You may consider this the
population distribution of hospital discharges for the year 2000 in California.

.4
Percentage of Patients
.2
.3
.1
0
0 1

6.

10
15
20
Hospital Length of Stay (Days)

25

30

If a random sample of 1,000 discharges were taken from the California all-discharge
database, and a histogram were made of patient length of stay for the sample, which of the
following is most likely true:
a) The histogram will look approximately like a normal distribution
because the sample size is large , and the Central Limit Theorem applies.
b) The histogram will look approximately like a normal distribution
because the number of samples is large , and the Central Limit Theorem
applies.
c) The histogram will appear to be right skewed.
d) The histogram will appear to be left skewed.
e) The histogram will look like a uniform distribution

7.

Suppose we compared 2 random samples taken from the California all-discharge database
described above. Sample A is a random sample with 100 discharges. Sample B is a
random sample with 2,000 discharges. What can be said about the relationship between the
sample standard error in Sample A (SEA) relative to the sample standard error of length-ofstay value in Sample B (SEB)?
a)
b)
c)
d)

SEA < SEB

SEA > SEB
SEA is exactly equal to SEB
Not enough information given to determine relationship between the two
standard errors.

8.

Suppose we took 5,000 random samples from the California all-discharge data set, each
sample containing 100 discharges. For each of the 5,000 samples, the sample mean was
computed. A histogram was then created with the 5,000 sample mean values. Which of
the following statements most likely describes this histogram?
a) The histogram will look approximately like a normal distribution
because the size of each sample is large , and the Central Limit Theorem applies.
b) The histogram will look approximately like a normal distribution
because the number of samples is large , and the Central Limit Theorem
applies.
c) The histogram will appear to be right skewed.
d) The histogram will appear to be left skewed.
e) The histogram will look like a uniform distribution.

9.
In a health care utilization journal, results are reported from a study performed on a
random sample of 100 deliveries at a large teaching hospital. The sample mean birth weight is
reported as 120 ounces, and the sample standard deviation is 25 ounces. The researchers
neglected to report a 95% confidence interval for the population birth weight (i.e.: mean
birthweight for all deliveries in the hospital). You decide to do so, and find the 95% confidence
interval for the population mean birth weight to be:
a)
b)
c)
d)

119.5 ounces to 120.5 ounces

115 ounces to 125 ounces
70 ounces to 170 ounces
117.5 ounces to 122.5 ounces

10. A survey was conducted on a random sample of 1,000 Baltimore residents. Residents were
asked whether they have health insurance. 650 individuals surveyed said they do have health
insurance, and 350 said they do not have health insurance. A 95% CI for the proportion of
Baltimore residents with health insurance is:
a)
b)
c)
d)

60% to 75%
32% to 38%
62% to 68%
36% to 46%

BIOSTATISTICS
HYPOTHESIS TESTING
1.

A study was undertaken to evaluate the effect of percutaneous transluminal coronary

angioplasty (PTCA) in patients with one-vessel coronary artery disease. A random sample
of one hundred and seven patients with coronary artery disease were given PTCA.
Patients were given exercise tests at baseline and after 6 months of follow-up. Exercise
tests were performed up to maximal effort until symptoms (such as angina) were present.
The change in the duration of exercise was calculated. Change is defined as the 6
month test minus the baseline test. The mean change was 2.1 minutes and the standard
deviation of the changes was 3.1.
(a)
(b)
(c)

2.

What statistical test can be performed to see if there has been a statistically
significant change in duration of exercise for this group of patients given PTCA?
Compute a 95% confidence interval for the mean change in exercise duration.
Can we conclude from this study that PTCA is effective in increasing exercise
duration? Are there any limitations or weaknesses in this study for answering that
question?

A researcher wishes to determine if vitamin E supplements could increase cognitive

ability among elderly women. In 1999 the researcher recruits a sample of elderly women
age 75-80. At the time of the enrollment into the study, the women were randomized to
either take Vitamin E, or a placebo for six months. At the end of the six month period,
the women were given a cognition test. Higher scores on this test indicate better
cognition. The mean and standard deviation of the test scores of 81 women who took
vitamin E supplements was 27 and 6.9 respectively. The mean and standard deviation of
the test scores of the 90 women who took placebo supplements was 24 and 6.2,
respectively.
1.
2.
3.
4.

Compute a 95% confidence interval for the mean difference in

cognition test scores between Vitamin E and placebo groups.
What statistical test would you perform to compare the mean
scores?
Are there limitations to this study for drawing conclusions about
whether vitamin E can enhance cognitive ability in elderly
women?
What would you conclude from these study results?

3.

Measurements on babies of mothers who used marijuana during pregnancy were

compared to measurements on babies of mothers who did not. The sample mean
head circumference was larger in the group who were not exposed to marijuana
and the 95% confidence interval for the difference in mean circumference
between the 2 groups was .61 to 1.19 cm. What can be said about the (2sided) p value for testing the hypothesis of equal means?
(a)
(b)
(c)
(d)
(e)

4.

A study of 100 patients is performed to determine if cholesterol levels are lowered

after 3 months of taking a new drug. Cholesterol levels are measured on each
individual at the beginning of the study and 3 months later. The cholesterol
change is calculated which is the value at 3 months minus the value at the
beginning of the study. On average the cholesterol levels among these 100
patients decreased by 15.0 and the standard deviation of the changes in
cholesterol was 40. What can be said about the 2 sided p-value for testing the
null hypothesis of no change in cholesterol levels?
(a)
(b)
(c)
(d)

5.

The p value is greater than .05

The p value is equal to .05
The p value is less than .05
The p value is 0
Cannot be determined from the information given.

The p value is less than. 05

The p value is greater than .05
The p value is equal to .05
Cannot be determined from the information given

The standard error of a statistic is

(a)
(b)
(c)

the mean of the sampling distribution

the standard deviation of the sampling distribution
the statistic divided by the square root of the sample size (that is,
statistic/ N )

6.

Two hundred hypertensive patients are randomized to either a diet program or an

exercise program. (102 patients to diet program, 98 patients to exercise program) Blood
pressure is measured on each patient both before the programs start and 3 months after
the start of each program. The correct statistical procedure to determine whether or not
the mean blood pressure change (after-before) was statistically significantly different for
the two programs is:
a.
b.
c.
d.

7.

Paired t-test
2 sample unpaired t-test
Fishers exact test
None of the above

Measurements on a (random) sample of babies born to mothers who took Prescription

Drug A during pregnancy were compared to measurements on a (random) sample of
babies born to mothers who did not take Prescription Drug A. A statistically
significant difference in the mean head circumference was found between children born
to the two groups of mothers (p = .03). Based only on this information you can
conclude:
a. There is a 3% chance the null hypothesis is true.
b. Taking Prescription Drug A during pregnancy causes a reduction in childs
head circumference.
c. Taking Prescription Drug A is associated with an increased child head
circumference.
d. The sample mean difference in childrens head circumference between
children born to the two groups of mothers is clinically important/significant.
e. None of the above.

8.

You are reading an article detailing a study designed to compare the average body mass
index among hypertensive individuals (persons with high blood pressure) to
normotensive individuals. The study was conducted using participants in a health plan
offered by a large insurance carrier. 200 randomly selected hypertensive participants
were compared to 200 randomly selected normotensive participants. The study reports a
95% confidence interval (CI) for the mean difference in BMI between hypertensives and
normotensives. The 95% CI is (0.15 kg/m2, 2.43 kg/m2). However, no p-value is
reported for testing the null hypothesis of no mean difference in BMI between the two
groups (a mean difference of 0 kg/mg2) versus the alternative of a non-zero mean
difference. Luckily, you have taken this course, so you are able to determine:
a.
b.
c.
d.
e.

the p-value is < .05

the p-value is > .05
the p-value is exactly .05.
the p-value is exactly .009
None of the above.

Question 9 refers to the following information:

A study was performed on 200 elementary school students to investigate whether regular
Vitamin A supplementation was effective in preventing colds during the month of March.
100 were randomized to receive daily Vitamin A supplements during the month of
March, and 100 students were randomized to a placebo group (and did not receive
Vitamin A) during the same month. The number of students getting at least one cold in
March was computed in the two groups, and the results are given in the following 2 X 2
table.

Vitamin A
Placebo

Cold
15
25
40

No Cold
85
75
160

100
100
200

9. If you were interested in testing for a statistical relationship between taking Vitamin A
and cold status in the population of elementary school students (ie: testing the null
hypothesis of no difference in the proportion of colds in Vitamin A and placebo groups,
versus the alternative of a difference in proportions), the correct statistical test is:
a.
b.
c.
d.

Two-sample t-test
Ad-hoc test for testing the equality of things
Chi-squared test
Paired t-test

BIOSTATISTICS
PROPORTIONS
1.

An article in the Journal of the American Medical Association1 documents the

results of a randomized clinical trial designed to evaluate whether the influenza
vaccine is effective in reducing the occurrence of acute otitis media (AOM) in young
children. Acute otitis media is an infection that causes inflammation of the middle ear
canal. In the study, children were randomized to receive either the influenza vaccine
or a placebo. (randomization was done in a 2 to 1 ratio, meaning that two times as
many children were randomized to the vaccine treatment as were randomized to the
placebo group). The children were followed for one year after randomization, and
monitored for AOM during this period. 262 children were randomized to the vaccine
group, and 150 of these children experienced at least one incident of AOM during the
follow-up period. 134 children were randomized to the placebo group, and 83 of these
children experience at least one incident of AOM during the follow-up period. Note
that the standard error of the differences in the proportions in the two groups is
0.0519.
(a)

(b)
(c)
(d)
1

Estimate a 95% confidence interval for the proportion of children experiencing

at least one incident of AOM during the follow-up period in each of the
randomization groups. How do these 95% CIs compare? (similar range of
values? Overlap?)
Estimate the 95% confidence interval for the difference in the two proportions.
State the null and alternative hypotheses associated with testing for an
association between the influenza vaccine and AOM. Is the p-value for testing
these hypotheses significant at the 0.05 level?
Is this a randomized study? What does this suggest when translating the
observed difference in proportions?

based on data from:

Hoberman, A. et al. Effectiveness of Inactivated Influenza Vaccine in Preventing
Acute Otitis Media in Young Children: A Randomized Controlled Trial (2003).
Journal of the American Medical Association, 290, 1608-1616.

2.

A study was done to investigate whether there is a relationship between survival of

patients with coronary heart disease and pet ownership. A representative sample of 92
patients with CHD was taken. Each of these patients was classified as having a pet or
not and by whether they survived one year following their first heart attack. Of 53 pet
owners, 50 survived. Of 39 non-pet owners, 28 survived. Note that the standard error
of the difference in the two proportions is 0.34.
Suppose you were interested in doing a statistical analysis of these study results.
Answering the follow questions to help you with this goal!
(a)
(b)

3.

Estimate a 95% confidence interval for the proportion of patients surviving at

least one year beyond the first heart attack in each of the groups (pet/no pet).
Is this a randomized study? What does this suggest when translating the
statistical result from part (a) into a substantive/scientific conclusion?

To evaluate the effectiveness of 2 different smoking cessation programs, smokers

are randomized to receive either program A or program B. Of 6 smokers on
program A, 1 stopped smoking and 5 did not. Of 6 smokers on program B, 4
stopped smoking and 2 did not. Which statistical procedure would you use
to test the null hypotheses that the programs are equally effective and to obtain
a p-value?
(a)
(b)
(c)
(d)
(e)
(f)

Paired t- test
Chi Square Test
One way Analysis of Variance
2 sample t- test
Fishers exact test
Mann-Whitney (Wilcoxon rank sum) nonparametric test

4.

Suppose you are asked to help design a study to compare the mean birth weights
of 2 groups of infants. The study researcher plans to have the same sample size in
both groups. The researcher tells you that she would like to have 80% power to
detect a difference in mean birth weights of 5 ounces using a significance level of
.05. Has the researcher provided you with enough information for you or your
computer to perform the sample size calculation?
a. Yes, there is enough information to calculate the sample size
b. No, but there would be enough information if I was also told the mean birth
weight in both groups
c. None of the above

BIOSTATISTICS
LINEAR REGRESSION
The objective of a study is to understand the factors that are associated with systolic
blood pressure in infants. Systolic blood pressure, weight (ounces) and age (days) are
measured in 100 infants. A multiple linear regression is performed to predict blood
pressure (mm Hg) from age and weight. The following results are presented in a journal
article. (Questions 1-3 refer to these results)
Multiple Linear Regression Analysis of the Predictors
of Systolic Blood Pressure in Infants

Intercept
Birth Weight
Age (days)

s (coefficients)
b'
50.
0.10
4.0

s)
SE( b'
4.0
0.3
0.60

1. How much higher would you expect the blood pressure to be of an infant who
weighed 120 ounces compared to an infant who weighed 90 ounces if both infants
were of exactly the same age?
a.
b
c.
d.
e.

0.1 mm Hg
1.0 mm Hg
2.0 mm Hg
3.0 mm Hg
4.0 mm Hg

2. Which of the following is a 95% confidence for the difference in SBP between two
infants of the same weight who differ by 2 days in age (older compared to younger)?
a.
b.
c.
d.

2.8 mmHg to 5.2 mmHg

5.6 mmHg to 10.4 mmHg
6.8 mmHg to 9.6 mmHg
0.5 mmHg to 0.7 mmH

3. Suppose the R2 from the above regression model is .57, which means that roughly 57% of
the variability in the infants blood pressure measurements is explained by infants age and
weight. What would happen to this R2 value, if weight had been recorded as kilograms
instead of ounces?
a.
b.
c.
d.
4.

R2 would go increase.
R2 would decrease
R2 would equal .57.
Not enough information to determine.

A recent study of the relationship between Scholastic Aptitude Test (SAT) scores and
U.S. state level characteristics found a statistically significant (p < .05) relationship
between average SAT scores and the percent of high school seniors who actually took the
SAT within a state. Linear regression was used to estimate this relationship , and the
resulting regression equation was:
y = 1024 2.3x1
where y represents average SAT score, and x1 represents the percentage of high school
seniors taking the SAT.
The coefficient of determination, R2 is 0.76. What can be said about the correlation
coefficient, r?
a.
b.
c.
d.

The correlation coefficient is 0.76

The correlation coefficient is 0.76
The correlation coefficient is .87
The correlation coefficient is .87

A data set contains information about the hourly wage (in U.S. dollars) and the gender of each of
the 534 workers surveyed in 1985, as well as information about each workers age, union
membership, and education level (measured in years of education). A linear regression analysis
was performed to model hourly wage as a function of worker sex, number of years of education,
and union membership. Below find the results from this regression:

sex (1 = Female, 0 = Male)

union member (1 = yes, 0 = no)
years of education
intercept

Regression
Coefficient
-1.9
1.9
0.76
-0.3

Standard Error
of Regression Coefficient
0.4
0.5
0.08
1

5. Using the above regression results, estimate the mean hourly wage in 1985 for male workers
with a high school education (12 years of education), who were not union members.
a.
b.
c.
d.

$10.72 per hour

$6.93 per hour
$9.12 per hour
$8.82 per hour

6.. Give a 95% confidence interval for the mean difference in hourly wages for male workers
with a high school education who were union members when compared to male workers with a
high school education who were not union members.
a. $0.90 per hour to $2.90 per hour
b. - $2.70 per hour to -$1.20 per hour
c. Cannot be estimated with the reported regression results.

7.

The relationship between forced expiratory volume (FEV), which is measured in liters,
and age, which is measured in years, is evaluated in a random sample of 200 men
between the ages of 20 and 60. A simple linear regression analysis is performed to predict
FEV from age. The following results are published in a paper.
Results of Simple Linear Regression Analysis
Intercept
Age

Regression Coefficient
-4.0
0.02

Standard Error
.30
.005

a) Interpret the coefficient of age in words.

b) Give a 95% confidence interval for the coefficient of age. Write a sentence
explaining the interpretation of this confidence interval.
c) Given the above results, can you ascertain whether the linear relationship between
FEV and age is strong? Why or why not?
d) Suppose above results are used to compare 60 year old men to 50 year old men
what would be the estimated average difference in FEV between the two groups of
men?
e) Would it make sense to use the above results to estimated the average FEV levels for
men 80 years of age? Why or why not?

BIOSTATISTICS
SURVIVAL ANALYSIS
1.

Ten health care workers who were accidentally stuck with needles contaminated with
HIV were followed for onset of AIDS. Six of the workers developed AIDS at 36, 65, 90,
110, 140 and 121 months. Four of the workers had still not developed AIDS at the time
they were last contacted which was 40, 75, 130 and 160 months after the needle stick
occurred. What statistical method would you use to find the median incubation period
(time from HIV exposure to AIDS) ?

The following information is referenced in questions 2 3.

NNIPS-II was a randomized study of 15,987 infants born alive to 43,559 women who received
Vitamin A, Beta-carotene, or a placebo prior to and during pregnancy. (Investigators: Drs. Keith
West, Joanne Katz, Parul Christian et al..) Infants were followed for up to 180 days after birth,
until death (the event (outcome) being studied), dropout or studys end (180 days). We are using
a representative subset of 10,295 live births from the original data set to investigate factors
associated with increased risk of infant mortality in this population.
Kaplan Meier curves for overall infant survival in the first 180 days, and survival stratified by
each of the three drug groups are as follows:

Percentage of Infants Surviving Beyong Time Point

Overall Infant Survival in First 180 Days After Birth

1

.95

.9
0

50

100
Time (days)

150

200

Percentage of Infants Surviving Beyong Time Point

Overall Infant Survival in First 180 Days After Birth

1

.95

Placebo
Beta C

Vit A

.9
0

2.

100
Time (days)

150

200

Based on the first Kaplan Meier curve (Overall Infant Survival in First
180 days), an estimate of the median survival time after birth for this
sample of infants is:
a.
b.
c.
d.

3.

50

47 days
100 days
150 days
The median survival time cannot be estimated using the given Kaplan-Meier
curve.

Based on the first Kaplan Meier curve, an estimate of the 100 day survival rate is
a.
b.
c.
d.
e.

50 days
0.94
1.00
0.90
Cannot be estimated using the information given

4. Suppose a random subsample of 1,000 infants was followed for up to 10

years after their birth. 122 of these infants died within 10 years of their birth
date, and the remaining infants either were lost to followup, or survived the full
10 year study period. Suppose the mean of the recorded death and censoring
times was computed for this group of infants to estimate mean survival times in the first
ten years following birth, and this sample mean is 6.7 years. Is this sample mean a good
estimate of the true mean survival time in the 10 years following birth?
a. Yes, it is a good estimate.
b. No, the sample mean will tend to overestimate the true mean survival time.
c. No, the sample mean will tend to underestimate the true mean survival time.

SOLUTIONS TO
BIOSTATISTICS
PRACTICE
PROBLEMS

BIOSTATISTICS
DESCRIBING DATA, THE NORMAL DISTRIBUTION
SOLUTIONS
1.
a. To calculate the mean, we just add up all 7 values, and divide by 7. In
7

fancy statistical notation, X =

X
i =1

=
7
12.0 + 9.5 + 13.5 + 7.2 + 10.5 + 6.3 + 12.5
= 10.2 years.
7

b. To calculate the sample median, first rank the values from lowest to
highest:
6.3

7.2

9.5

10.5

12.0

12.5

13.5

Since there are 7 values, an odd number, we can simply select the middle
value, 10.5, to calculate the sample median.
b. Its a good thing we have calculated the sample mean- we ned this to
calculate the sample standard deviation! Recall the formula for SD:
7

SD =

(X
i =1

X) 2

7 1

(12.0 10.2) 2 + (9.5 10.2) 2 + ...............(12.5 10.2) 2

6

= 2.71 years
d.

1. sample mean Would decrease, as the lowest value gets lower,

pulling down the mean.
2. sample median Would remain the same since the middle value
is still 10.5 By replacing the 6.3 with 1.5, the rank of the 7 values
is not affected.
3. sample standard deviation Would increase. Because our
minimum value has now gotten smaller, while the rest of the data
points remain unchanged, the spread or variability in our data has
increased; since SD is a measure of spread, it too will increase
(prove it to yourself!).

e.

While the sample mean and sample standard deviations of the 14

observation will likely be different than the respective quantities

from the sample with seven observations, it is not possible to
predict how the values will differ (at least without seeing the data!)
as neither the sample mean nor the sample mean values are linked
explicitly to sample size. Recall, these sample quantities are
estimating the same underlying population parameters whether
they are computed from a sample of size 7, 14, or 1,000.
In this example, the sample mean of the 14 observations is
9.9 years, smaller than the sample mean of 10.5 years for the
original seven observations. The sample standard deviation of the
14 observations is 3.1 years, larger than the sample standard
deviation of 2.7 years for the original seven observations.

2.
This question is really about is calculating standard normal scores. Recall,

Z=

Observed Mean
SD

170 146 24
=
= 3 SDs.
8
8
148 146 2
b. The boy who is 148 cm tall is above average by
= = .25 SDs.
8
8
c. A third boy was 1.5 SDs below the average height. He was 146 1.5*8 =
146-12 = 134 cm tall.
a. The boy who is 170 cm tall is above average by

d. If a boy was within 2.25 SDs of average height, the shortest he could be is
146 2.25*8 = 128 cm tall, and the tallest he could be is 146 + 2.25*8 = 164
cm tall.
e.

1.
2.
3.
4.

150 cm about average (.5 SDs above mean)

130 cm - unusually short (2 SDs below mean)
165 cm unusually tall (2.4 SDs above mean)
140 cm about average (.75 SDs below mean)

3.
These questions refer to the table relating normal scores to area (percent
population) under the density curve.

More than Z
SDs above
the mean

Within Z SDs
of the mean

More than Z
SDs above or
below the mean

1.0
2.0
2.5
3.0

68.27%
95.45%
98.76%
99.73%

15.87%
2.28%
0.62 %
0.13%

31.73%
4.55%
1.24%
0.27%

a. If individuals considered abnormal have glucose levels outside of 1 standard

deviation of the mean (above or below) , then approximately 32% (31.73 to be
exact) of the individuals will need to be retested. The normal range of glucose
level would range from (90 38) mg/dL to (90 + 38) mg/dL, or from 52 mg/dL
to 128 mg/dL.
b. If individuals considered abnormal have glucose levels outside of 2 standard
deviations of the mean (above or below) , then approximately 5% (4.55 to be
exact of the individuals will need to be retested. The normal range of glucose
levels would range from (90 2*38) mg/dL to (90 + 2*38) mg/dL, or from 14
mg/dL to 166 mg/dL.
4. A is the correct answer. Remember, in order to calculate the median, you must first
order the values in the sample from lowest to highest. Doing so yields:
110

116

124

132

168

This sample is of size 5, and odd number, so the middle value of 124 is the sample
median.
5. C is the correct answer. Here the sample mean, X = 64 inches, and the SD = 5 inches.
Since we are given that the distribution of heights in 12 year old boys is normal, we know
that 2 SDs above or below the sample mean will give us an interval containing
approximately 95% of the heights in the sample. This interval would run from 64 2*5
to 64 + 2*5, or 54 inches to 74 inches.

8. D is the correct answer. Remember, whether we calculate sample SD from a sample of

1,000 or a sample of 3,000, both are estimating the same quantity- the population
standard deviation. These two estimates should be about the same, and we cannot
predict which will be larger.

BIOSTATISTICS
SAMPLING DISTRIBUTIONS, CONFIDENCE INTERVALS
SOLUTIONS
QUESTION 1.
a.

b.

c.
d.

It can not be determined which researcher will get the bigger

standard deviation both sample SDs from the sample with n =
100, and with n = 1,000 are estimating the same quantity the
population standard deviation. Therefore, the two estimates
should be similar, and it is not possible to tell which will be
larger , prior to calculating the values. Standard deviation does
not depend on sample size, but will vary from random sample to
random sample.
Standard error does depends on sample size, however; the
larger the sample size, the smaller the standard error of the
mean (SEM). Therefore, the SEM calculated from the sample
with n = 1,000 will likely be smaller the SEM calculated from
the sample with n = 100.
Extreme values are more likely in larger samples therefore,
the investigator with the sample of n = 1,000 is more likely to
have the tallest man.
Extreme values are more likely in larger samples therefore,
the investigator with the sample of n = 1,000 is more likely to
have the shortest man.

QUESTION 2.
a. In this study of 60 year old women with glaucoma, n = 200, X =140
mmHg, and SD = 25mm Hg. Since n is large, we can use the Central
Limit Theorem to aid us in constructing a 95% confidence interval for
the population mean blood pressure, . Its business as usual via the
formula:

X 2*(SEM), where SEM =

SD
n

25
200

= 1.77 mm Hg

Plugging in our sample values gives us:

140 2*(1.77) (136.5 mm Hg, 143.5 mmHg)

b. If a second study yielded the same sample statistic values, but were
done with 100 women, what would happen to the width of the 95%
confidence interval? Well, we know since this sample is smaller than
the previous example, the SEM will be larger, leading to a wider
confidence interval. In non-mathematical terms, our sample contains
less information than a sample of 200 women, and therefore will yield
a less precise (more uncertain) estimate of the population mean. The
proof is as follows:
SD
25
X 2*(SEM), where SEM =
=
= 2.5 mm Hg
n
100
Plugging in our sample values gives us:
140 2*(2.5) (135 mm Hg, 145 mm Hg)
3. A is the correct answer. Here the sample is of size n = 500, which is large enough to
ensure that the Central Limit Theorem kicks in . By the Central Limit theorem, the
sampling distribution the of the sample mean from a sample of 500 will be normally
distributed.
4. D is the correct answer. No general statement can be made as we do not know whether
or not the sample of 200 women who agreed to participate from the original random
sample of 300 was still representative of all 18 year old females. If these 200 women are
inherently different from the other 100 non-participants, the results shown are biased.
5. B is the correct answer. The more confident we want to be, the wider our confidence
interval. Ninety-nine percent confidence is higher than ninety-five percent confidence;
therefore the 95% confidence interval is not so wide as the 99% confidence interval.
6. C is the correct answer. The sample is random, i.e. representative therefore, the sample
distribution should mimic the larger population distribtion, which is right-skewed.
7. B is the correct answer. We would expect the two samples to have SD values that are
similar. but, recall that the standard error (SE) is the standard deviation divided by the
square-root of the sample size. Because Sample B is much larger (N=2000) than Sample
A (N=100), we would then expect the SE of Sample B to be smaller than the SE of
Sample A.
8. A is the correct answer. This question is asking about the shape of the sampling
distribution of the sample mean, based on samples of size 100: As the sample size is
large (n=100) the Central Limit Theorem applies and the sampling distribution should be
normal: hence a histogram based on the sample means of 3,000 random samples should
be approximately normal : note it is not the number of samples that determines whether
the Central Limit Theorem kicks in but the size of each of the samples.

9. B is the correct answer. A very straightforward application of the formula

x 2 SE ( x ) - you are given sample s.d. of 25 ounces, and know that the sample size is
25
100 the estimated standard error of the sample mean is s
= 25
=
= 2.5. all
100 10
n
you need do is plug in:
x 2SE( x ) = 1202(2.5) = 1205 = (115, 125).

10. The correct answer is C. In this sample, p , the estimated proportion of Baltimoreans
650
with health insurance, is
= .65 , or 59%. As 1000*.65*(1-.65)228, we can use the
1000
normal approximation for the 95% CI for a population proportion, given info from a
(.65)(1 .65)
random sample. The standard error of this estimate is
.015 Applying
1000
the formula p 2SE(p) , yields as 95% confidence interval of (.62,.68), or 62% to 68%
for the proportions of Baltimoreans with health insurance.

BIOSTATISTICS
HYPOTHESIS TESTING
SOLUTIONS
QUESTION 1. (answers will vary, of course)

A sample of 107 patients with one-vessel coronary artery disease was given percutaneous
transluminal coronary angioplasty (PTCA). Patients were given exercise tests at baseline
and after 6 months of follow up. Exercise tests were performed up to maximal effort
until symptoms, such as angina, were present. A paired t-test was used to assess whether
there was a significant change in duration of exercise after 6 months of PTCA treatment,
and a 95% confidence interval was constructed for the mean difference (after - before) in
exercise duration.
Exercise duration increased 2.1 minutes (95% CI 1.5 2.7 minutes) on average after the
PTCA treatment. There was evidence that exercise was significantly higher after
exposure to 6 months of PTCA treatment (p < .001). As there was no comparison group
of individuals not receiving PTCA, we cannot prove PTCA as the cause of this increase
in exercise duration. It is not known whether there would have been a similar 6-month
change without PTCA.
QUESTION 2.(answers will vary, of course)

A sample of 171 women between 75 and 80 years old were classified into one of two
groups based on whether the subject took Vitamin E supplements at the time of
enrollment. Each woman was subsequently given a test to measure cognitive ability.
Higher scores on this test indicate better cognition. A two sample t-test was used to
compare mean cognition test scores between the two groups of women, and a 95%
confidence interval for the difference was constructed.
The average test score amongst the women taking vitamin E was 27 (sd = 6.9) as
compared to a mean score of 24 (sd = 6.2) for women not taking the supplements. The
average score difference between the two groups is 3.0 points (95% CI 1.0 5.0 points).
The cognition scores were statistically significantly the women taking Vitamin E
supplements. (p < .01) As the women were randomized to the vitamin and placebo
groups, the results of this study strongly suggest a positive relationship between Vitamin
E consumption and increased cognition amongst elderly women.
If the study was not randomized, and women self-selected to be in the Vitamin E group,
the statistical comparisons could still be made, but the scientific conclusions would be
harder to make without further analyses (the type of which is coming in 612!). The
write-up of the results would be similar, but the last sentence in the second paragraph in
part 1 would change to something like the following paragraph:

However, because women were not randomized to take the vitamin supplements but
were self-selected into the vitamin exposure groups, it is not possible to attribute the
higher scores to Vitamin E. It is possible that the women taking Vitamin E differed on
multiple factors when compared to the women who were not taking the supplement. The
difference in test scores could be attributable, at least partially, to some of these other
factors.
3. The correct answer is C. Because the 95% confidence interval does not include zero,
we would reject null hypothesis of a true mean difference of zero at the = .05 level.
Testing
Ho: 2 - 1 = 0
is equivalent to testing Ho: 2 = 1, the equality of the two means.

4. The correct answer is A. The data collected in this example is paired data, and a pvalue would be obtained from the paired t-test. The test statistics would be:

t=

X diff
observed _ mean _ difference
=
s tan dard _ error _ of _ mean _ difference se( X diff )

where X = 15, and se( X ) =

40
100

40
= 4.
10

So Z = 15/4 = 3.75. Since t > 2, we know p < .05

5. The correct answer is B. The standard error of a statistic is a measure of the
variability of that statistic across different sample sizes the variability of the sampling
distribution. Therefore, the standard error of a statistic is the standard deviation of the
sampling distribution.
6. B is the correct answer. Despite the fact that we are computing before/after
differences we ultimately are comparing these differences between two independent
groups: those randomized to the diet program, and those randomized to exercise. Since
we are making a comparison of mean changes between two independent groups, the
appropriate test is the 2 sample unpaired t-test.

7. The correct answer is E. This is a hard, but important question : choice a is just flatout incorrect, based on the definition of the p-value, and choices b-c are impossible to
ascertain from just a p-value, as it imparts no information about the direction/magnitude
and clinical or scientific significance of the results of a study.
8. A is the correct answer. As the 95% confidence interval for the mean difference does
not include, the resulting p-value would be less than .05.
9. C is the correct answer. The chi-squared is the correct statistical test for comparing
two population proportions based on information from two (large) samples both the
sample meet the large sample criteria.

BIOSTATISTICS
PROPORTIONS
SOLUTIONS
Question 1.
(a) To estimate the 95% confidence interval for each group, we need to know the
estimated proportion in each group (150/262 = 0.57 in the vaccine group and
83/134 = 0.62 in the placebo group), and their standard errors. Recall that the
p (1 p )

, so that the standard error

formula for the standard error of a proportion is
N
of estimate p in the vaccine group is 0.030 and in the placebo group is 0.042.
Now we can implement the formula for the confidence interval for a proportion
(for large N): p$ 2 se( p$ )
Plugging into this equation for the vaccine group, we have:
(0.57 2*0.03, 0.587+ 2*0.03) = (0.51, 0.63)
Plugging into this equation for the placebo group, we have:
(0.62 2*0.04, 0.62 + 2*0.04) = (0.54, 0.70)
These confidence intervals do overlap in the range of 0.0.54 to 0.63, which seems
to be a large fraction of the intervals.
(b) To compute the 95% confidence interval for the difference in proportions, we use the
general formula for the confidence interval, where we use the standard error for
the difference of proportions provided:

( p$1 p$ 2 ) 2 se( p$1 p$ 2 )

Plugging into this equation:
(0.57 0.62 -2*0.05, 0.57 - 0.62 + 2*0.05) = (-0.15, 0.05).
The interpretation of this 95% CI basically suggests that the results from our
samples indicates that the vaccine could be associated with a decrease in the
proportion of children experiencing at least one episode of AOM of at most 15%,
but could also be associated with an increase as large as 5%.
(c) The null hypothesis would be that the underlying true proportions of children
experiencing at least one episode of AOM are the same for the vaccinated and
non-vaccinated children : in other words, there is no relationship between the

influenza vaccine and occurrence of AOM in children. The alternative hypothesis

is the underlying true proportions of children experiencing at least one episode of
AOM in the follow-up period are different for the vaccinated and non-vaccinated
children : in other words, there is a relationship between the influenza vaccine and
occurrence of AOM in children.
The p-value for testing this is greater than 0.05. We know this because the 95%
CI for the difference in proportions between the two groups includes 0.
(d) This is a randomized study (it says so right in the question!): because
randomization helps to equalize the two groups of children in terms of other
characteristics (age, health, etc) it makes it easier to attribute any differences
found in AOM episodes to the vaccine, or attribute non-difference to the lack of
vaccine efficacy in affecting AOM (as is this case with these study results). In
other words, the randomized study design indicates that the lack of association
found between the flu vaccine and episodes of AOM is not because the vaccine is
really associated with AOM and this association is being hidden by other
characteristics of the children that differ between the treatment and placebo group.

2. (a) Using the same approach as in question 1, the large sample approximation for the
95% confidence intervals for the proportions in the two groups are (0.58, 0.86) in
the pet group and (0.88, 1.01) in the non-pet group. But, we see a problem here!
One of these confidence intervals overlaps 1! This is impossible because
proportions must take values between 0 and 1. So, in thinking about the large
sample approximation again, perhaps it isnt such a good idea: the sample sizes
in the two groups are only 39 and 53. An exact approach is needed in this case.
(c) Most likely, it was not possible for the researchers to randomize these 92
patients to a pet ownership group (for practical reasons, and ethical issues for both
the patients and the animal!). Ergo, it is not possible to attribute the increase
survival in the pet-ownership group to owning a pet. The pet ownership-survival
relationship may be fueled by other differences existing between the pet owners
and those without pet: for example, differences in level and depression status.
Further analysis would be necessary to help control for some of these potential
difference when estimating the pet ownership/survival relationship.
3. The best answer is E. Statistically speaking, the question of interest reduces to testing
for a difference in the proportion of individuals who quit smoking on program A as
compared to program B. This limits our possible choices to (b) and (e). Because of the
small sample sizes (the best answer is (e), Fishers Exact Test.

4. The correct answer is C. In order to complete the story you would also need to have
estimates of the standard deviations of the birth weight measurements in each of the two
groups of infants being compared.

BIOSTATISTICS
LINEAR REGRESSION
SOLUTIONS
1. The correct answer is D. The coefficient for weight is 0.10, indicating that the expected
difference in SBP for two children of the same age who differ by one ounce in birth weight is
0.10 mmHg, the heavier child compared to the lighter child. So if we are comparing a child
who weighed 120 ounces at birth to a child who weighed 90 ounces at birth, and both children
were the same age, the estimated expected (mean) difference in SBP is 30*.10mmHG = 3.0
mmHg.
2. The correct answer is B. Well, the coefficient for age is an estimate of the difference in
SBP between 2 infants with the same birthweight who differ by one day in age: the older
compared to the younger will have SBP of 4 mmHg higher, one average (95% CI: 42*.6 =
(2.8, 5.3)). To get the corresponding CI for the difference in SBP for equally weighted infants
who differ by 2 days In age, we can just double the endpoints for the previously computed CI.
3. C is the correct answer. All thats being changed is the units in which the weight is
measured the measurements themselves are not being altered, just the units in which the
values are expressed ergo, the correlation between SBP and a childs age and weight should
not be altered.
4. The correct answer is D. Recall, r tells us something about both the strength and the
direction of a relationship. It is the appropriately signed value of R 2 . Since the slope
is negative, we know r must be negative: hence it is 0.76 = -.87.
5. D is the correct answer. This model relates wage as a function of a subject's sex,
union membership status, and years of education via the following equation y = 0.3 + 1.9 * sex + 1.9 * union _ member + 0.76 * years _ education. Male, non-union
workers with 12 years of education have the following predictor values: sex = 0,
union_member = 0, years_education = 12, so the resulting predicted value
is y = 0.3 + 1.9 * 0 + 1.9 * 0 + 0.76 * 12 = 0.3 + 9.12 = 8.82 _ dollars / hr.
6. A is the correct answer. What this is asking for in more user friendly terms is the 95%
confidence interval for the coefficient of union_member in a model that also includes sex
and years_education: recall the interpretation of this coefficient is that it estimates the
adjusted mean hourly wage for union members compared to non-union members of the
same sex and same years of education (ie: adjusted for sex and years of education). So
this estimated coefficient is 1.9, and its standard error is 0.5: as we have a large sample,
we can just employ the b1 2 SE (b1 ) = 1.9 2 * 0.5 method to get the 95% CI of (.90,

2.90), or $0.90 to $2.90 per hour.

7. (a)
Two possible phrasings:
- a 1 year increase on age is associated with an .02 liter increase in FEV, on
average
- In two groups of men who differ by one year of age, the older groups will
have average FEV of .02 liters higher than the younger group
(b) Since we have a sample of 200 men, we need not fuss with pesky tcorrections, and can just employ the general formula b1 2 SE (b1 ) , which gives a
95% CI of 0.022*(.005), giving a 95% CI of (.01, .03). So based on this sample
of 200 men, the true increase associated with an 1 year increase in age is between
.01 liters and .03 liters. (with 95% confidence, etc..)
(c) The strength of the linear association can not be assessed without viewing a
scatterplot and seeing an estimated correlation coefficient.
(d) To find the difference between 60 and 50 year old men, we simply multiply
the coefficient for age (representing a 1 year difference) by 10: 0.02*10 = 0.2.
(e) No these results are based on information from a sample of men aged 20
60: The results are not necessarily applicable to men outside this age range.

BIOSTATISTICS
SURVIVAL ANALYSIS
SOLUTIONS

1. Survival analysis would be used. The outcome variable is time to AIDS, where
some of the times are censored. When we have time to event data, the best choice is to
use survival, and we could more specifically use the Kaplan-Meier approach to estimate
the survival curve and the median time to AIDS.
2. The correct answer is D. The median time (i.e. the time at which S(t) = 0.50) is not
shown on the plot. We see that S(t) only ranges from 0.90 to 1.00, meaning that the
median time is not within the 180 days.
3. The correct answer is B. At 100 days, the height of the survival curve, S(t), is
approximately 0.94.
4. C is the correct answer. By taking the average, we are treating the censored times as
observed times of death. But, when an observation is censored, we know that the true
time of death must be after the censored time of death. So, the censored times are
underestimates of the true survival times. As a result, taking the mean of both the
observed time of death and censored times of death, we get an underestimate of the true
mean survival time.