UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
1

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UNIVERSITY OF
KWAZULU-NATAL
SCHOOL OF MATHEMATICS STATISTICS
& COMPUTER SCIENCE
FINAL EXAMINATION
6 NOVEMBER 2014
COURSE AND CODE
BIOSTATISTICS METHODS (STAT305)
_________________________________________________________________________
DURATION: 3 hours
TOTAL MARKS: 100
INTERNAL EXAMINER: Dr S F Melesse
EXTERNAL EXAMINER: Dr C Lombard, MRC, Cape Town
THIS EXAM PAPER CONSISTS OF A TOTAL OF 9 PAGES INCLUDING THIS ONE.
PLEASE SEE THAT YOU HAVE THEM ALL.
INSTRUCTIONS:

Attempt all questions.

Please start each question on a new page
Show all workings where appropriate; Do not re-calculate information that is given
Write in Ink. Rough work can be done in pencil on the reverse side of each page and will
not be marked

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

You may leave your answers in terms of or in surd form.

For tests use 0.05

a)

b)
c)

d)
e)

a)

6 November 2014
2

QUESTION 1 (20)
Briefly discuss the following, please be to the point.

Explain what the coefficient in a logistic regression tells us:- i) for a continuous
predictor ii) for an indicator variable.
[4]
Explain briefly the difference between a case control study and a cohort study.
[4]
Define over dispersion in the context of logistic regression model and list the
possible causes of over dispersion.

[4]
Describe the difference between a prevalence rate and an incidence rate. What do
these rates measure?
[4]
Define the sensitivity and specificity of screening tests
[4]

QUESTION 2 (12)

The objective of the following data is to compare the infant mortality rates of two states,
Colorado and Louisiana. It was suspected that race may be a confounder in the relationship
between state and infant mortality rate. The data by race is shown below.

Colorado
Louisiana
Race
Live
Infant
Live
Infant
births
deaths
births
deaths
Black
3166
52
29670
525
White
48805
469
42749
344
Other
1837
6
1548
3
Total
53808
527
73967
872

Find the crude infant death rate for Colorado and Louisiana and compare the results.
[3]

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
3

b) Find the race specific infant mortality rate for Colorado and Louisiana and compare the results.
[3]
c) Suppose we choose the live births in the United States in 1987 as a standard population. The
race-specific infant mortality rate for United States is as given below.

Rac
Infant mortality
e
rate
Bla
17.9
ck
Whi
8.6
te
Oth
6.5
er

Find the expected number of deaths for both Colorado and Louisiana.
[2]

d) Find the standardized mortality ratios for Colorado and Louisiana. Comment on both mortality
ratios in comparison with the United States mortality.
[4]

QUESTION 3 (18)

The following data are taken from a study that attempts to determine whether the use of
electronic fetal monitoring (EFM) during labor affects the frequency of caesarean section
deliveries. Caesarian delivery can be thought of as the disease and electronic monitoring
as the exposure . Of the 5824 infants included in the study , 2850 were electronically
monitored during labor and 2974 were not. The outcomes are as follows.

Caesarian
EFM exposure

Delivery

Total
Yes
No
Yes
358
229
587
No
2492
2745
5237
Total
2850
2974
5824

a) Find the odds ratio of being delivered by caesarian section for EFM monitored group as
compared non-monitored group. Interpret
[2]
b) Construct a 95% confidence interval for the true odds ratio and interpret the confidence
interval. Use the same confidence interval to test the hypothesis that the odds ratio is 1.

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
4

[8]
c) Test if the Caesarian delivery is independent of the use of electronic fetal monitoring
(EFM) using the likelihood ratio statistics.
[8]

QUESTION 4 (16)

The following data are obtained from a study investigating the relationship between the
consumption of caffeinated coffee and nonfatal myocardial infraction among adult males
under the age of 55. The study provides exposure and disease information for two samples
of men: a group of 1559 smokers and a group of 937 non-smokers.

Smoking status

Coffee
Myocar
Contr
dial cases
ols

Smokers

yes

1011

390

No

81

77

Total

1092

467

Non-smokers

yes

383

365

No

66

123

Total

449

488

a) For smokers, find the odds of suffering a nonfatal myocardial infraction for males drinking
caffeinated coffee versus males drinking no coffee at all and interpret. [2]

b) Estimate the odds ratio in part( a) for non-smokers and interpret

[2]

c) Conduct a test of homogeneity of the odds ratios from (a) and (b). Based on the results of
the test, do you think it is appropriate to use Mantel Haenszel method to combine the
information in these two tables?
[5]
d) Assuming it is appropriate to combine the information in the above two tables, using the
Mantel Haenszel method, estimate the summary odds ratio.
[2]
e) At 5% level of significance tests the hypothesis that the summary odds ratio is 1. Interpret
your result.
[5]

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
5

QUESTION 5 (18)

The following information is from a study that involves 156 patients to investigate the
relationship between white blood cell count (WBC) and coronary abnormalities. Coronary
abnormality (CA) is indicated by a binary outcome variable (yes, no) and WBC is
considered as continuous independent variable.
The logistic model

(WBC )
(WBC )
ln
(
1

(
WBC
))

where (WBC) is the probability of coronary abnormality (CA) at different values of

WBC.
The following parameter estimates were obtained.

variable

cept

d.f

Inter

WBC

Estimated

coefficient

3.385

0.125

Standard
error

0.584

0.036

a) At 5% level of significance test the hypothesis that WBC is linearly related to the ln( odds)
of CA.
[4]
b) Estimate the probability of CA for a patient with WBC=10.
[2]
c) Estimate the odds of CA for a patient with WBC =10
[2]
d) Find the estimate of the odds ratio comparing person with WBC=15 to person with
WBC=10 and interpret.
[4]
e) Find a 95% confidence interval for the odds ratio comparing two people with WBC values
1 unit apart.
[3]
f) Find the estimated relative risk of CA for a patient with WBC =10 as compared to a patient
with WBC =5 and interpret.
[3]

QUESTION 6 (16)
a) Determine the survival and density functions for the survival random variable with
hazard function

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

h x

[6]

b) Consider a small study with 8 subjects. The event times were recorded as follows

1, 2, 2*, 3, 3, 3*, 5*, 6 * .

Note * denotes a censored observation.

Calculate the Kaplan Meier estimates for the survival function S t . The Kaplan Meier
estimator is

2x
1 x2

6 November 2014
6

ti t

mi
ri

[6]

c) Make a plot of the survival function based on the estimates obtained in part (b).

[4 ]

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
7

02.05 1

3.84

02.05 2

5.99

Z 0.025 1.96

N p
N
i

r
n P
i

var[ M ]

n
n

pi qi

Pi

OE
E

w wi 2 i

( wi i ) 2

~ k21

where i log( i ) and wi

Some quantities and formulas:

1
1 1 1 1
[ ]
ai bi ci d i

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

mh

E ( ai )

n1i

var( ai )

a
b

d i / ni

ci / ni

m1i
ni

n1i

6 November 2014
8

and

n2 i m1i m2 i
ni2 ( ni 1)

2
mh

1 pe

var(ln( RR ))
ne pe
var(ln( ))

1
ai E ( ai )

var( ai )

Confidence interval s

1
a

1 pu

nu pu
1
b

1
1

c
d

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
9

)
ln( RR

ln( ) Z

))
S .e(ln( RR

S .e(ln( ))

2 Oij log

Oij

Eij

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
10

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
11

Table of the chi square distribution

-Appendix J, p. 915 Level of Significance 0:

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UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

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6 November 2014
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UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)
.
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6 November 2014
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UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

6 November 2014
14

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UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

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UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)
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5
6
5

6
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1
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9
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9
6
9

9
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3
4
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3
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6
9
1

7
1
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2
0

8
3
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2
9
8

9
0
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0
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1
0
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.
8
8
0

l
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3
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1
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5

.
5
0
5

6 November 2014
16
3
.
4
0
3

.
7
6
6

8
6

7
6
.
1
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4

8
8
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3
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9
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7
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2
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l

8
9
.
5
6
4

UNIVERSITY OF KWAZULU-NATAL EXAMINATIONS

Biostatistics Methods (Stat305)

1
1
1
.
6
6
7

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l
8
.
4
9
8

1
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1
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6 November 2014
17
1
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