Introduction to Biostatistics

Evidence Based Medicine and Biostatistics

• Evidence Based Medicine (EBM)
‒ the conscientious, explicit, and judicious use of current best evidence in
making decisions about the care of individual patients
‒ Method of integrating individual clinical expertise with the best available
external clinical evidence from systematic research
• Biostatistics
‒ Statistical Methods – employed in biological sciences and medicine
‒ Concerned with: (1) the collection, organization, summarization and analysis
of data; (2) drawing inferences
‒ Providing credibility for the evidence required in EBM
 Deductive and Inductive Inference
General Theories

Inference Prediction
Biostatistics/ Probability/
Induction Deduction
Statistics Statistical
Models
Observations
Biostatistics in medicine
• Evaluating the literature
• Applying Study Results to Patient Care
• Interpreting Vital Statistics
• Understanding Epidemiologic Problem
• Interpreting Information about Drugs and Equipment
• Using Diagnostic Procedures
• Being Informed
• Appraising Guidelines
• Evaluating Study Protocols and Articles
• Participating and Directing Research Projects
The Stages of Gathering Information and
Analysis
• Description
‒ What is the proportion of female students in the faculty of Medicine?
‒ What is the range of cholesterol levels for 40 year-old men?
• Explanation (inference)
‒ Is the proportion of female students larger than male students?
‒ Is the average of cholesterol levels for 40 year-old men who have routine
exercises less than those who do not have routine exercises?
• Prediction
‒ What is the probability (or the risk) of having high cholesterol levels for a 40
year-old man who do not have routine exercises?
Unit of Observation, Variable and Data
Data: information from 30 infants variable
id weight (g) Apgar gender smoking parity
1 3710 8 L T 1
2 3650 7 P T 1
3 4490 8 L T 0
4 3421 6 P Y 1
... ... ... ... ... ... data
30 3886 8 L Y 1
Types of Variable/Data
Quantitative (metric)
Measured Counted
Blood pressure, height, weight, Number of children in a family
age Number of heart attacks
Number of cases

(with certain measured units) (with certain counted units)

Categorical
Ordinal Nominal
Grade of cancer Sex (female/male)
better, same, worse Alive or Dead
Diagree, neutral, agree Blood group (O, A, B, AB)

(no units) (no units)

Scale of measurements
Measurements: the assignment of numbers to each observation unit
according to certain rules
Scale Examples
Nominal male, female; dead, alive; cause
of death
Ordinal age group, rating scale,
education level
Interval temperature, time period

Ratio blood pressure, body weight,

height
Nominal Scale
• Identification-classification

Variable response
Health facility  available  unavailable

Type of health facilities  Primary Health Care

 Clinic
 Hospital
 Other
Ordinal Scale
• Identification-classification
• Order-rank

Variable response
Patient satisfaction  Very satisfied
 satisfied
 unsatisfied
 Very unsatisfied
Education  University
 High school
 Junior high school
 Elementary school
Interval Scale
• Identification-classification
• Order-rank
• Difference

Variable response
Temperature in Celcius 0, 36, 40, dst.
Calendar year 0, 1945, 2007, etc
Ratio Scale
• Identification-classification
• Order-rank
• Difference
• Ratio (zero value exists)

Variable response
weight (kg) 12, 64, 100, etc
Height (cm) 50, 100, 170, etc
Examination cost (rupiahs) 25.000, 50.000, 5 juta, ect
Age (years) 2, 10, 40, 65, etc.
Sources of Data
• Routine data records
• Surveys
• Experiments
• External Sources (Secondary data)
Using Computer in Biostatistics

Access Manage

Data

Present Analysis
Using Computer in Biostatistics
• Access: data entry; importing and exporting data (from and to other
format)
• Management: Sorting, selection, tranformation, taking subsets of
data, data merging
• Presentation: Creating tables, summary of statistics, graphics
• Analyzing: Performing statistical analysis
Using Computer in Biostatistics
Spreadsheet
Database program
Statistical Packages
Statistical Packages for
Epidemiology or Biomedical
data
Good for managing, presenting
and analyzing small and
uncomplicated data sets
Good for managing large data
sets
Good for data analysis,
presentation and managing data;
some packages are menu
oriented; others are command
oriented
Good for data analysis,
presentation for biomedical data
Using Computer in Biostatistics
The good news is that statistical analysis is becoming easier and
cheaper. The bad news is that statistical analysis is becoming easier
and cheaper.
References
• Daniel, W.B. (2005) Biostatistics. A Foundation for Analysis in the Health
Sciences, 8th Ed. John Wiley and Sons.
• Dawson, Beth; Trapp, Robert G (2004) Basic & Clinical Biostatistics, 4th
Edition, McGraw-Hill
• Riffenburgh, R. H. (2005). Statistics in Medicine 2nd Ed. Academic Press
• Rosner, B. (2015). Fundamentals of Biostatistics 8th Ed. Cengage Learning
• Sackett, et al (1996) Evidence based medicine: what it is and what it isn't.
BMJ. p71-72
• Wassertheil-Smoller, Sylvia (2004) Biostatistics and Epidemiology. A Primer
for Health and Biomedical Professionals. Springer