Hypothesis Testing

Objectives:

Students should be able to identify the null and alternative

(research) hypotheses in a statistical test

Students should know the difference between one-and twodirectional hypothesis testing

Students should know what alpha, beta, power, and p-values are

Students should be able to identify/define type I and type II errors

Students should understand the differences between statistical

significance and clinical importance

Students should know how to determine statistical significance

given alpha and a calculated p-value OR given alpha and a
corresponding confidence interval

Hypothesis Testing
The second type of inferential statistics
Hypothesis testing is a statistical method used to
make comparisons between a single sample and a
population, or between 2 or more samples.
The result of a statistical hypothesis test is a
probability, called a p-value, of obtaining the results
(or more extreme results) from tests of samples, if
the results really werent true in the population.

Commonly Used Statistical

Tests
Tests for quantitative data (i.e. comparing means):
Two groups: t-test (paired or 2-sample)
Two or more groups (ANOVA: analysis of variance)
Tests for categorical (nominal, ordinal) data (i.e.
comparing proportions):
Chi-square, Fishers exact test
Tests for association between two quantitative
variables:
Correlation and regression

Hypothesis Testing
In all hypothesis testing, the numerical result from the
statistical test is compared to a probability distribution to
determine the probability of obtaining the result if the result is
not true in the population.
Examples of
two
probability
distributions:

normal
distribution
t distribution

the normal
and tdistributions
-4

-3

-2

-1

Steps in Statistical
Hypothesis Testing
1. Formulate null and research hypotheses
2. Set alpha error (Type I error) and beta
error (Type II error)
3. Compute statistical test and determine
statistical significance
4. Draw conclusion

Step 1: Formulate Null

and Research Hypotheses
Null Hypothesis (H0):
There is no difference between groups;
there is no relationship between the independent
and dependent variable(s).
Research Hypothesis (HR):
There is a difference between groups;
there is a relationship between the
independent
and dependent variable(s).

Directional vs
Non-directional
Hypotheses
Null and research hypotheses are either non-directional (two-tailed) or
directional (one-tailed):
Non-directional (two-tailed):
Directional (one-tailed):
H0: Drug A = Drug B
H0: Drug A Drug B
HR: Drug A Drug B
HR: Drug A > Drug B
or
H0: Drug A Drug B
HR: Drug A < Drug B

Rejection
Region
2.5%

NonRejection
Region

Rejection
Region
2.5%

NonRejection
Region

Rejection
Region
5.0%

Example:
Directional vs Nondirectional
Research question: Does age of onset of paranoid
schizophrenia differ for males and females?
Non-directional (two-tailed):
H0: Male Age = Female Age
HR: Male Age Female Age

Directional (one-tailed):
H0: Male Age Female Age
HR: Male Age > Female Age
(or the opposite)

Rejection
Region
2.5%

NonRejection
Region

NonRejection
Region

Rejection
Region
2.5%

Rejection
Region
5.0%

Step 2: Set Alpha (Type I)

and Beta (Type II) Errors
Alpha () is the level of significance in hypothesis
testing:
Alpha is a probability specified before the test is
performed.
Alpha is the probability of rejecting the null
hypothesis when it is true.
By convention, typical values of alpha specified in
medical research are 0.05 and 0.01.
Alphas have corresponding critical values, the same

Step 2: Set Alpha (Type I)

and Beta (Type II) Errors
Beta () is the probability of accepting the
null hypothesis when it is false.
Typical values for beta are 0.10 to 0.20
Beta is directly related to the power of a statistical
test:
Power is the probability of correctly rejecting the
null hypothesis when it is false. Power = 1 - Beta
A type II error occurs when a false null hypothesis is
accepted.

P-values
P-values are the actual probabilities calculated from
a statistical test, and are compared against alpha to
determine whether to reject the null hypothesis or
not.
Example:
alpha = 0.05; calculated p-value = 0.008; reject
null hypothesis
alpha = 0.05; calculated p-value = 0.110; do not
reject null hypothesis
A type I error occurs when a true null hypothesis is

Possible Outcomes in
Statistical Testing
Null Hypothesis
(Treatment A = Treatment B)
POPULATION

Decision Based
on Inferential
Statistical Test

Accept H0
(No difference)
Reject H0
(Difference)

True
(No difference)

False
(Difference)

Correct
Decision

Type II Error
(beta () error)

Type I Error
(alpha ()
error)

Correct
Decision
Power (1-)

Post treatment mortality in CABG/PTCA study:

What are the null and alternative hypotheses for a
two-tailed test?
Null Hypothesis (H0)
There is no difference in posttreatment mortality
between the CABG and PTCA groups
(the post treatment mortality is equal, i.e. P1 = P2)
Research Hypothesis (HR)
There is a difference in posttreatment mortality
between the CABG and PTCA groups (the post
treatment mortality is not equal, i.e. P1 P2)

Hypothesis Testing

Step 3
Compute statistical test and determine statistical
significance

Calculations for statistical tests are different depending

on the type of test

All involve determining a value of a test statistic that is

then converted to a probability of obtaining that test
statistic if the null hypothesis is true.

The value of a test statistic is determined from the

measurement being tested, and the variability of the

measurement in the sample (the SE of the
measurement).

Example of a statistical test: two-sample t test

Does age of onset of paranoid schizophrenia differ for
males and females?
H0: Male Age = Female Age
HR: Male Age Female Age
n mean age SD
Male
12
26.8 5.8
Female 12
29.6 6.2

Test statistic:

(x1 x 2 )
t
SE(x1 x 2 )

Example of a statistical test: two-sample t test

Does age of onset of paranoid schizophrenia differ for males

and females?
calculated test statistic: t = -1.142
Critical value of t for alpha = 0.05: + 1.960
The computed value of t does not exceed the critical value
so the null hypothesis of no difference in age is not
rejected (the p value is greater than 0.05)
Conclusion:
The mean age of onset is not different for males versus
females

Is the post treatment mortality different for patients

receiving CABG compared to patients receiving
PTCA?
There are a number of statistical tests that can be
used:
2 examples are 1) chi-square test, or 2) z test for
proportions. The resulting p values will be the
same regardless of the test used.
The researchers used a z test:
the p value from the test was 0.3508.
If alpha = 0.05, what did they conclude?

Is the post treatment mortality different for patients

receiving CABG compared to patients receiving
PTCA?

The p value is 0.3508 this is

>0.05, so the conclusion from the
study is that there is no difference

If there is truly no difference between

CABG and PTCA, the probability of
obtaining the difference of 0.6% is
~35%

Hypothesis Testing

Step 4
Draw conclusion about the population
based on the results of the statistical test
on the sample
Statistical conclusion: the results either are
or are not statistically significant
BUT
You need to interpret the results in a
meaningful (and not just statistical) way

Principles for Statistical Significance

1. The size of a p value does not indicate importance of the
result.
2. Interpret nonsignificance cautiously.
a. finding no difference may be important
b. statistically nonsignificant clinically unimportant
3. Results may be statistically significant but
clinically trivial.

P Values vs. Confidence Intervals

There is a direct relationship between levels of alpha set for a statistical test and the level set for
constructing a confidence interval.
For example, alpha = 0.05 for a 2-sided statistical test is equivalent to a 95% confidence interval

Rejection
Region
2.5%

NonRejection
Region

95% confidence interval

Rejection
Region
2.5%

P Values vs. Confidence Intervals

Statistical significance can be obtained from a confidence interval as
well as a hypothesis test
AND
Confidence intervals convey more information than p values
For this reason, most medical journals now prefer that results be
presented with confidence intervals rather than p values.

If the NULL VALUE for a statistical hypothesis test using alpha = 0.05
is contained within the 95% confidence interval,
we can conclude NO statistical significance at alpha = 0.05
without doing the hypothesis test:

P Values vs. Confidence Intervals

Example:
For differences between means or proportions, the null hypothesis is
that the difference is equal to zero:
If the 95% CI includes the value zero, the differences are not statistically
significant at alpha = 0.05.
For the test comparing the ages of males and females for onset of
paranoid schizophrenia, the null hypothesis is that the difference in age
is zero years.

P Values vs. Confidence Intervals

Example:
n
Male
Female

mean age SD
12
26.8
5.8
12
29.6
6.2

The difference in age obtained from the sample is:

26.8-29.6 = -2.8 years
The standard error of the difference is 2.45
(calculation not shown)

The 95% confidence interval is:

-2.8 +/- 2(2.45) = -2.8 +/- 4.9 = -7.7 to 2.1 years

P Values vs. Confidence Intervals

The 95% confidence interval is:

-2.8 +/- 2(2.45) = -2.8 +/- 4.9 = -7.7 to 2.1 years
This means that the true population mean difference in
age is somewhere between males being 7.7 years
younger to males being 2.1 years older than females
The 95% CI includes 0 years, so there is no statistically
significant difference in age. In addition, we have
information about the precision of our estimate of the
difference, which cannot be obtained from p values
alone.
Note: This is a relatively wide confidence interval
because the sample size is small

P Values vs. Confidence Intervals

For the CABG/PTCA result:

The 95% CI is 0.6% to 1.7%
We can be 95% confident that the true difference in
mortality between CABG and PTCA is between 0.6%
and +1.7%
This confidence interval contains the value zero;
therefore, we could have concluded that the mortality
is not different based on the confidence interval alone.

P Values vs. Confidence Intervals

For ratio variables, such as relative risk and

odds ratio, the value one represents equality.
The null hypothesis is that the ratio is equal to
one:
If the 95% CI includes the value one, the
difference is not statistically significant at
alpha = 0.05.