Biostatistics Basics: An Introduction To An Expansive and Complex Field

2006
1
Biostatistics Basics
An introduction to an expansive
and complex field
2006 Evidence-based Chiropractic
2
Common statistical terms
Data
Measurements or observations of a variable
Variable
A characteristic that is observed or
manipulated
Can take on different values
3
Statistical terms (cont.)
Independent variables
Precede dependent variables in time
Are often manipulated by the researcher
The treatment or intervention that is used in a
study
Dependent variables
What is measured as an outcome in a study
Values depend on the independent variable
4
Statistical terms (cont.)
Parameters
Summary data from a population
Statistics
Summary data from a sample
5
Populations
A population is the group from which a
sample is drawn
e.g., headache patients in a chiropractic
office; automobile crash victims in an
emergency room
In research, it is not practical to include all
members of a population
Thus, a sample (a subset of a population)
is taken
6
Random samples
Subjects are selected from a population so
that each individual has an equal chance
of being selected
Random samples are representative of the
source population
Non-random samples are not
representative
May be biased regarding age, severity of the
condition, socioeconomic status etc.
7
Random samples (cont.)
Random samples are rarely utilized in
health care research
Instead, patients are randomly assigned to
treatment and control groups
Each person has an equal chance of being
assigned to either of the groups
Random assignment is also known as
randomization
8
Descriptive statistics (DSs)
A way to summarize data from a sample
or a population
DSs illustrate the shape, central tendency,
and variability of a set of data
The shape of data has to do with the
frequencies of the values of observations
9
DSs (cont.)
Central tendency describes the location of the
middle of the data
Variability is the extent values are spread
above and below the middle values
a.k.a., Dispersion
DSs can be distinguished from inferential
statistics
DSs are not capable of testing hypotheses
10
Hypothetical study data
(partial from book)
Case # Visits
1 7
2 2
3 2
4 3
5 4
6 3
7 5
8 3
9 4
10 6
11 2
12 3
13 7
14 4
Distribution provides a summary of:
Frequencies of each of the values
2 3
3 4
4 3
5 1
6 1
7 2
Ranges of values
Lowest = 2
Highest = 7
etc.
11
Frequency distribution table
Frequency Percent Cumulative %
2 3 21.4 21.4
3 4 28.6 50.0
4 3 21.4 71.4
5 1 7.1 78.5
6 1 7.1 85.6
7 2 14.3 100.0
12
Frequency distributions are
often depicted by a histogram
13
Histograms (cont.)
A histogram is a type of bar chart, but
there are no spaces between the bars
Histograms are used to visually depict
frequency distributions of continuous data
Bar charts are used to depict categorical
information
e.g., MaleFemale, MildModerateSevere,
etc.
14
Measures of central tendency
Mean (a.k.a., average)
The most commonly used DS
To calculate the mean
Add all values of a series of numbers and
then divided by the total number of elements
15
Formula to calculate the mean
Mean of a sample

Mean of a population

(X bar) refers to the mean of a sample and refers to the
mean of a population
EX is a command that adds all of the X values
n is the total number of values in the series of a sample and
N is the same for a population
X
N
X

n
X
X


16
Measures of central
tendency (cont.)
Mode
The most frequently
occurring value in a
series
The modal value is
the highest bar in a
histogram
Mode
17
Measures of central
tendency (cont.)
Median
The value that divides a series of values in
half when they are all listed in order
When there are an odd number of values
The median is the middle value
When there are an even number of values
Count from each end of the series toward the
middle and then average the 2 middle values
18
Measures of central
tendency (cont.)
Each of the three methods of measuring
central tendency has certain advantages
and disadvantages
Which method should be used?
It depends on the type of data that is being
analyzed
e.g., categorical, continuous, and the level of
measurement that is involved
19
Levels of measurement
There are 4 levels of measurement
Nominal, ordinal, interval, and ratio
1. Nominal
Data are coded by a number, name, or letter
that is assigned to a category or group
Examples
Gender (e.g., male, female)
Treatment preference (e.g., manipulation,
mobilization, massage)
20
Levels of measurement (cont.)
2. Ordinal
Is similar to nominal because the
measurements involve categories
However, the categories are ordered by rank
Examples
Pain level (e.g., mild, moderate, severe)
Military rank (e.g., lieutenant, captain, major,
colonel, general)
21
Ordinal values only describe order, not
quantity
Thus, severe pain is not the same as 2 times
mild pain
The only mathematical operations allowed
for nominal and ordinal data are counting
of categories
e.g., 25 males and 30 females
22
3. Interval
Measurements are ordered (like ordinal
data)
Have equal intervals
Does not have a true zero
Examples
The Fahrenheit scale, where 0 does not
correspond to an absence of heat (no true zero)
In contrast to Kelvin, which does have a true zero
23
4. Ratio
Measurements have equal intervals
There is a true zero
Ratio is the most advanced level of
measurement, which can handle most types
of mathematical operations
24
Ratio examples
Range of motion
No movement corresponds to zero degrees
The interval between 10 and 20 degrees is the
same as between 40 and 50 degrees
Lifting capacity
A person who is unable to lift scores zero
A person who lifts 30 kg can lift twice as much as
one who lifts 15 kg
25
NOIR is a mnemonic to help remember
the names and order of the levels of
measurement
Nominal
Ordinal
Interval
Ratio
26
Measurement scale
Permissible mathematic
operations
Best measure of
central tendency
Nominal Counting Mode
Ordinal
Greater or less than
operations
Median
Interval Addition and subtraction
Symmetrical Mean
Skewed Median
Ratio
Addition, subtraction,
multiplication and division
Symmetrical Mean
Skewed Median
27
The shape of data
Histograms of frequency distributions have
shape
Distributions are often symmetrical with
most scores falling in the middle and fewer
toward the extremes
Most biological data are symmetrically
distributed and form a normal curve (a.k.a,
bell-shaped curve)
28
The shape of data (cont.)
Line depicting
the shape of
the data
29
The normal distribution
The area under a normal curve has a
normal distribution (a.k.a., Gaussian
distribution)
Properties of a normal distribution
It is symmetric about its mean
The highest point is at its mean
The height of the curve decreases as one
moves away from the mean in either direction,
approaching, but never reaching zero
30
The normal distribution (cont.)
Mean
A normal distribution is symmetric about its mean
As one moves away from
the mean in either direction
the height of the curve
decreases, approaching,
but never reaching zero
The highest point of
the overlying
normal curve is at
the mean
31
The normal distribution (cont.)
Mean = Median = Mode
32
Skewed distributions
The data are not distributed symmetrically
in skewed distributions
Consequently, the mean, median, and mode
are not equal and are in different positions
Scores are clustered at one end of the
distribution
A small number of extreme values are located
in the limits of the opposite end
33
Skewed distributions (cont.)
Skew is always toward the direction of the
longer tail
Positive if skewed to the right
Negative if to the left
The mean is shifted
the most
34
Skewed distributions (cont.)
Because the mean is shifted so much, it is
not the best estimate of the average score
for skewed distributions
The median is a better estimate of the
center of skewed distributions
It will be the central point of any distribution
50% of the values are above and 50% below
the median
35
More properties
of normal curves
About 68.3% of the area under a normal
curve is within one standard deviation
(SD) of the mean
About 95.5% is within two SDs
About 99.7% is within three SDs
36
More properties
of normal curves (cont.)
37
Standard deviation (SD)
SD is a measure of the variability of a set
of data
The mean represents the average of a
group of scores, with some of the scores
being above the mean and some below
This range of scores is referred to as
variability or spread
Variance (S
2
) is another measure of
spread
38
SD (cont.)
In effect, SD is the average amount of
spread in a distribution of scores
The next slide is a group of 10 patients
whose mean age is 40 years
Some are older than 40 and some younger
39
SD (cont.)
Ages are spread
out along an X axis
The amount ages are
spread out is known as
dispersion or spread
40
Distances ages deviate above
and below the mean
Adding deviations
always equals zero
Etc.
41
Calculating S
2
To find the average, one would normally
total the scores above and below the
mean, add them together, and then divide
by the number of values
However, the total always equals zero
Values must first be squared, which cancels
the negative signs
42
Calculating S
2
cont.
Symbol for SD of a sample
for a population
S
2
is not in the
same units (age),
but SD is
43
Calculating SD with Excel

Enter values in a column
44
SD with Excel (cont.)
Click Data Analysis
on the Tools menu
45
Select Descriptive
Statistics and click OK
46
Click Input Range icon
47
Highlight all the
values in the column
48
Check if labels are
in the first row
Check Summary
Statistics
Click OK
49
SD is calculated precisely
Plus several other DSs
50
Wide spread results in higher SDs
narrow spread in lower SDs
51
Spread is important when
comparing 2 or more group means
It is more difficult to
see a clear distinction
between groups
in the upper example
because the spread is
wider, even though the
means are the same
52
z-scores
The number of SDs that a specific score is
above or below the mean in a distribution
Raw scores can be converted to z-scores
by subtracting the mean from the raw
score then dividing the difference by the
SD
X
z

53
z-scores (cont.)
Standardization
The process of converting raw to z-scores
The resulting distribution of z-scores will
always have a mean of zero, a SD of one,
and an area under the curve equal to one
The proportion of scores that are higher or
lower than a specific z-score can be
determined by referring to a z-table

54
z-scores (cont.)

Refer to a z-table
to find proportion
under the curve
55
z-scores (cont.)

Partial z-table (to z = 1.5) showing proportions of the
area under a normal curve for different values of z.

Z 0.00 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09
0.0 0.5000 0.5040 0.5080 0.5120 0.5160 0.5199 0.5239 0.5279 0.5319 0.5359
0.1 0.5398 0.5438 0.5478 0.5517 0.5557 0.5596 0.5636 0.5675 0.5714 0.5753
0.2 0.5793 0.5832 0.5871 0.5910 0.5948 0.5987 0.6026 0.6064 0.6103 0.6141
0.3 0.6179 0.6217 0.6255 0.6293 0.6331 0.6368 0.6406 0.6443 0.6480 0.6517
0.4 0.6554 0.6591 0.6628 0.6664 0.6700 0.6736 0.6772 0.6808 0.6844 0.6879
0.5 0.6915 0.6950 0.6985 0.7019 0.7054 0.7088 0.7123 0.7157 0.7190 0.7224
0.6 0.7257 0.7291 0.7324 0.7357 0.7389 0.7422 0.7454 0.7486 0.7517 0.7549
0.7 0.7580 0.7611 0.7642 0.7673 0.7704 0.7734 0.7764 0.7794 0.7823 0.7852
0.8 0.7881 0.7910 0.7939 0.7967 0.7995 0.8023 0.8051 0.8078 0.8106 0.8133
0.9 0.8159 0.8186 0.8212 0.8238 0.8264 0.8289 0.8315 0.8340 0.8365 0.8389
1.0 0.8413 0.8438 0.8461 0.8485 0.8508 0.8531 0.8554 0.8577 0.8599 0.8621
1.1 0.8643 0.8665 0.8686 0.8708 0.8729 0.8749 0.8770 0.8790 0.8810 0.8830
1.2 0.8849 0.8869 0.8888 0.8907 0.8925 0.8944 0.8962 0.8980 0.8997 0.9015
1.3 0.9032 0.9049 0.9066 0.9082 0.9099 0.9115 0.9131 0.9147 0.9162 0.9177
1.4 0.9192 0.9207 0.9222 0.9236 0.9251 0.9265 0.9279 0.9292 0.9306 0.9319
1.5 0.9332 0.9345 0.9357 0.9370 0.9382 0.9394 0.9406 0.9418 0.9429 0.9441
0.9332
Corresponds to the area
under the curve in black

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2006

2006 Evidence-based Chiropractic

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