Glossary of Terms

Epidemiology and Biostatistics

The following definitions have been taken from, or adapted from, Last, JM. 2001 A
Dictionary of Epidemiology (4th Ed.). Oxford University Press.

Allocation concealment a method of generating a sequence that ensures

random allocation between two or more arms of a study
without revealing this to either the study participants or
the researchers.

Alpha () error (type I error) the error of rejecting a null hypothesis

when it is true (ie: declaring that a difference exists
when it does not). See also significance level.

Alternative hypothesis (HA) the hypothesis that there is a difference between

two comparison groups.

Analytical epidemiology studies designed to measure associations or test

hypotheses about particular risk factors or exposures.
Common study designs are cross-sectional, case-
control and cohort.

Ascertainment bias systematic failure to represent equally all classes of

cases or persons supposed to be represented in a
sample population. This bias typically arises from the
sources from which study participants are selected.

Attack rate the cumulative incidence of infection in a group

observed over a period during an epidemic or outbreak.

Attributable risk the rate (proportion) of disease or other outcome in

exposed individuals that can be attributed to the
exposure.

Attributable risk percent attributable risk expressed as a percentage rather than

as a proportion.

Beta () error (type II error) the error of failing to reject a false null
hypothesis (ie: declaring that a difference does not exist
when in fact it does). See also power of a study.

Bias any trend in the collection, analysis, interpretation,

publication or review of data that can lead to
conclusions that are systematically different from the
truth.
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Biological plausibility in causation: does the association agree with currently
accepted understandings of pathobiological processes?
This criterion should be applied with caution many
pathogens have been identified long before the
biological mechanisms of effect have been understood.

Biomarker a cellular or molecular indicator of exposure, health

effects or susceptibility.

Blinding when observers and/or study participants are kept

unaware of the group to which the subjects are
assigned. This is done to reduce bias. A single-blind
study is when the participants are blinded; a double-
blind study is when both observers and participants are
blinded.

Case a person in the study group who is identified as having

the particular disease, health disorder or condition
under investigation, according to the case definition
criteria for the study.

Case ascertainment the process of determining the occurrence of cases of

specific diseases (also known as case finding).

Case definition a set of diagnostic criteria (such as clinical and/or

laboratory findings) that must be fulfilled in order for a
person to be classed as a case of a particular disease,
health disorder or condition. These criteria are used to
define inclusion and exclusion criteria for a study
population.

Case report a descriptive study of a single individual in which the

possibility of an association between an observed effect
and a specific exposure is based on detailed clinical
evaluations and histories of the individual. Also see
Case Series.

Case series a descriptive study of a small number of case reports.

Case reports and case series may be first to provide
clues in identifying a new disease or adverse health
effect from an exposure. Also see Case Report.

Case-control study a type of analytical study design that examines persons

with a particular disease/health condition against a
control (or reference) group of similar persons who do
not have the disease/health condition being
investigated. The study begins after disease onset and
exposure to risk factors of interest is assessed
retrospectively.

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Causation the relating of specific causes (risk factors) to the
specific health outcomes they produce. Sir Austin
Bradford Hill proposed a set of criteria that must be
fulfilled in order for an association between an
exposure/risk factor and a disease/health outcome to be
defined as causal. Hills criteria for a causal association
between a factor and a disease are: consistency;
strength; specificity; temporality; biological plausibility;
coherence; experiment (see individual entries for
definitions).

Clinical significance a difference in effect size considered by experts to be

important in clinical or policy decisions, regardless of
the level of statistical significance.

Clinical trials a study design that involves the administration of a test

regimen to humans to evaluate its efficacy and safety.
The term is widely used to cover a range of clinical
studies, from tests in humans with no control subjects,
to the rigorously designed and executed randomised
controlled trials (RCTs) that involve both test and control
subjects, randomisation and blinding.

Coherence in causation: is the association compatible with existing

theory and knowledge?

Cohort any designated group of persons who are studied,

followed and/or traced over a period of time.

Cohort study an analytical study design in which groups of persons

can be identified who have been exposed and not
exposed to, or exposed to different levels of, a particular
risk factor (exposure), and who are then followed up
over time to see if they develop the health outcome/s of
interest. Cohort studies typically involve large numbers
of participants who are followed up for long periods of
time (commonly years). Also known as prospective
studies, longitudinal studies or follow-up studies.

Confidence interval a computed interval with a given probability (e.g.: 95%)

that the true value of a variable (such as a mean,
proportion or rate) is contained within the interval.

Confounder a variable that can independently cause or prevent the

outcome of interest, is not an intermediate variable, and
is associated with the risk factor under investigation.
Also known as a confounding variable.

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Confounding 1 a distortion of the apparent effect of an exposure on
risk brought about by the association with other risk
factors that can influence the outcome. 2 a
relationship between the effects of two or more risk
factors as observed in a set of data such that it is not
possible to separate the contribution that any single
factor has made to the observed effect. 3 a situation
in which a measure of the effect of an exposure on risk
is distorted because of the association of exposure with
another factor/s that influences that outcome being
investigated.

Consistency close conformity between the findings in different

samples, strata or populations, or at different times or in
different circumstances, or in studies conducted by
different methods or different investigators. In
causation: is the association consistent when results
are replicated in studies using different methods and/or
in different settings?

Control a person in a comparison group (or control group or

reference group) who differs in disease status or
allocation to a regimen from the subjects (cases) of the
study.

Correlation the degree to which variables change together.

Correlation co-efficient a measure of association that indicates the degree to

which two variables have a linear relationship.

Cross-over study a study design to compare two or more treatments or

interventions in which the study participants, upon
completion of the first treatment or intervention, are
switched to the other treatment or intervention. In the
case of two treatments (A and B), half the participants
are randomised to receive the treatments in the order A
B, with the other half of participants receiving the
treatment in the order B A. A criticism of this design is
that the effects of the first treatment may carry over to
the period of the second treatment.

Cross-sectional study a descriptive study design that examines the

relationship between diseases or other health outcomes
and other variables of interest as they exist in a defined
population at one particular point in time. This design
examines disease prevalence.

Degrees of freedom the number of independent comparisons that can be

made between members of a sample.

Denominator the lower portion of a fraction used to calculate a rate or

ratio.

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Dependent variable a variable whose value is dependent on the effect of
other, independent, variable/s in the relationship under
investigation.

Descriptive epidemiology studies that only describe the existing distribution of

variables, without consideration of causal and other
hypotheses. Descriptive studies are typically used to
generate hypotheses for further (analytical) studies.
Examples are ecological studies and cross-sectional
studies. Also known as observational studies.

Differential error also known as Non-Systematic Error. Also see

Misclassification.

Disability Adjusted Life Years (DALYs)

measure of the burden of disease on a defined
population. They are calculated using a disability
weight (a proportion less than 1) multiplied by
chronological age to reflect the burden of the disability.

Distribution the complete summary of the frequencies of the values

or categories of a measurement made on a group of
persons. It tells either how many or what proportion of
the group was found to have each value (or each range
of values) out of all the possible values.

Dose-response relationship the relationship of observed outcomes in a population to

varying levels of an agent, such as a medication or
environmental contaminant. Important aspects are the
rate at zero dose (baseline), the presence or absence
of a threshold dose (a dose that below which, no
responses are observed and above which, responses
are observed, or, with a linear relationship, a dose
above which no further change in response is
observed), the mathematical nature of the relationship
(linear, logarithmic etc), time (how soon after the dose is
the response observed? Is there a latent period?), and
the range of individual variation (what proportion of
those exposed experience no response, slight,
moderate or severe response?). In causation: does an
increasing level of exposure (in amount and/or time)
increase the risk?

Double-blind in a randomised controlled trial, the process in which

there is blind assignment to study and control groups
and blind assessment of outcomes. This is to ensure
that ascertainment of outcome is not biased by
knowledge of the group to which an individual was
assigned.

Ecological fallacy a form of bias that may occur because an association

observed between variables on an aggregate level does

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 not necessarily represent the association that exists at
an individual level.
Ecological study a descriptive study in which the units of analysis are
populations, or groups of people, rather than
individuals.

Effect modification when a factor modifies the effect of a causal factor

under study. For example, age is an effect modifier for
many conditions, and immunisation status is an effect
modifier for the consequences of exposure to many
pathogenic organisms. Effect modification is detected
by varying the selected effect modifier for the factor
under study across levels of another factor.

Epidemic curve a graph plotting the distribution of cases by time of

onset.

Epidemic the occurrence in a community or region of cases of an

illness, specific health-related behaviour or other health-
related event, clearly in excess of normal expectancy.
The community or region and the period in which the
cases occur are specified precisely, and the number of
cases that specify an epidemic varies according to the
agent, size, and type of population exposed, previous
experience or lack of exposure to the disease, and time
and place of occurrence.

Epidemiology the study of the distribution and determinants of health-

related states or events in specified populations and the
application of this study to control of health problems.
Study includes surveillance, observation, hypothesis
testing, analytical research and experiments.
Distribution refers to analysis by time, place and
groups of persons affected. Determinants are all the
physical, biological, social, cultural, environmental and
behavioural factors that influence health. Health-related
states and events include diseases, causes of death,
behaviours such as tobacco use, reactions to
preventive regimens and the provision and use of health
services. Specified populations are those with
identifiable characteristics such as precisely defined
numbers. Application to control makes the aim of
epidemiology explicit to promote, protect and restore
health.

Ethics a branch of philosophy that deals with distinctions

between right and wrong, and the moral consequences
of human actions. The ethical issues that arise in
epidemiologic practice and research include informed
consent, confidentiality, respect for human rights and
scientific integrity.

Etiology the science of causes or causality.

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Evidence-based medicine the consistent use of current best evidence derived from
published clinical evidence and epidemiologic research
in the management of patients, with attention to the
balance of risks and benefits of diagnostic tests and
alternative treatment regimens, and taking account of
each patients unique circumstances, including baseline
risk, co-morbid conditions and personal preferences.

Experiment in causation: can the condition be altered (prevented or

ameliorated) by an appropriate experimental regimen?

Experimental study a study in which the investigator intentionally alters one

or more factors under controlled circumstances in order
to study the effects of doing so. A randomised
controlled trial is an example of an experimental
epidemiological study.

Exposure assessment the process of estimating concentration or intensity,

duration, and frequency of exposure to an agent that
can affect health.

Exposure 1 proximity and/or contact with a source of a disease

agent in such a manner that effective transmission of
the agent or harmful effects of the agent may occur.
2 the amount of a factor to which a group or individual
was exposed; sometimes contrasted with dose, which
is the amount that enters or interacts with the organism.
3 the process by which an agent comes into contact
with a person in such a way that the person may
develop the relevant outcome, such as a disease.
4 may be beneficial or harmful, such as exposure to
immunising agents.

False negative a negative test result in a person who possesses the

attribute being tested for. The labelling of a diseased
person as healthy when screening to detect disease.

False positive a positive test result in a person who does not possess
the attribute being tested for. The labelling of a healthy
person as diseased when screening to detect disease.

Field epidemiology the practice of epidemiology in the field ie: in the

community. Epidemics and outbreaks are investigated
by field epidemiology, as well as implementing
measures to protect and improve the health of the
public. Field epidemiology must deal with unexpected,
sometimes urgent problems that demand immediate
solution. Field methods are designed to answer specific
epidemiological questions in order to plan, implement
and/or evaluate public health interventions, and to
communicate study results in a timely manner to those
who need to know.

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Gold standard
Healthy worker effect
Hierarchy of evidence
Hills criteria of causation
Incidence
Independent variable
a method, procedure or measurement that is widely
accepted as being the best available. The term is often
used when comparing new methods against existing
ones.
a phenomenon observed in studies of occupational
diseases. Workers usually exhibit lower overall mortality
rates than the general population because the severely
ill and chronically disabled are ordinarily excluded from
employment. Mortality rates in the general population
may be inappropriate for comparison if this effect is not
taken into account.
a scale developed to assess the quality of
epidemiological evidence. The classes of evidence are:
I: Evidence from at least one properly designed
randomised controlled trial
II-1: evidence from well-designed controlled trials
without randomisation
II-2: evidence from well-designed cohort or case-control
analytical studies, preferably from more than one
research group or centre.
II-3: evidence obtained from multiple time-series, with or
without the intervention; dramatic results in uncontrolled
experiments (eg: the first use of penicillin in the 1940s)
III: opinions of respected authorities, based on clinical
experience, descriptive studies, reports of expert
committees etc
It is not always possible to achieve complete scientific
rigour when researching humans for example, the
ideal randomised controlled trial or cohort study may
be unethical or not feasible.
the first complete statement of the epidemiologic criteria
of a causal association is attributed to British medical
statistician Sir Austin Bradford Hill (1897-1991). Hills
criteria of a causal association between a factor and a
disease are: consistency; strength; specificity;
temporality; biological plausibility; coherence;
experiment (see individual entries for definitions).
the number of instances of illness commencing, or of
persons falling ill, during a given period in a specified
population. More generally, it is the number of new
events in a defined population over a given time period.
New cases are referred to as incident cases.
the characteristic being observed or measured that is
hypothesised to influence an event or manifestation (the
dependent variable) within the relationship under study.
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Information bias a flaw in measuring exposure or outcome data that
results in different quality (accuracy) of information
between comparison groups.

Intention-to-treat analysis a procedure in the conduct and analysis of randomised

controlled trials. All participants allocated to each arm of
the treatment regimen are analysed together as
representing that treatment arm, whether or not they
received or completed the prescribed regimen. Failure
to do this defeats the purpose of randomisation and can
invalidate the results.

Interaction see Effect Modification.

Intervention an intentional change in some aspect of the status of

the participants, such as the introduction of a
therapeutic or preventative treatment.

Interviewer bias systematic error due to interviewers subconscious or

conscious gathering of selective data.

Lead time bias overestimation of survival time when diseases such as

cancer are detected early by screening procedures.
This can result in systematic error when follow-up of
groups does not begin at comparable stages in the
natural history of a condition.

Least-squares method a principle of estimation in which the estimates of a set

of parameters in a statistical model minimise the sum of
the squared differences between the observed values of
the dependent variable and the values predicted by the
model.

Length time bias a systematic error due to the selection of

disproportionate numbers of long-duration cases (cases
who survive longest) in one group but not in another.
This can occur when prevalent rather than incident
cases are used in a case control study.

Loss to follow-up when study participants do not, or cannot, complete

participation in a study. A common source of loss to
follow-up is the loss of contact with participants in a
cohort study over the years of the study. Loss to follow-
up can contribute to bias if the participants who are lost
differ from those who remain in the study.

Matching the process of making a study group and a comparison

group comparable with respect to extraneous factors.
Matching is typically done for age (+/- 5 years), gender
and socioeconomic status.

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Mean a measure of central tendency; computed by adding all
the individual values in the group and dividing it by the
number of values in the group.

Measure of association a quantity that expressed the strength of association

between variables. Commonly used measures of
association are differences between means, proportions
or rates, the rate ratio, the odds ratio and correlation
and regression co-efficients.

Measure of central tendency a general term for several values of the distribution of a
set of values or measurements located at or near the
middle of the set. The principle measures of central
tendency are the mean, median and mode.

Median a measure of central tendency. The point on the scale

the divides the set of measurements into two equal
halves.

Meta-analysis a statistical synthesis of data from separate but

comparable studies, leading to a quantitative summary
of the pooled results. The aim is to identify the overall
trend of results.

Misclassification the incorrect classification of an individual, value or

attribute into a category other than that to which it
should be assigned. The probability of misclassification
may be the same in all study groups (nondifferential
misclassification), or may vary between groups
(differential misclassification).

Mode a measure of central tendency. The most frequently

occurring value in a set of observations.

Natural history (of a disease). The course of a disease from onset to

resolution.

Necessary cause a causal factor whose presence is required for the

occurrence of the disease. If the cause is absent, the
disease never occurs. Also see Sufficient Cause.

Negative predictive value (of a diagnostic or screening test) the probability that a
person with a negative test does not have the disease.

Nested case-control study a case control study in which cases and controls are
drawn from the population of a cohort study. As some
data are already available about both cases and
controls, the effects of some potential confounding
factors are reduced or eliminated.

N-of-one trials a variation of a randomised controlled trial in which a

sequence of alternative treatments are randomly
allocated to a patient. The outcomes of each treatment

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 are then compared, with the aim of deciding on the
optimum treatment for that patient.

Non-differential error also known as Systematic Error. Also see

Misclassification.

Nonparametric test a statistical test that does not depend upon the normal
distribution of the underlying data; statistical tests used
with skewed data sets.

Non-systematic error an error that is different between study groups. For

example, two sets of scales are used in a study. The
scales used to weigh the cases are not calibrated
properly, so the cases have 2kg mistakenly added to
their weight measurement, but the control group are
correctly weighed. Also known as Differential Error.

Notifiable disease a disease that, by statutory requirements, must be

reported to the public health authority when the
diagnosis is made; a disease deemed of sufficient
importance to public health to require that its
occurrence be reported to health authorities.

Null hypothesis (HO) the hypothesis that there is no difference between

two groups.

Numerator the upper portion of a fraction used to calculate a rate or

ratio.

Observational studies an epidemiologic study that does not involve any

intervention, experimental or otherwise. Such a study
may be one where nature is allowed to take its course,
with changes in one characteristic being studied in
relation to changes in another characteristic. Case
control and cohort are observational study designs,
because the investigator is observing without
intervention other than to record, classify, count and
statistically analyse results.

Odds ratio a ratio of the odds of exposure among cases to the

odds of exposure among the controls (in a case control
study).

Outbreak an epidemic limited to localised increase in the

incidence of a disease, e.g.: in a small town or
institution.

Outcome all the possible results that may stem from exposure to
a causal factor, or from preventive or therapeutic
interventions; all identified changes in health status
arising as a consequence of the handling of a health
problem.

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Over-matching may occur in case control studies and reduces the
precision of the findings. There are several types:
1 the matching procedure partially or completely
obscures evidence of a true causal association between
variables.
2 the matching procedure uses one or more
unnecessary matching variables that have no causal
effect or influence on the dependent variable and hence
cannot cause confounding.
3 the matching procedure is unduly elaborate, using
numerous matching variables and/or insisting on very
close similarity with respect to matching variables,
making it very difficult to find suitable controls.

P-value a statement of the probability that an observed

difference between two groups could have occurred by
chance if the groups were really alike (i.e.: if the null
hypothesis were true). Most biomedical and
epidemiological research considers that a study result
with a probability value of less than 5% (P=0.05), or
sometimes 1% (P=0.01), is unlikely to have occurred by
chance and is thus designated statistically significant.

Paired data pairs of participants may be studied. One member of

each pair receives the experimental regimen, the other
receives a control regimen. Pairing should be based on
a prognostic variable, such as age and gender.

Pandemic an epidemic occurring worldwide, or over a very wide

area, crossing international borders and usually
affecting a large number of people.

Parametric methods statistical tests that depend upon the assumption that
the data is normally distributed.

Participant person on whom research is conducted; person who

agrees to participate in a research study.

Percentiles the set of divisions that produce exactly 100 equal parts
in a series of continuous values, such as height or
weight. Thus a person above the 90th percentile has a
greater value for height/weight than over 90% of all in
the series.

Person-years a measurement combining persons and time as the

denominator in incidence rates when individual subjects
are at risk of developing the disease for varying periods.
It is the sum of years at risk for each of the study
participants.

Placebo an inert medication or procedure ie: one having no

pharmacological effect but that is intended to give the

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 study participants the perception that they are receiving
treatment.

Placebo effect the effect (usually, but not necessarily or always,

beneficial) attributed by participants to a medication or
treatment that has been prescribed by their medical
adviser/researcher. The perceived benefits of a placebo
are due to the expectation that the medication or
treatment will have an effect (ie: the power of
suggestion).

Population attributable risk percent:

the attributable fraction in the population expressed as a
percentage.

Population health the health of the population, measured by health status

indicators. Also, the prevailing or aspired level of health
in a specified population. It is influenced by physical,
biological, social and economic factors in the
environment, by personal health behaviour, health care
services etc. Also often used to describe the disciplines
involved in studying the determinants and dynamics of a
populations health status.

Population pyramid a graphic presentation of the age and gender

composition of the population, using the percentage
distribution simultaneously cross-classified by age and
gender. It is intended to provide a quick overall
comprehension of age and gender structure in a
population and the changing shape of the pyramid over
time reflects changes in fertility and mortality at each
age.

Positive predictive value (of a diagnostic or screening test) the probability that a
person with a positive test does have the disease.

Power (of a study) the ability of a study to demonstrate an association if

one truly exists. It is determined by the frequency of the
condition being studied, the magnitude of the effect, the
study design, and the sample size. Mathematically,
power is defined as 1 (Type II error).

Pragmatic study a study whose aim is to improve health status or health

care of a specified population, provide a basis for
decisions about health care, or evaluate previous
actions. Also known as a management trial/study.

Prevalence the number of events in a given population at a

designated time. Period prevalence the total number
of persons known to have had the disease/condition at
any time during a specified period. Point prevalence
the number of persons with the disease/condition at a
specified point in time.

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Prevention actions aimed at eradicating, eliminating or minimising
the impact of disease and disability, or if none of these
is feasible, retarding the progress of disease and
disability.
Preventive health the application of preventive measures by clinicians in
order to promote and maintain health and well-being,
and prevent disease, disability and premature death.

Primary prevention a public health campaign that refers to the prevention of

initial disease onset, thus the target population have no
signs of the disease (they are asymptomatic).

Probability a measure, ranging from zero to 1, of the degree of the

belief in a hypothesis or statement.

Probability sample (random sample) all individuals have an equal chance

of being selected out of the entire population.

Prospective cohort a cohort study which follows patients going forward in

time. Participants are recruited prior to disease onset
and are followed forward over time to see who develops
the outcome/s of interest.

Public health the combination of sciences, skills and beliefs that is

directed to the maintenance and improvement of the
health; the programs, services and institutions involved
emphasise the prevention of disease and the health
needs of the population as a whole. It is thus a social
institution, a discipline and a practice.

P-value the probability that a test statistic would be as extreme

as or more extreme than observed if the null hypothesis
were true; a statement of the probability that the
difference observed could have occurred by chance if
the groups were really alike.

Random error an error that is governed by chance. It can vary from

measurement to measurement, or sample to sample,
without any predictable pattern.

Random sample a sample that is arrived at by selecting sample units

such that each possible unit has a fixed and equal
probability of selection.

Randomisation the allocation of individuals to groups by chance.

Randomisation should make the control and
experimental groups similar at the start of the
investigation and ensure that personal judgement and
prejudices of the investigator do not influence allocation.

Randomised controlled trial an experimental study design in which participants in a

population are randomly allocated into groups to

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 receive, or not receive, a procedure, medication or
intervention. RCTs are generally regarded as the most
scientifically rigorous method of hypothesis testing
available in epidemiology.

Range the difference between the largest and smallest values

in a distribution.
Rate a measure of the frequency of occurrence of a specific
health event/state in a defined population in a specified
period of time. The use of rates is essential for making
comparisons between populations at different times, in
different places or between different groups of people.
The denominator is usually person-time.

Recall bias systematic error due to differences in accuracy or

completeness of recall to memory of past experiences
or events.

Relative risk the ratio of the risk of disease among the exposed to
the risk of disease among the unexposed (in a cohort
study).

Reliability the degree of stability exhibited when a measurement is

repeated under identical conditions and thus, the
degree to which results obtained by a measurement
procedure can be replicated.

Representativeness the sample represents the population in some way; the

sample is typical in respect of certain characteristics.

Response bias systematic error due to differences in characteristics

between those who choose or volunteer to take part in a
study, and those who do not.

Retrospective cohort a cohort study that examines outcomes in the present

or future, against exposures that have occurred in the
past. The key distinction between this and a case
control study is that a retrospective cohort study defines
the comparison groups by their exposure status (which
is determined retrospectively), whereas a case control
study defines the comparison groups by their disease
status.

Risk difference the absolute difference between two risks (also known
as excess risk).

Risk difference percent the absolute difference between two risks expressed as
a percentage.

Risk factor an aspect of personal behaviour, lifestyle, an

environmental exposure or an inherited/genetic
characteristic that, on the basis of epidemiologic
evidence, is known to be, likely to be, or hypothesised

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 to be, associated with the health outcome or condition
being investigated.

Risk the probability that an event (e.g.: develop a disease)

will occur.

Sampling the process of selecting a number of subjects from all

the subjects in a particular group.
Sampling bias systematic error due to study of a non-random sample
of a population.

Screening test a test that is used to detect disease that is not yet under
medical care. Screening is carried out on healthy
individuals who have no clinical symptoms of illness and
is used to identify apparently well people who probably
have a disease from those who probably do not have
the disease. Persons who test positive are then directed
to their physicians for diagnosis and treatment.

Secondary prevention a public health campaign that refers to the prevention of

further development of a disease. The target population
have the disease, with the possibility of further disease
progression leading to increased morbidity and
mortality.

Selection bias error due to systematic differences in characteristics

between those who are selected to take part in a survey
and those who are not.

Sensitivity in diagnostic/screening tests: the proportion of truly

diseased persons in the screened population who are
identified as diseased by the test.

Sentinel case a case that can be used to assess the stability or

change in health levels of a population. In outbreak
investigation, the sentinel case is usually the case that
signals the start of the outbreak.

Significance level the probability that an observed result has occurred by

chance; it is typically set at 5% (or occasionally at 1%)
in an epidemiological study. Also see Statistical
Significance and P-value.

Specificity in causation: does a single agent result in a specific

effect?

Specificity in diagnostic/screening tests: the proportion of truly

nondiseased persons in the screened population who
are identified as nondiseased by the test.

Standard deviation a measure of dispersion or variation; a summary of how

widely dispersed the values are around the central
value.

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Standard error
Standardisation
Statistical significance
Stratification
Strength (of an association) in causation: what is the size of the risk, as identified by
appropriate statistical methods?
Sufficient cause
Surveillance
Systematic error
Systematic review
the standard deviation of an estimate or sample; used
to calculate confidence intervals.
a set of techniques used to remove as much as
possible the effects of differences in age or other
confounding variables when comparing two or more
populations.
statistical methods allow an estimate to be made of the
probability of the observed association between
variables under the null hypothesis. From this estimate,
the statistical significance of a result can be stated:
how likely it was to have occurred by chance. This is
usually stated by the P-value.
the process of, or result of, separating a sample into
several subsamples according to specified criteria, such
as age groups, gender or socioeconomic status. This
may be done to control the effect of confounding
variables, as well as detecting effect modification.
a minimum set of risk factors needed to produce a
particular outcome. If the cause is present, the disease
always occurs. Also see Necessary Cause.
systematic ongoing collection, collation, analysis and
interpretation of health data, essential to the planning,
implementation and evaluation of public health practice,
and closely integrated with the timely dissemination of
those data to those who need to know. Surveillance is
designed to observe trends in time, place and persons,
so that changes can be observed or anticipated and
appropriate action (such as investigative or control
measures) can be taken.
an error that is the same in all study groups. For
example, a set of scales is not calibrated properly, so
both the study groups have 2kg mistakenly added to
their weight measurement. Also known as Non-
differential Error. Also see Bias.
the assembly, critical appraisal and synthesis of all
relevant studies on a specific topic. Meta-analysis may
be used as a part of this process. Systematic reviews
focus on peer-reviewed publications about a specific
problem and use rigorous, standardized methods to
select and assess articles.
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Temporality in causation: does exposure precede the outcome? This
is the only absolutely essential causation criterion.

Tertiary prevention a public health campaign that refers to the alleviation of

the consequences of symptomatic disease to prevent
further morbidity, mortality or disability. The target
population have fully symptomatic disease, and tertiary
prevention often accompanies treatment.

Type I error alpha error; the error of rejecting a true null hypothesis;
declaring that a difference exists when it does not.

Type II error beta error; the error of failing to reject a false null
hypothesis; declaring that a difference does not exist
when in fact it does.

Validity for a measurement: an expression of the degree to

which a measurement measures what it is supposed to
measure.

Validity for a study: the degree to which the inference drawn

from a study is warranted when the study method is
taken into account, as well as the representativeness of
the study population. Internal validity is when the
comparison groups are selected and compared in such
a manner that the observed differences between them
on the variables under study may be attributed only to
the hypothesised effect being investigated. External
validity (or generalisability) is when a study can
produce unbiased inferences regarding a population
beyond the subjects in the study.

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 Disclaimer: The information in this report was correct
at the time of publication. Monash University reserves
the right to alter this information should the need arise.
CRICOS provider: Monash University 00008C.
www.med.monash.edu June 2012. MMS343878