NURSING DATA ANALYSIS

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NURSING DATA ANALYSIS

© All Rights Reserved

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A binomial logistic regression (often referred to simply as logistic regression), predicts the

probability that an observation falls into one of two categories of a dichotomous dependent

variable based on one or more independent variables that can be either continuous or categorical.

For example, you could use binomial logistic regression to understand whether exam performance

can be predicted based on revision time, test anxiety and lecture attendance (i.e., where the

dependent variable is "exam performance", measured on a dichotomous scale – "passed" or

"failed" – and you have three independent variables: "revision time", "test anxiety" and "lecture

attendance"). Alternately, you could use binomial logistic regression to understand whether drug

use can be predicted based on prior criminal convictions, drug use amongst friends, income, age

and gender (i.e., where the dependent variable is "drug use", measured on a dichotomous scale –

"yes" or "no" – and you have five independent variables: "prior criminal convictions", "drug use

amongst friends", "income", "age" and "gender").

This paper will show you how to carry out binomial logistic regression using SPSS Statistics, as

well as interpret and report the results from this test. However, before we go to the test procedure,

we need to understand the different assumptions that a data must meet in order for binomial logistic

regression to give a valid result.

Assumptions

When a researcher chooses to analyze a data using binomial logistic regression, part of the process

involves checking to make sure that the data can actually be analyzed using a binomial logistic

regression. The researcher needs to do this because it is only appropriate to use a binomial logistic

regression if a data "passes" seven assumptions that are required for binomial logistic regression

to give a valid result. In practice, checking for these seven assumptions just adds a little bit more

time to a data analysis, requiring us to click a few more buttons in SPSS Statistics when performing

an analysis.

Assumption #2: You have one or more independent variables, which can be

either continuous (i.e.,an interval or ratio variable) or categorical (i.e., an ordinal or nominal variable).

Assumption #3: You should have independence of observations and the dependent variable

should have mutually exclusive and exhaustive categories.

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Assumption #4: There needs to be a linear relationship between any continuous independent

variables and the logit transformation of the dependent variable.

You can check assumption #4 using SPSS Statistics. Assumptions #1, #2 and #3 should be checked

first, before moving onto assumption #4. It is suggested that a testing on these assumptions must

be done in this order because it represents an order where, if a violation to the assumption is not

correctable, the researcher will no longer be able to use a binomial logistic regression. Just

remember that if you do not run the statistical tests on these assumptions correctly, the results you

get when running binomial logistic regression might not be valid. 1

Problem Statement

A health researcher wants to be able to predict whether the "incidence of heart disease" can be

predicted based on "age", "weight", "gender" and "VO2max" (i.e., where VO2max refers to

maximal aerobic capacity, an indicator of fitness and health). To this end, the researcher

recruited 100 participants to perform a maximum VO2max test as well as recording their age,

weight and gender. The participants were also evaluated for the presence of heart disease. A

binomial logistic regression was then run to determine whether the presence of heart disease could

be predicted from their VO2max, age, weight and gender.

Ha: The incidence of heart disease can be predicted based on a person’s age, weight, gender and

VO2max.

In this example, there are six variables: (1) heart_disease , which is whether the participant

has heart disease: "yes" or "no" (i.e., the dependent variable); (2) VO2max , which is the

maximal aerobic capacity; (3) age , which is the participant's age; (4) weight , which is the

participant's weight (technically, it is their 'mass'); and (5) gender , which is the

participant's gender (i.e., the independent variables); and (6) caseno , which is the case

number. The caseno variable is used to make it easy for you to eliminate cases (e.g.,

"significant outliers", "high leverage points" and "highly influential points") that you have

1

https://statistics.laerd.com/spss-tutorials/binomial-logistic-regression-using-spss-statistics.php

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identified when checking for assumptions. It is not used directly in calculations for a

binomial logistic regression analysis.

Computations

The 10 steps below will be utilized to analyze data using a binomial (binary) logistic regression

in SPSS Statistics when none of the assumptions have been violated. At the end of these 10 steps,

data will be interpreted which is the result from binomial logistic regression.

• Click Analyze > Regression > Binary Logistic... on the main menu, as shown below:

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You will be presented with the Logistic Regression dialogue box, as shown below:

• Transfer the dependent variable, heart_disease , into the Dependent: box, and the independent

variables, age , weight , gender and VO2max into the Covariates: box, using the buttons, as

shown below:

For a standard logistic regression you should ignore and buttons because they

are for sequential (hierarchical) logistic regression. The Method: option needs to be kept at the

default value, which is . If, for whatever

reason, is not selected, you need to change Method: back

to . The "Enter" method is the name given by SPSS Statistics to

standard regression analysis.

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• Click the button. You will be presented with the Logistic Regression: Define

Categorical Variables dialogue box, as shown below:

SPSS Statistics requires you to define all the categorical predictor values in the logistic

regression model. It does not do this automatically.

• Transfer the independent, categorical variable, gender , from the Covariates: box to the Categorical

Covariates: box, as shown below:

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• In the –Change Contrast– area, change the Reference Category: from the Last option to the First option.

Then, click the button, as shown below:

Whether you choose Last or First will depend on how you set up your data. In this example, males

are to be compared to females, with females acting as the reference category (who were coded

"0"). Therefore, First is chosen.

• Click the button. You will be returned to the Logistic Regression dialogue box.

• Click the button. You will be presented with the Logistic Regression:

Options dialogue box, as shown below:

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• In the –Statistics and Plots– area, click the Classification plots, Hosmer-Lemeshow goodness-of-fit, Casewise

listing of residuals and CI for exp(B): options, and in the –Display– area, click the At last step option. You

will end up with a screen similar to the one below:

• Click the button. You will be returned to the Logistic Regression dialogue box.

• Click the button. This will generate the output.

SPSS Statistics generates many tables of output when carrying out binomial logistic regression. In

this example, three main tables will be used to understand results from the binomial logistic

regression procedure, assuming that no assumptions have been violated.

However, the focus will only be on the three main tables needed to understand a binomial logistic

regression results, assuming that the data has already met the assumptions required for binomial

logistic regression to give you a valid result:

In order to understand how much variation in the dependent variable , it can be explained by the

model (the equivalent of R2 in multiple regression), or consult the table below, "Model

Summary":

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This table contains the Cox & Snell R Square and Nagelkerke R Square values, which are both

methods of calculating the explained variation. These values are sometimes referred to as pseudo

R2 values (and will have lower values than in multiple regression). However, they are interpreted

in the same manner, but with more caution. Therefore, the explained variation in the dependent

variable based on our model ranges from 24.0% to 33.0%, depending on whether you reference

the Cox & Snell R2 or Nagelkerke R2 methods, respectively. Nagelkerke R2 is a modification of

Cox & Snell R2, the latter of which cannot achieve a value of 1. For this reason, it is preferable to

report the Nagelkerke R2 value.

Category prediction

Binomial logistic regression estimates the probability of an event (in this case, having heart

disease) occurring. If the estimated probability of the event occurring is greater than or equal to

0.5 (better than even chance), SPSS Statistics classifies the event as occurring (e.g., heart disease

being present). If the probability is less than 0.5, SPSS Statistics classifies the event as not

occurring (e.g., no heart disease). It is very common to use binomial logistic regression to predict

whether cases can be correctly classified (i.e., predicted) from the independent variables.

Therefore, it becomes necessary to have a method to assess the effectiveness of the predicted

classification against the actual classification. There are many methods to assess this with their

usefulness often depending on the nature of the study conducted. However, all methods revolve

around the observed and predicted classifications, which are presented in the "Classification

Table", as shown below:

Firstly, notice that the table has a subscript which states, "The cut value is .500". This means that

if the probability of a case being classified into the "yes" category is greater than .500, then that

particular case is classified into the "yes" category. Otherwise, the case is classified as in the "no"

category. While the classification table appears to be very simple, it actually provides a lot of

important information about your binomial logistic regression result, including:

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A. The percentage accuracy in classification (PAC), which reflects the percentage of

cases that can be correctly classified as "no" heart disease with the independent variables

added (not just the overall model).

B. Sensitivity, which is the percentage of cases that had the observed characteristic (e.g.,

"yes" for heart disease) which were correctly predicted by the model (i.e., true positives).

C. Specificity, which is the percentage of cases that did not have the observed

characteristic (e.g., "no" for heart disease) and were also correctly predicted as not having

the observed characteristic (i.e., true negatives).

D. The positive predictive value, which is the percentage of correctly predicted cases

"with" the observed characteristic compared to the total number of cases predicted as

having the characteristic.

E. The negative predictive value, which is the percentage of correctly predicted cases

"without" the observed characteristic compared to the total number of cases predicted as

not having the characteristic.

Level of Significance

The "Variables in the Equation" table shows the contribution of each independent variable to the

model and its statistical significance. This table is shown below:

Computation

The Wald test ("Wald" column) is used to determine statistical significance for each of the

independent variables. The statistical significance of the test is found in the "Sig." column. From

these results you can see that age (p = .003), gender (p = .021) and VO2max (p = .039) added

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significantly to the model/prediction, but weight (p = .799) did not add significantly to the model.

You can use the information in the "Variables in the Equation" table to predict the probability of

an event occurring based on a one unit change in an independent variable when all other

independent variables are kept constant. For example, the table shows that the odds of having heart

disease ("yes" category) is 7.026 times greater for males as opposed to females.

Analysis/Interpretation:

Based on the results of the data analysis above, we could report the results of the study as

follows:

A logistic regression was performed to ascertain the effects of age, weight, gender and VO2max

on the likelihood that participants have heart disease. The logistic regression model was

statistically significant, χ2(4) = 27.402, p < .0005. The model explained 33.0% (Nagelkerke R2) of

the variance in heart disease and correctly classified 71.0% of cases. Males were 7.02 times more

likely to exhibit heart disease than females.

Conclusion: The study showed that Increasing age was associated with an increased likelihood of

exhibiting heart disease, but increasing VO2max was associated with a reduction in the likelihood

of exhibiting heart disease.

Implication: a person with increasing age must increase his VO2 max in order to prevent heart

disease.

DScN Student

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