Main Menu - The hyperlinks below take you to the appropriate wo

Basic Concepts
Normal Distribution & 'Standard Deviation
Skewed Distribution

Epidemic curve (how to create one)

Descriptive Statistics (mean, median,mode, 95% confidence interval for a mean, standard deviation, standard error, ra
 Epidemiology/Biostatistics Tools

Wayne W. LaMorte, MD, PhD, MPH Copyright

2006

Menu - The hyperlinks below take you to the appropriate worksheet.

Statistical Tests
ANOVA (Analysis of Variance)
Chi Squared Test
Confidence Interval for a Proportion
Correlation & Linear Regression
T-test (Unpaired)
T-test (Paired)

Standardized Rates (Proportions) - Direct Standardization

Standardized Incidence Ratio

Fisher's Exact Test (You need to be online to use this.)

appropriate worksheet.
Study Analysis
Case-Control
Cohort Studies

Screening Test Performance - Sensitivity/Specificity

Sample Size Calculations

Survival Curves

Random Assignment to Groups

 Making an Epidemic Curve for a Disease Outbreak
Case ID #
1 Date of Onset Onset # Cases Onset # Cases
2
1) The cases are 9/1 4/14/2005 1 9/1/04 1
3
sorted by date of 11/24 28-Apr 1 11/24/04 1
disease onset.4 12/15 29-Apr 2 12/15/04 1 3) Starting with 4/2
5 2/2 30-May 2 2/2 1 the number of case
6 2/10 1-May 1 2/10 1 intervals. In this ca
7 3/15 2-May 2 3/15 1 intervals were used
8 4/14 3-May 0 4/14 1

}
9 4/28 4-May 4 4/28 6
10 4/29 5-May 3 5/2 9
11 4/29 6-May 3 5/6 14 4) Select the bloc
12 4/30 7-May 5 5/10 11 dates and tallies,
13 4/30 8-May 3 5/14 7 graphing tool (or
14 5/1 9-May 3 5/18 4 "Charts", "Colum
15 5/2 10-May 4 column chart as s
16 5/2 11-May 2
17 5/4 12-May 1 16
18 5/4 13-May 4 14
19 5/4 14-May 1
12
20 5/4 15-May 3
21 5/5 16-May 2 10
22
2) Then,
5/5
tally the 17-May 1 8
23 number5/5 of cases 18-May 2 6
24 by day.
5/6 19-May 1
4
25 5/6 20-May 1
26 5/6 21-May 2
27 5/7 22-May 2 0
28 5/7 23-May 2
05 05 05
29 5/7 24-May 2 / 20 / 20 / 20
2 2 2
30 5/7 25-May 2/ 3/ 4/
31 5/7 26-May
32 5/8 27-May 1
33 5/8 28-May
34 5/8 29-May 1
35 5/9 30-May
36 5/9 31-May
37 5/9 1-Jun 2
38 5/10 2-Jun
39 5/10 3-Jun
40 5/10 4-Jun
41 5/10 5-Jun 2
42 5/11 6-Jun 1
43 5/11 7-Jun 3
44 5/12 8-Jun 1
45 5/13 9-Jun 1
46 5/13 10-Jun 2
47 5/13 11-Jun 3
48 5/13 12-Jun 3
49 5/14 13-Jun 4
50 5/15 14-Jun 2
 Main Menu

3) Starting with 4/28, tally

the number of cases at
intervals. In this case, 4-day
intervals were used.

4) Select the block of data to the left with

dates and tallies, and use the Excel
graphing tool (or click on "Insert",
"Charts", "Column") to create a vertical
column chart as shown below.

5 05 05
/ 20 / 20
2 2
4/ 5/
Wayne W. LaMorte, MD, PhD, MPH Confidence Intervals for a Single Preval
Copyright 2006

Use these first four rows to compute the confidence limits for a single proportion (i.e., a prevalence of a cumulative incidence in one group
symmetrically distributed above and below the point estimate. They are more accurate than the approximations that assume large sample
or 1. (See the formula in Rothmans K: Epidemiology: An Introduction, Oxford University Press, 2002, page 132).

90% Confidence Interval

"N" Estimated +/- Lower Upper +/-
Numerator Denominator proportion Limit Limit
4 8 0.5 0.24863 0.75137
10 20 0.5 0.32739 0.67261
70 100 0.7 0.62016 0.76930
7 10000 0.0007 0.00038 0.00129

The lower section uses Byar's approximation of the exact limits as described by Rothman, K: Epidemiology: An Introduction, Oxford U
above, these can be used for small or large samples, and the limits are not necessarily symmetrically distributed above and below the

Confidence Intervals for a Sing

90% Confidence Interval
Person-Time Estimated +/- Lower Upper +/-
Numerator Denominator Rate Limit Limit
3 2500 0.0012 0.00043 0.00281
10 2500 0.004 0.00232 0.00653
20 2500 0.008 0.00546 0.01139
50 2500 0.02 0.01576 0.02509
rvals for a Single Prevalence or Cumulative Incidence
Main Menu

of a cumulative incidence in one group. These use Wilson's approximation of the exact limits for a binomial distribution. These are not
proximations that assume large sample size. These formulas can be used when the sample size is small or the proportion is close to 0
2, page 132).

95% Confidence Interval 99% Confidence Interval

Lower Upper +/- Lower Upper
Limit Limit Limit Limit
0.21521 0.78479 0.16369 0.83660
0.29929 0.70071 0.25063 0.74949
0.60415 0.78105 0.57263 0.80251
Wilson's Approximation
0.00034 0.00144 0.00027 0.00179

pidemiology: An Introduction, Oxford University Press, 2002, page 134. As with Wilson's approximation
rically distributed above and below the point estimate.

ence Intervals for a Single Incidence Rate

95% Confidence Interval 99% Confidence Interval
Lower Upper +/- Lower Upper
Limit Limit Limit Limit
0.00033 0.00320 0.00019 0.00407
0.00205 0.00710 0.00160 0.00829
(Byar's Approximation)
0.00504 0.01211 0.00428 0.01362
0.01502 0.02614 0.01363 0.02827
s Approximation

Approximation)
 Chi Squared Test Main Menu
Wayne W. LaMorte, MD, PhD, MPH
Copyright 2006
Example Observed Data Expected Under H0
+ Outcome -Outcome + Outcome -Outcome
Exposed 7 124 131 Exposed 4.99 126.01 131
Non-exposed 1 78 79 Non-exposed 3.01 75.99 79
8 202 210 8 202 210

p-value= 0.13481471 8/210= 0.03809524

The Chi Squared statistic is calculated from the difference between observed and expected values for each cell. The
difference is squared and then divided by the expected value for the cell. This calculation is repeated for each cell and
the results are summed. Note that the chi squared test is a "large sample test"; it should not be used if the number of
expected observations in any of the cells is <5, because it gives falsely low p-values. In this case, Fisher's Exact Test
should be used.

Enter data into the blue cells to calculate a p-value with the chi squared test.
Observed Data Expected Under H0
+ Outcome -Outcome + Outcome -Outcome
Exposed 0 Exposed #DIV/0! #DIV/0! ###
Non-exposed 0 Non-exposed #DIV/0! #DIV/0! ###
0 0 0 #DIV/0! #DIV/0! ###
Chi Sq= #DIV/0!
p-value= #DIV/0! #DIV/0!
The chi squared test can also be applied to situations with multiple groups and outcomes.
For example, the number of runners who finished a marathon in less than 4 hours among those who trained not at all, a little, m
The Excel function CHITEST will calculate the p-value automatically, if you specify the range of actual (observe
frequencies and the range of expected observations. For example,
Observed Data Expected Under H0
Finished Didn't finish Finished Didn't finish
Not at all 2 5 7 3.29 3.71 7
A little 8 30 38 17.86 20.14 38
Moderately 20 15 35 16.45 18.55 35
A lot 25 12 37 17.39 19.61 37
55 62 117 55 62 117

p-value= 0.000280
 The Chi Squared Test is based on the difference
PhD, MPH
between the frequency distribution that was observed
Copyright 2006
and the frequency distribution that would have been
expected under the null hypothesis. In the example
above, only 8 of 210 subjects had the outcome of
interest (3.8095%). Under the null hypothesis, we would
expect 3.8095% of the exposed group to have the
outcome, and we would expect 3.8095% of the non-
exposed group to have the outcome as well. The 2x2
table to the right calculates the frequencies expected
under the null hypothesis
for each cell. The
ed for each cell and

(O-E) 2
d if the number of


Fisher's Exact Test

=
2
E

o trained not at all, a little, moderately, or a lot.

he range of actual (observed)
 Case-Control Studies

Enter data into the blue cells to calculate a p-value with the chi squared test.
Lamorte, Wayne W:
Enter data into the Observed Data
turquoise cells. Cases Controls
Exposed 23 27 50
Non-exposed 11 39 50
34 66 100

0.95 Select Confidence Level

Confidence Limits
Lower Limit Upper Limit
Odds Ratio= 3.02 1.27 7.21
Chi Sq= 6.417
p-value= 0.011303

Online Fisher's Exact Test

Stratified Analysis
The area below provides an illustration of a stratified analysis that is limited to two substrata.
For stratified analysis of case-control data for up to 12 sbstrata use the worksheet entitled:
Stratified Analysis (for 2 Substrata) Crude
Cases Controls
688 650 1338
21 59 80
709 709 1418
Lamorte, Wayne W:
Enter data into the
turquoise cells.
Stratum 1
Cases Controls
Exposed 647 622 1269
Non-exposed 2 27 29
649 649 1298

Odds Ratio= 14.04

Chi Sq= 22.044
p-value= 0.000003
Conf. Level= 0.95
Upper CI= 59.30
The weights in this row are used for
the Chi Square test of HOMGENEITY. Lower CI= 3.33
See Aschengrau and Seage, p.347- lnOR 2.64 2.6421
348. (2nd edition)
 The weights in this row are used for
the Chi Square test of HOMGENEITY.
See Aschengrau and Seage, p.347-
348. (2nd edition)
se(lnOR) 0.734976428
(weight) w 1.851199307
ad/T= 13.45839753 G1
bc/T= 0.958397535 H1
(a+d)/T 0.519260401 P1
(b+c)/T 0.480739599 Q1
Var(lnOR) 0.540190349
ChiSq_het 2.37518211
Expected Under H0
Cases Controls
Exposed 634.50 634.50 1269.00
Non-exposed 14.50 14.50 29.00
649 649 1298

O-E 634.5
O 647

n0n1m0m1/(n2(n-1)= 7.093484965 n0n1m0m1/(n2(n-1)=

Y-Values X-Values
From Ken Rothm p-value Curve 1 Null Bar
0.0037312 0.0037312 0.81150403
z value 0.0051099 0.0051099 0.849124856
2.9 0.0069335 0.0069335 0.88848976
2.8 0.009322 0.009322 0.929679597
2.7 0.0124189 0.0124189 0.97277897
2.6 0.0163947 0.0163947 1.017876402
2.5 0.0214478 0.0214478 1.065064524
2.4 0.0278065 0.0278065 1.114440258
2.3 0.0357284 0.0357284 1.166105021
2.2 0.0454999 0.0454999 1.22016493
2.1 0.0574327 0.0574327 1.276731023
2 0.0718603 0.0718603 1.335919485
1.9 0.0891306 0.0891306 1.397851888
1.8 0.1095982 0.1095982 1.462655439
1.7 0.133614 0.133614 1.530463242
1.6 0.161513 0.161513 1.601414573
1.5 0.1936006 0.1936006 1.675655164
1.4 0.230139 0.230139 1.753337504
1.3 0.2713318 0.2713318 1.834621148
1.2 0.3173102 0.3173102 1.919673052
1.1 0.36812 0.36812 2.00866791
1 0.4237105 0.4237105 2.101788515
0.9 0.4839271 0.4839271 2.199226133
0.8 0.548506 0.548506 2.301180899
0.7 0.6170749 0.6170749 2.407862226
0.6 0.6891563 0.6891563 2.519489232
0.5 0.764177 0.764177 2.636291198
0.4 0.8414805 0.8414805 2.758508031
0.3 0.9203442 0.9203442 2.886390761 1
0.2 1 1 3.020202055 1
0.1 0.9203443 0.9203443 3.160216758
0 0.8414805 0.8414805 3.306722457
0.1 0.7641771 0.7641771 3.460020069
0.2 0.6891564 0.6891564 3.620424464
0.3 0.6170749 0.6170749 3.788265108
0.4 0.5485061 0.5485061 3.96388674
0.5 0.4839271 0.4839271 4.147650083
0.6 0.4237106 0.4237106 4.339932581
0.7 0.36812 0.36812 4.541129177
0.8 0.3173102 0.3173102 4.751653123
0.9 0.2713318 0.2713318 4.971936829
1 0.230139 0.230139 5.202432752
1.1 0.1936007 0.1936007 5.443614323
1.2 0.161513 0.161513 5.695976923
1.3 0.1336141 0.1336141 5.960038898
1.4 0.1095982 0.1095982 6.236342623
1.5 0.0891306 0.0891306 6.525455618
1.6 0.0718603 0.0718603 6.827971713
1.7 0.0574327 0.0574327 7.144512268
1.8 0.0454999 0.0454999 7.475727447
1.9 0.0357285 0.0357285 7.822297557
2 0.0278065 0.0278065 8.184934444
2.1 0.0214478 0.0214478 8.564382954
2.2 0.0163947 0.0163947 8.961422461
2.3 0.0124189 0.0124189 9.376868476
2.4 0.009322 0.009322 9.811574311
2.5 0.0069335 0.0069335 10.26643284
2.6 0.0051099 0.0051099 10.74237833
2.7 0.0037312 0.0037312 11.24038836
2.8
2.9
 Wayne W. LaMorte, MD, PhD, MPH
Main Menu Copyright 2006

1.00
h the chi squared test.
0.90
Expected Under H0 0.80

p-- value
Cases Controls
Exposed 17.00 33.00 50 0.70
Non-exposed 17.00 33.00 50 0.60
34 66 100
0.50
ect Confidence Level 0.40
0.30
80% confidence
0.20
90% confidence
0.10 95% confidence
0.00
0.01 0.1 1 10
Odds Ratio (log scale)

Strat. Case-Control (Rothman)

Crude Odds Ratio= 2.973773

Lamorte, Wayne W:
Stratum 2 This is the p-value for the used to
Cases Controls P-value (HOMOG)= 0.02636859 ok compute a p-value for the Chi Square Te
41 28 69 for homogeneity across strata in order to
determine if there is effect measure
19 32 51
modification.
60 60 120

Odds Ratio= 2.47 ORmh= 4.52 ok

Chi Sq= 5.763 P-value (MH)= 5.97585E-07 ok
p-value= 0.016367 4.52 ok
Conf. Level= 0.95 LL95%CI 2.42 ok
Upper CI= 5.19 UL95%CI 8.47 ok
Lower CI= 1.17
lnOR 0.9027 ln(OR mh)= 1.51 ok
se(lnOR) 0.379455
w 6.9451144
ad/T= 10.933333 G2 0.01146262 ok
bc/T= 4.4333333 H2 + 0.05302419 ok
(a+d)/T 0.6083333 P2 + 0.03778932 ok
(b+c)/T 0.3916667 Q2 Var[ln(ORmh)]= 0.10227613 ok
0.1439861 SE= 0.31980639 ok
ChiSq_het 2.5565032 ChiSQ_HOMG= 4.93168534 ok
Expected Under H0
Cases Controls
34.50 34.50 69.00
25.50 25.50 51.00
60 60 120

34.5 Sum D54+H54 669.00 ok

41 Sum c55+g55 688.00 ok
Difference 19.00 ok
7.392857142857 14.49 ok
ChiSqMH= 24.9200245 ok

For p-value function

90% 95% 99%
Lower Bound 1.27
Upper Bound 7.21

RR
3.02020205515235

SE(ln)
0.45316884850608

Curve 1 p-value
0.811504 0.003731
0.8491249 0.00511
0.8884898 0.006934
0.9296796 0.009322
 0.972779 0.012419
1.0178764 0.016395
1.0650645 0.021448
1.1144403 0.027807
1.166105 0.035728
1.2201649 0.0455
1.276731 0.057433
1.3359195 0.07186
1.3978519 0.089131
1.4626554 0.109598
1.5304632 0.133614
1.6014146 0.161513
1.6756552 0.193601
1.7533375 0.230139
1.8346211 0.271332
1.9196731 0.31731
2.0086679 0.36812
2.1017885 0.423711
2.1992261 0.483927
2.3011809 0.548506
2.4078622 0.617075
2.5194892 0.689156
2.6362912 0.764177
2.758508 0.841481
0 2.8863908 0.920344
1 3.0202021 1
3.1602168 0.920344
3.3067225 0.841481
3.4600201 0.764177
3.6204245 0.689156
3.7882651 0.617075
3.9638867 0.548506
4.1476501 0.483927
4.3399326 0.423711
4.5411292 0.36812
4.7516531 0.31731
4.9719368 0.271332
5.2024328 0.230139
5.4436143 0.193601
5.6959769 0.161513
5.9600389 0.133614
6.2363426 0.109598
6.5254556 0.089131
6.8279717 0.07186
7.1445123 0.057433
7.4757274 0.0455
7.8222976 0.035729
8.1849344 0.027807
8.564383 0.021448
8.9614225 0.016395
9.3768685 0.012419
9.8115743 0.009322
10.266433 0.006934
10.742378 0.00511
11.240388 0.003731
 0.99
0.95
0.9

80% confidence

90% confidence
95% confidence

1 10 100
tio (log scale)

orte, Wayne W:
is the p-value for the used to
pute a p-value for the Chi Square Test
omogeneity across strata in order to
mine if there is effect measure
fication.
0.00
0.00
0
 Estimating Cumulative Incidence (CI) from Incidence Ra
 Relationship of Incidence Rate to Cumulative Incidence (Risk)
Cumulative incidence (the proportion of a population at risk that will develop an outcome in a given period of time
measure of risk, and it is an intuitive way to think about possible health outcomes. An incidence rate is less intuitive
really an estimate of the instantaneous rate of disease, i.e. the rate at which new cases are occurring at any paricul
Incidence rate is therefore more analgous to the speed of a car, which is typically expressed in miles per hour. Time
to measure a car's speed, but we don't have to wait a whole hour; we can glance at the speedometer to see the ins
of travel. Rather than measuring risk per se, incidence rate measures the rate at which new cases of disease occur
time, and time is an integral part of the calculation of incidence rate. In contrast, cumulative incidence or risk asses
probability of an event occurring during a stated period of observation. Consequently, it is essential to describe the
period in words when discussing cumulative incidence (risk), but time is not an integral part of the calculation. Des
distinction, these two ways of expressing incidence are obviously related, and incidence rate can be used to estima
incidence. At first glance it would seem logical that, if the incidence rate remained constant the cumulative inciden
equal to the incidence rate times time:
CI = IR x T
This relationship would hold true if the population were infinitely large, but in a finite population this approximatio
increasingly inaccurate over time because the size of the population at risk declines over time. Rothman uses the e
population of 1,000 people who experience a mortality rate of 11 deaths per 1,000 person-years over a period of y
words, the rate remains constant. The equation above would lead us to believe that after 50 years the cumulative i
death would be CI = IR X T = 11 X 50 = 550 deaths in a population which initally had 1,000 members. In realtity, the
be 423 deaths after 50 years. The problem is that the equation above fails to take into account the fact that the size
population at risk declines over time. After the first year there have been 11 deaths, and the population now has o
not 1,000. As a result, the equation above overestimates the cumulative incidence, because there is an exponentia
population at risk. A more accurate mathematical expression that takes this into account is:
CI = 1 - e(-IR x T), where 'e' = 2.71828
This constant 'e' arises in many mathematical relationships describing growth or decay over time. If you are using a
spreadsheet, you could calculate the CI using the formula:
CI = 1 - EXP(-IR xT)
 
In the graph below the upper blue line shows the predicted number of deaths using the approximation CI = IR x T. T
in red, shows the more accurate projection of cumulative deaths using the exponential equation.
 
Nevertheless, note that the prediction from CI = IR x T gives quite reasonable estimates in the early years of follow-

This means CI=1 minus the constant 'e' (2.71828)

raised to the power (- IRxT).
In Excel this can be programmed as
"1-exp(-IR*T)" or as "1-POWER(2.71828, -IR*T).
This column gives the approximation of CI from the
IR (person-yr) Time (yr) CI=1-e(-IRxT) CI=IRxT formula CI=IRxT. This approximation is only valid
when CI is low, i.e. <0.01 per person-year.
0.001 8 0.008 0.008
0.005 8 0.039 0.040
0.010 8 0.077 0.080
0.020 8 0.148 0.160
 0.040 8 0.274 0.320
0.060 8 0.381 0.480
0.080 8 0.473 0.640 Note that cumulative incidence cannot be greater than 1
0.100 8 0.551 0.800 increasing incidence rates, and column B sets the observ
approximations of CI only when the IR is low (i.e. <0.10)
0.200 8 0.798 1.600
0.400 8 0.959 3.200
0.800 8 0.998 6.400

Here, IR is low (0.01 p-yrs) and we observe the

effect of increasing Time on the estimates of CI.

Estimate over time when IR is low (0.01 person-yr)

IR (person-yr) Time (yr) CI=1-e(-IRxT) CI=IRxT
0.010 1 0.010 0.010
0.010 2 0.020 0.020
0.010 3 0.030 0.030
0.010 4 0.039 0.040
0.010 5 0.049 0.050
0.010 8 0.077 0.080
0.010 10 0.095 0.100
0.010 12 0.113 0.120
0.010 14 0.131 0.140
0.010 16 0.148 0.160
0.010 18 0.165 0.180
0.010 20 0.181 0.200
0.010 30 0.259 0.300
0.010 40 0.330 0.400
0.010 50 0.393 0.500
0.010 60 0.451 0.600
0.010 80 0.551 0.800
0.010 100 0.632 1.000
from Incidence Rate (IR)
k) time Predicted # Deaths
e in a given period of time) provides a IR (yrs) CI=IR*T CI=1-exp(-IR*T)
idence rate is less intuitive because it is 0.011 1 11.0 10.9
e occurring at any paricular moment. 0.011 2 22.0 21.8
ed in miles per hour. Time has to elapse 0.011 3 33.0 32.5
peedometer to see the instanteous rate 0.011 4 44.0 43.0
w cases of disease occur per unit of 0.011 5 55.0 53.5
tive incidence or risk assesses the
s essential to describe the relevant time 0.011 6 66.0 63.9
art of the calculation. Despite this 0.011 7 77.0 74.1
ate can be used to estimate cumulative 0.011 8 88.0 84.2
nt the cumulative incidence would be 0.011 9 99.0 94.3
0.011 10 110.0 104.2
0.011 15 165.0 152.1
pulation this approximation becomes 0.011 20 220.0 197.5
time. Rothman uses the example of a
n-years over a period of years; in other 0.011 25 275.0 240.4
50 years the cumulative incidence of 0.011 30 330.0 281.1
members. In realtity, there would only 0.011 35 385.0 319.5
count the fact that the size of the 0.011 40 440.0 356.0
the population now has only 989 people, 0.011 45 495.0 390.4
se there is an exponential decay in the 0.011 50 550.0 423.1
is:
600.0
er time. If you are using an Excel

500.0
pproximation CI = IR x T. The lower line,
quation. 400.0

n the early years of follow-up. Predicted # Deaths

300.0 CI=IR*T
CI=1-exp(-IR*T)
200.0

100.0

0.0
0 5 10 15 20 25 30 35 40 45 50

e approximation of CI from the

s approximation is only valid
0.01 per person-year.
dence cannot be greater than 1 (i.e., 100%). In this example, column A lists
s, and column B sets the observation time at T=8 years. CI=IRxT gives good
y when the IR is low (i.e. <0.10).

Here, IR is very low (0.001 p-yrs) and

we observe the effect of increasing Time
on the estimates of CI.

Estimate over time when IR is very low (0.001 person-yr)

IR (person-yr)Time (yr)
CI=1-e(-IRxT)CI=IRxT
0.001 1 0.001 0.001
0.001 2 0.002 0.002
0.001 3 0.003 0.003
0.001 4 0.004 0.004
0.001 5 0.005 0.005
0.001 8 0.008 0.008
0.001 10 0.010 0.010
0.001 12 0.012 0.012
0.001 14 0.014 0.014
0.001 16 0.016 0.016
0.001 18 0.018 0.018
0.001 20 0.020 0.020
0.001 30 0.030 0.030
0.001 40 0.039 0.040
0.001 50 0.049 0.050
0.001 60 0.058 0.060
0.001 80 0.077 0.080
0.001 100 0.095 0.100
Predicted # Deaths
CI=IR*T
CI=1-exp(-IR*T)
Cohort Studies- Cumulative Incidence
Enter data into the blue cells to calculate a p-value with the chi squared test.
Observed Data
Diseased No Disease
Exposed 23 27 50 Exposed
Non-exposed 11 39 50 Non-exposed
34 66 100
0.95 Select Confidence Level

Incidence in exposed= 0.4600 Confidence Limits

Incidence in non-exposed= 0.2200 Lower Limit Upper Limit
Risk Ratio= 2.09 1.15 3.82
Risk Difference= 0.2400 0.06 0.42
Attrib. Prop. (AR%)= 52.2
Chi Sq= 6.417 Population Attributable Fraction=
p-value= 0.011302580

Online Fisher's Exact Test

# Needed to Treat= 4

Cohort Studies- Incidence Rate

Enter data into the blue cells to calculate a p-value with the chi squared test.
Observed Data
Diseased No Disease Person-Time observation
Exposed 261 - 737397 Exposed
Non-exposed 363 - 878,547 Non-exposed
624 1615944
0.95 Select Confidence Level
Incidence exposed= 0.0004 Confidence Limits
Incidence nonexpos 0.0004 Lower Limit Upper Limit
Rate Ratio= 0.86 0.73 1.00
Rate Difference= -0.000059 -0.000120 0.000001
Chi Sq= 3.643
p-value= 0.056313 (if p=0.000000 it means that p<0.000001)
NNT= -16882 for a year if the denominator is person-years

Stratified Analysis
For stratified analysis of risk data (cumulative incidence) use the worksheet entitled: Strat. Cohort CI (Rothman)
For stratified analysis of rate data (incidence rates) use the worksheet entitled: Strat. Cohort IR (Rothman)
 Lower Bound
Upper Bound

From Ken Rothman's Episheet

Y-Values X-Values
z value p-value Curve 1 Null Bar
2.9 0.003731 0.0037312 0.84205
2.8 0.00511 0.0051099 0.868877
2.7 0.006934 0.0069335 0.896559
2.6 0.009322 0.009322 0.925123
2.5 0.012419 0.0124189 0.954598
2.4 0.016395 0.0163947 0.985011
2.3 0.021448 0.0214478 1.016393
2.2 0.027807 0.0278065 1.048774
2.1 0.035728 0.0357284 1.082188
2 0.0455 0.0454999 1.116666
1.9 0.057433 0.0574327 1.152242
1.8 0.07186 0.0718603 1.188952
1.7 0.089131 0.0891306 1.226832
1.6 0.109598 0.1095982 1.265918
1.5 0.133614 0.133614 1.30625
1.4 0.161513 0.161513 1.347866
1.3 0.193601 0.1936006 1.390809
1.2 0.230139 0.230139 1.435119
1.1 0.271332 0.2713318 1.480842
1 0.31731 0.3173102 1.528021
0.9 0.36812 0.36812 1.576703
0.8 0.423711 0.4237105 1.626936
0.7 0.483927 0.4839271 1.678769
0.6 0.548506 0.548506 1.732254
0.5 0.617075 0.6170749 1.787443
0.4 0.689156 0.6891563 1.84439
0.3 0.764177 0.764177 1.903152
0.2 0.841481 0.8414805 1.963785
0.1 0.920344 0.9203442 2.02635 1 0
0 1 1 2.090909 1 1
0.1 0.920344 0.9203443 2.157525
0.2 0.841481 0.8414805 2.226262
0.3 0.764177 0.7641771 2.29719
0.4 0.689156 0.6891564 2.370378
0.5 0.617075 0.6170749 2.445897
0.6 0.548506 0.5485061 2.523822
0.7 0.483927 0.4839271 2.60423
0.8 0.423711 0.4237106 2.687199
0.9 0.36812 0.36812 2.772812
1 0.31731 0.3173102 2.861153
1.1 0.271332 0.2713318 2.952308
1.2 0.230139 0.230139 3.046367
1.3 0.193601 0.1936007 3.143423
1.4 0.161513 0.161513 3.243571
1.5 0.133614 0.1336141 3.34691
1.6 0.109598 0.1095982 3.453541
1.7 0.089131 0.0891306 3.56357
1.8 0.07186 0.0718603 3.677103
1.9 0.057433 0.0574327 3.794254
2 0.0455 0.0454999 3.915138
2.1 0.035729 0.0357285 4.039872
2.2 0.027807 0.0278065 4.168581
2.3 0.021448 0.0214478 4.30139
2.4 0.016395 0.0163947 4.43843
2.5 0.012419 0.0124189 4.579837
2.6 0.009322 0.009322 4.725748
2.7 0.006934 0.0069335 4.876309
2.8 0.00511 0.0051099 5.031666
2.9 0.003731 0.0037312 5.191973
 Wayne W. LaMorte, MD, PhD, MPH
Main Menu Copyright 2006

p-value (test-based)
Expected Under H0
Diseased No Disease p-value function
17.00 33.00 50
17.00 33.00 50
34 66 100 1.00
Confidence Level 0.95
0.90
0.85
0.80
0.75
0.70
0.65
0.60
0.55
0.50
ble Fraction= 0.3529412
0.45
0.40
0.35
0.30
0.25
0.20
0.15
0.10
0.05
0.00
0.01 0.1 1 10
Expected Under H0
Diseased No Disease RR
284.75 - From Rothman: Epidemiology: An Introduction, p. 121:
339.25 - "… significance testing is only a qualitative proposition. The end result is a declaration of 's
significant' that provides no quantitative clue about the size of the effect. [The p value func
624
quantitative visual message about the estimated size of the effect. The message comes in
Confidence Level
to the strngth of the effect and the precision. Strength is conveyed by the location of the c
horizontal axis and precision by the spread of the function around the point estimate. Beca
only one number, it cannot convey two separate quantitative messages."

Cohort CI (Rothman)
Cohort IR (Rothman)
 For p-value function
90% 95% 99%
Lower Bound 1.15
Upper Bound 3.82

RR
2.0909091

SE(ln)
0.3136258

Curve 1 p-value
0.8420501 0.0037312
0.8688774 0.0051099
0.8965595 0.0069335
0.9251235 0.009322
0.9545975 0.0124189
0.9850106 0.0163947
1.0163926 0.0214478
1.0487744 0.0278065
1.0821879 0.0357284
1.1166659 0.0454999
1.1522424 0.0574327
1.1889524 0.0718603
1.2268319 0.0891306
1.2659182 0.1095982
1.3062498 0.133614
1.3478664 0.161513
1.3908088 0.1936006
1.4351194 0.230139
1.4808416 0.2713318
1.5280206 0.3173102
1.5767027 0.36812
1.6269357 0.4237105
1.6787692 0.4839271
1.7322541 0.548506
1.7874429 0.6170749
1.8443901 0.6891563
1.9031515 0.764177
1.9637851 0.8414805
2.0263505 0.9203442
2.0909091 1
2.1575246 0.9203443
2.2262624 0.8414805
2.2971901 0.7641771
2.3703776 0.6891564
2.4458968 0.6170749
2.523822 0.5485061
2.6042299 0.4839271
2.6871995 0.4237106
2.7728125 0.36812
2.8611531 0.3173102
2.9523082 0.2713318
3.0463674 0.230139
3.1434234 0.1936007
3.2435715 0.161513
3.3469103 0.1336141
3.4535414 0.1095982
3.5635697 0.0891306
3.6771035 0.0718603
3.7942544 0.0574327
3.9151377 0.0454999
4.0398723 0.0357285
4.1685808 0.0278065
4.30139 0.0214478
4.4384304 0.0163947
4.5798369 0.0124189
4.7257485 0.009322
4.8763088 0.0069335
5.0316659 0.0051099
5.1919725 0.0037312
 confidence
0.90
0.95
ction 0.99

80%
confidence
90%
confidence
95%
confidence

1 10 100

RR
21:
end result is a declaration of 'significant' or 'not
of the effect. [The p value function]...presents a
effect. The message comes in two parts, relating
nveyed by the location of the curve along the
around the point estimate. Because the p value is
e messages."
 Sample Size Calculations
Part I - Sample Size Calculations for Means
Anticipated Values: Put your anticipated proportions in the blue boxes.
Mean Stan. Dev
Group 1 205 30 The cells in the table below show the estimated number of
subjects needed in each group to demonstrate a statistically
Group 2 200 30
significant differenence at "p" values ranging from 0.10-0.01 and
at varying levels of "power." [Power is the probability of finding a
Difference in means = 2.44 % statistically significant difference, assuming it exists, at a given
"p" value.]

Sample Size Needed in Each Group

alpha level Power
("p" value) 95% 90% 80% 50%
0.10 778 619 446 194 The red cells indicate the two
0.05 936 756 562 274 most commonly used estimates,
0.02 1138 936 720 389 i.e. based on 90% or 80% power
0.01 1282 1073 842 475
=================================================================

Part II - Sample Size Calculations for a Difference in Proportions (frequency)

Anticipated Values: Put your anticipated proportions in the blue boxes.
Proportion with (without)
Group 1 0.4 0.6 The cells in the table below show the estimated number of subjects needed in each g
statistically significant differenence at "p" values ranging from 0.10-0.01 and at varyin
Group 2 0.1 0.9
probability of finding a statistically significant difference, assuming it exists, at a given
Difference in frequency = 75.00 %
Sample Size Needed in Each Group
alpha level Power
("p" value) 95% 90% 80% 50%
0.10 40 32 23 10 The red cells indicate the two
0.05 48 39 29 14 most commonly used estimates,
0.02 58 48 37 20 i.e. using a p-value <0.05 and
0.01 65 55 43 24 either 90 or 80% power.

Using Lisa Sullivan's "Essentials of Biostatistics in Public Health", chapter 8

p1 0.6
p2 0.9
overall p 0.75
Effect Size= 0.69282032

Z(1-a/2) 1.96
Z(1-b) 0.84
n 32.6666667
 Main Menu

Table for (Z1-alpha/2+Z1-beta)squared

beta
alpha 0.05 0.1 0.2 0.5
0.1 10.8 8.6 6.2 2.7
0.05 13 10.5 7.8 3.8
0.02 15.8 13 10 5.4
0.01 17.8 14.9 11.7 6.6

equency)

er of subjects needed in each group to demonstrate a

ng from 0.10-0.01 and at varying levels of "power." [Power is the
e, assuming it exists, at a given "p" value.]

ells indicate the two

monly used estimates,
a p-value <0.05 and
or 80% power.
 Random Number Generator Main Menu
Number of groups= 4

Enter a seed # 7

Assign to Group: 1

random # 0.135125
13
This program usesxe2a random number
52 generator to assign subjects randomly to a group. You
need to specify how
/100many groups
0.52you want in the first blue cell. You then need to “spark” the
random number generator
trunc by entering
1 some number (ANY number) in the 2nd blue cell. Enter
a number and click outside the cell; this will generate a random number and specify to which
group the subject should be assigned, based on how many groups you specified.
 Main Menu

a group. You
to “spark” the
blue cell. Enter
ecify to which
d.
 The Normal Distribution: Mean, Variance, and Standard Deviation
Data set 1:
BMI Many biological characteristics that are measurements follow a Normal distribution fai
22 meaning their frequency distributions are bell-shaped and symmetrical around a mean or av
23 The shape of the bell will vary between tall & skinny for samples with relatively little variabili
23 wide for samples that have a lot of variability. To the right and left in green are two datasets
23 of body mass index (BMI). I can graph the frequency distribution of each dataset by
24
steps: 1) select the block of data; 2) click on "Data" from the tool bar above, and choose "S
24
that it is to be sorted according to the column the data is located in, and select "Ok." 3) With
25
I can easily determine the minimum and maximum values and the frequency of each of valu
25
25
Put these tallies in the smaller table entitled "Counts for Bar Chart". 4) select the 2 column b
25 the "Counts for Bar Chart" and click on the Graph icon from the toolbar above (the miniature
25 vertical bar chart). Indicate a vertical bar chart. Note: If it graphs the BMI and Frequency as
26 entities, you may have to first create the chart as an "XY Scatter" to indicate that they are re
26 convert the chart to a vertical bar. Scroll down to view the graph and for information abo
26 standard deviation, etc.
rom the tool bar above,
26 and then choose "Sort"; 3) I then indicate that it is to be sorted according to the column the data is located in, and s
26
26 Counts for Bar Chart
26 BMI frequency
27 22 1
27 23 3
27 24 2
27 25 5
27 26 7
27 27 9
27 28 6
27 29 5
27 30 3
28 31 1
28 32 1
28 33 1
28
28
10
28
9
29
8
29
7
29
29 6
29 5
30 4
30 3
30 2
31 1
32 0
33 22 23 24 25 26 27 28 29 30 31 32 33
27.00 Mean
 5.77 Variance +/- 1 SD =68%
2.40 Standard Deviation

+/- 2 SD =95%

Variability in the data can be quantified from the variance, which basically calculates the average dist
the mean (the x with the "bar" over it). 2
(x – x)
n -1
Standard deviation is just the square root of the variance, and it is convenient because the mean +
observations, and the mean + 2 SD captures 95% of the observations.
2
(x – x)
n Excel.
Note the functions that are used to calculate variance and SD in -1 Then compare the standard dev
how these affect the shape of the frequency distributions. Data

Using SD versus SEM: A standard deviation from a sample is an estimate of the population SD, e.g. t
weight in the population. The SEM is a measure of the precision of our estimate of the population’s me
will increase as the sample size increases, i.e. the SEM will be narrower with larger samples.

If the purpose is to describe a group of patients, for example, to see if they are typical in their variability
Tables 2& 3 in Gottlieb et al.: N. Engl. J. Med. 1981; 305:1425-31). However, if the purpose is to estima
prevalence of disease, one should use SEM or a confidence interval.
 Wayne W. LaMorte, MD, PhD, MPH
Copyright 2006
Main Menu
Data set 2:
rmal distribution fairly closely, BMI
ical around#DIV/0!
a mean or average value. 23
th relatively little variability to short & 24
green are two datasets that show values 24
tion of each dataset by following these 25
25
r above, and choose "Sort"; 3) i indicate
25
and select "Ok." 3) With the data sorted
25
requency of each of value in the range.
25
4) select the 2 column block of data in 26
lbar above (the miniature, multicolored 26
e BMI and Frequency as two separate 26
o indicate that they are related, and then 26
and for information about mean, 26
26
26
27 Counts for Bar Char
27
27 BMI frequency
27 22 0
27 23 1
27 24 2
27 25 5
27 26 7
27 27 14
27 28 6
27 29 5
27 30 3
27 31 1
27 32 0
28 33 0
28
28 16
28
28 14
28 12
29 10
29
8
29
29 6
29 4
30
2
30
30 0
31 22 23 24 25 26 27 28 29 30 31 32 33
27.05 Mean
 3.02 Variance
+/- 1 SD =68%
1.74 Standard Deviation

+/- 2 SD =95%

culates the average distance between each individual value and

ient because the mean + 1 SD captures 68% of the

ompare the standard deviations for datasets 1 and 2, and see

he population SD, e.g. the degree of variability of body

e of the population’s mean. The precision of this estimate
arger samples.

typical in their variability one should use SD (e.g. see

the purpose is to estimate the mean in a group or the
30 31 32 33
 Direct Standardization (for Adjusted Rates)

Adapted from Dr. Tim Heeren, Boston University School of Public Health, Dept. of Biostatist
For specific strata of a population (e.g. age groups) indicate the number of observed events and the number of people in the s
Indicate the distribution of some standard reference population in column C. [Leave a "1" in column F for extra strata to preven
Distribution of
Reference Number of Number of Proportion
e.g. age Stratum Population Events Subjects or "Rate" SE
<5 1 0.20 200 46000 0.00435 0.00031
5-19 2 0.40 900 23000 0.03913 0.00128
20-44 3 0.40 2000 30000 0.06667 0.00144
45-64 4 0.00 0 1 0.00000 0.00000
65+ 5 0.00 0 1 0.00000 0.00000
6 0.00 0 1 0.00000 0.00000
7 0.00 0 1 0.00000 0.00000
8 0.00 0 1 0.00000 0.00000
Totals 1.00 3100 99005
Crude Rate 0.03131
Standardized Proportion or "Rate" 0.04319
Standard Error 0.00077
95% CI for Standardized Rate 0.04167 0.04470

Suppose you want to compare Florida and Alaska with respect to death rates from cancer. The problem is tha
Example: and Florida and Alaska have different age distributions. However, we can calculate age-adjusted rates by usin
determine what the overall rates for Florida and Alaska would have been if their populations had similar distrib
specific rates observed for each population and calculates a weighted average using the "standard" population
US age distribution in 1988 was used as a standard, but you can use any other standard. Note that the crude
substantially (1,061 per 100,000 vs.391 per 100,000, but Florida has a higher percentage of old people. The s
similar (797 vs. 750 per 100,000).

Distribution of Florida
US Population Number of Number of Proportion
e.g. age Stratum in 1988 Events Subjects or "Rate" SE
<5 1 0.07 2414 850000 0.00284 0.00006 Florida
5-19 2 0.22 1300 2280000 0.00057 0.00002 Age Deaths P
20-44 3 0.40 8732 4410000 0.00198 0.00002 <5 2,414 8
45-64 4 0.19 21190 2600000 0.00815 0.00006 5-19 1,300 2,2
65+ 5 0.12 97350 2200000 0.04425 0.00014 20-44 8,732 4,4
45-64 21,190 2,6
6 0.00 0 1 0.00000 0.00000
>65 97,350 2,2
7 0.00 0 1 0.00000 0.00000 Tot. 130,986 12,34
8 0.00 0 1 0.00000 0.00000
Totals 1.00 130986 12340003 Crude Rate= 130,9
Crude Rate 0.01061
Standardized Proportion or "Rate" 0.00797
Standard Error 0.00002
95% CI for Standardized Rate 0.00793 0.00802

Distribution of Alaska
US Population Number of Number of Proportion
in 1988
Alaska
Stratum Events Subjects or "Rate" SE
Age Deaths Pop
<5 164 60,
5-19 85 130,
20-44 450 240,
45-64 503 80,
>65 870 20,
Tot. 2,072 530,0
 Alaska
Age Deaths Pop
1 0.07 164 60000 0.00273 0.00021 <5 164 60,
2 0.22 85 130000 0.00065 0.00007 5-19 85 130,
3 0.40 450 240000 0.00188 0.00009 20-44 450 240,
4 0.19 503 80000 0.00629 0.00028 45-64 503 80,
5 0.12 870 20000 0.04350 0.00144 >65 870 20,
Tot. 2,072 530,0
6 0.00 0 1 0.00000 0.00000
7 0.00 0 1 0.00000 0.00000 Crude Rate= 2,072/5
8 0.00 0 1 0.00000 0.00000
Totals 1.00 2072 530003
Crude Rate 0.00391
Standardized Proportion or "Rate" 0.00750
Standard Error 0.00019
95% CI for Standardized Rate 0.00714 0.00786
 Main Menu

h, Dept. of Biostatistics
number of people in the stratum in columns E and F.
F for extra strata to prevent calculation error.]

0.00086957 0.00000000
0.01565217 0.00000026
0.02666667 0.00000033
0.00000000 0.00000000
0.00000000 0.00000000
0.00000000 0.00000000
0.00000000 0.00000000
0.00000000 0.00000000
0.04318841 0.00000060

ancer. The problem is that death rates are markedly affected by age,
age-adjusted rates by using a reference or "standard" distribution to
ulations had similar distributions. The calculation uses the age-
g the "standard" populations distribution for weighting. In this case, the
dard. Note that the crude rates for Florida and Alaska differ
ntage of old people. The standardized (age-adjusted) rates are very

0.00019880 0.00000000
Florida % of total Rate per
Age 0.00012544
Deaths 0.00000000
Pop. (Weight) 100,000
<5 0.00079202
2,414 850,000
0.000000007% 284
5-19 0.00154850
1,300 2,280,000 18%
0.00000000 57
20-440.00531000
8,732 4,410,000 36%
0.00000000 198
45-64 21,190 2,600,000 21% 815
0.00000000 0.00000000
>65 97,350 2,200,000 18% 4,425
0.00000000
Tot. 130,986 0.00000000
12,340,000 100%
0.00000000 0.00000000
Crude0.00797476 0.00000000
Rate= 130,986/12,340,000=1,061 per 100,000

Alaska % of total Rate per

Age Deaths Pop. (Weight) 100,000
<5 164 60,000 11% 274
5-19 85 130,000 25% 65
20-44 450 240,000 45% 188
45-64 503 80,000 15% 629
>65 870 20,000 4% 4,350
Tot. 2,072 530,000 100%
 Alaska % of total Rate per
Age Deaths Pop. (Weight) 100,000
<5 0.00019133
164 60,000 0.00000000
11% 274
5-19 0.00014385 0.00000000
85 130,000 25% 65
20-44 450 240,000
0.00075000 45%
0.00000000 188
45-64 503 80,000
0.00119463 15%
0.00000000 629
>65 870 20,000
0.00522000 4%
0.00000003 4,350
Tot. 2,072 530,000 100%
0.00000000 0.00000000
0.00000000
Crude Rate= 0.00000000per 100,000
2,072/530,000=391
0.00000000 0.00000000
0.00749980 0.00000003
 Standardized Incidence Ratios
SIR is useful for evaluating whether the number of observed cancers in a community exceeds
the overall average rate for the entire state.
(Column CxD) Calculation of Standardized Incidence R
State Cancer # People in Expected # Observed #
Rate Community Community Community In order to monitor for unusual increase
e.g. age Stratum (Standard) Strata Cancers Cancers
municipalities, cancer incidence data ar
overall rates of cancer for the entire sta
<20 1 0.00010 74657 7.5 11 'expected' rates for all communities. Th
20-44 2 0.00020 134957 27.0 25 demographics of each municipality in o
45-64 3 0.00050 54463 27.2 30 particular type of cancer. This is then co
65-74 4 0.00150 25136 37.7 40 that were observed in a given town. The
75-84 5 0.00180 17012 30.6 30 expected ) x 100. Thus, if a town's SIR f
85+ 6 0.00100 6337 6.3 8 suggest that the town's breast cancer in
state overall.
7 0.00000 0 0.0
8 0.00000 0 0.0
Totals 312562 136.4 144

Standarized Incidence Ratio (SIR): 106

The SIR is the ratio of the
Lower 95% Confidence Limit: 88 cases divided by the expe
Upper 95% Confidence Limit: 123 ratio is then multiplied X 1

Example:
(Column CxD)
State Cancer # People in Expected # Observed #
Rate Community Community Community
e.g. age Stratum (Standard) Strata Cancers Cancers Age Group Community
<20 1 0.00010 74657 7.5 11 population
20-44 2 0.00020 134957 27.0 25
45-64 3 0.00050 54463 27.2 30 0-19 .0001
65-74 4 0.00150 25136 37.7 40
20-44 .0002
75-84 5 0.00180 17012 30.6 30
85+ 6 0.00100 6337 6.3 8 45-64 .0005
7 0.00000 0 0.0
8 0.00000 0 0.0 65-74 .0015
Totals 312562 136.4 144
75-84 .0018
Standarized Incidence Ratio (SIR): 106 85+ .0010
Lower 95% Confidence Limit: 88
Upper 95% Confidence Limit: 123
 If the observed count is >30, the confidence interval for
Main Menu observed count is calculated using the Poisson distribu
mmunity exceeds to approximate the distribution of the observed counts.

If the observed count is >30, exact confidence limits are

lation of Standardized Incidence Ratios in the MA Cancer Registry calculated using the Poisson function to find the first co
that is significantly less than the observed count.
der to monitor for unusual increases in cancer rates in individual
cipalities, cancer incidence data are tabulated by age group and gender. The
ll rates of cancer for the entire state are computed and used to generated the
cted' rates for all communities. These expected rates are then applied to the Calculation by serial nested if statements
graphics of each municipality in order to compute the 'expected' number of a 120.48 120 120
ular type of cancer. This is then compared to the actual number of cancers gap lower upper Confidence Limits
were observed in a given town. The SIR is the (# ofobserved cancer cases / # 23.5 120.5 167.5 for Observed Count
ted ) x 100. Thus, if a town's SIR for breast cancer were 125, this would obs p value
st that the town's breast cancer incidence was 25% greater than that of the 144 0.522
overall.
143 0.489
142 0.456
141 0.423
140 0.390
139 0.358
The SIR is the ratio of the observed # 138 0.327
cases divided by the expected #. The 137 0.297
ratio is then multiplied X 100. 136 0.269
135 0.242
134 0.216
133 0.192
132 0.169
131 0.148
Community State Rate Expected Cases Observed 130 0.129
population Cases 129 0.112
128 0.096
.0001 74,657 7.47 11 127 0.083
126 0.070
.0002 134,957 26.99 25
125 0.059
.0005 54,463 27.23 30 124 0.050
123 0.041
.0015 25,136 37.70 40 122 0.034
121 0.028
.0018 17,012 30.62 30 120 0.023
.0010 6,337 6.34 8 119 0.018
118 0.015
117 0.012
116 0.009
115 0.007
, the confidence interval for the
d using the Poisson distribution
ion of the observed counts.

, exact confidence limits are

n function to find the first count
n the observed count.

nested if statements
120
Confidence Limits
for Observed Count
 Screening Main Menu
Gold Standard
+ -
Test + 4235 13337 17572 PPV= 0.241
Result - 1755 53563 55318 NPV= 0.968
5990 66900 72890

Sensitivity Specificity
0.707 0.801
 Descriptive Statistics: Mean, Median, Mode, 95% confidence
interval for a mean, Standard Deviation, Standard Error, Range Wayne W. LaMorte, MD, PhD, M
(minimum and maximum) Copyright 2006

N 12 Median 19
Mean 17.83 Mode 17
STD (Stand. Dev.) 4.80 Minimum 7
Std Error 1.39 Maximum 23
T-crititcal 2.12
T-crititcal*std err 2.94

Note:
Note:
CONFIDENCE 2.72 Using the Excel 'CONFIDENCE' function
1.96* Std Error= 2.72 gives same thing as 1.96 x stderr This worksheet is
currently under
Example Data: development.
14
17
22
18
22
17
12
7
20
21
21
23

Confidence interval for a mean = X =/- t critical * SD/sqr

 Wayne W. LaMorte, MD, PhD, MPH
Copyright 2006 Main Menu

Note:

This worksheet is
currently under
development.

n = X =/- t critical * SD/sqrt(n)

 Skewed Distributions Wayne W. LaMorte, MD, PhD, MPH
Main Menu Copyright 2006

Examining the frequency distribution of a data set is an important first step in analysis. It gives an overall picture of the data, a
distribution determines the appropriate statistical analysis. Many statistical tests rely on the assumption that the data are norm
this isn't always the case. Below in the green cells is a data set with hospital length of stay (days) for rwo sets of patients who
surgery. One data set was collected before instituting a new clinical pathway and one set was collected after instituting it.
Question: Was LOS different after
instituting the pathway?

LOS
Before After
3 3
12 1
2 1
1 5
11 1
4 6
2 1 We can rapidly get a feel for what is going on here by creating a frequency
2 5 histogram. The first step is to sort each of the data sets. Begin by selecting the
3 2
"before" values of LOS. Then, from the top toolbar, click on "Data", "Sort" (if you
1 3
get a warning about adjacent data, just indicate you want to continue with the
8 3
2 1
current selection). Also, indicate that there is no "header" row and that you want
3 5
to sort in ascending order. Repeat this procedure for the other data set.
6 2
1 2
13 2
3 3
8 3
10 7
6 3
4 4
12 1
9 3
7 3
1 2
3 2
3 2
2 4
5.07 2.86

Your data should now look like this:

LOS
Before After
1 1
1 1 And you can summarize it by
counting the frequency of each LOS.
 And you can summarize it by
1 1 counting the frequency of each LOS.
1 1
2 1 Summary: Frequency of each LOS
2 1 # of people # of people
2 2 LOS before after
2 2 1 4 6
2 2 2 5 7 9
3 2 3 6 8 8
3 2 4 2 2
7
3 2 5 0 3
6 Mean Mean
3 2 6 2 1 after before
3 3 7 1 1 5
3 3 8 2 0 4
4 3 9 1 0
4 3 10 1 0 3
6 3 11 1 0 2
6 3 12 2 0 1
7 3 13 1 0
0
8 3 14 0 0
1 2 3 4 5 6 7 8 9 10 11
8 4 15 0 0
9 4 total 28 28 Median
10 5
11 5 Note that the data is not normally distributed; it is a skewed distribution. As a
12 5
deviation is large, relative to the mean. In situations were the distribution is qu
12 6
standard deviation are misleading parameters to describe the data, and it is b
13 7
median (half of the observations are above the median and half are below) an
5.07 2.86 Mean
14.74 2.57 Variance
maximum values). Note that in this case one mean is almost twice as large as
3.84 1.60 SD values are the same. Consequently, it is not clear whether institution of the cli
improvement in hospital stay. With skewed data like this, a common mistake
3 3 Median t-test. This is NOT appropriate, because the validity of the t-test relies on the a
are normally distributed.
 Wayne W. LaMorte, MD, PhD, MPH
Copyright 2006

es an overall picture of the data, and the shape of the

assumption that the data are normally distributed, and
days) for rwo sets of patients who had femoral bypass
as collected after instituting it.

by creating a frequency
sets. Begin by selecting the
click on "Data", "Sort" (if you
want to continue with the
ader" row and that you want
r the other data set.
 before
after

4 5 6 7 8 9 10 11 12 13 14 15

s a skewed distribution. As a result the standard

ons were the distribution is quite skewed the mean and
describe the data, and it is better to use simply state the
median and half are below) and the range (minimum &
an is almost twice as large as the other, but the median
r whether institution of the clinical pathway produced an
like this, a common mistake is to compare them using a
dity of the t-test relies on the assumption that the data
 T-Tests
Unpaired T-test
Group 1 Group 2
Consider the values of body mass index for the two groups to
BMI BMI
25 23
represents values in a group that was treated with a regimen
25 26
variability from person to person. Values range from 22-34, a
27 24 two groups.
40
34 32
38 34 Not suprisingly, when I perform an
30 30 unpaired t-test on these data, the 35

25 24 differences are not statistically

28 26 significant (p=0.18).
30
29 22
32 31
27 28 25

28 25
30 27 20

31 30 0.8

29.21 Mean 27.29

3.70 SD 3.65

p-value for unpaired t-test 0.17682508

However, suppose these were not two independen
Paired T-test groups of individuals, but a single group whose
(before) (after) BMIs were measured before and after the 4 month
Subject BMI 1 BMI 2 difference treatment. In other words, the data were "paired" in
1 25 23 -2 the sense that each person acted as their own
2 25 26 1 control. Much of the "variability" that we are dealing
3 27 24 -3 with in the setting of two independent groups is due
4 34 32 -2 to the fact that there is substantial person-to-person
5 38 34 -4 variability to begin with. However, what we are really
interested in is the response to treatment.
6 30 30 0
7 25 24 -1 In this case, it looks like just about all subjects reduc
8 28 26 -2 factor out the person-to-person differences, it looks l
9 29 22 -7 effect.
10 32 31 -1
11 27 28 1 In the unpaired t-test the null hypothesis is that the
12 28 25 -3 t-test the null hypothesis is that the mean differe
13 30 27 -3
14 31 30 -1
Mean difference -1.9
p-value with paired t-test 0.004 In Excel a paired t-test is specified just like an unpaired t-test
except that the last parameter is set to 1.

A paired t-test can be used in two circumstances:

1) When doing a "before and after" comparison in each subject or comparing two treatments in each
2) In matched case-case control studies it is sometimes possible to make comparisons in pairs. [See
case-control study by Herbst et al.: Adenocarcinoma of the vagina: association of maternal stilbesterol
appearance in young women, N. Engl. J. Med 1971; 284:878-883.]

A paired t-test relies on the following assumptions:

A paired t-test can be used in two circumstances:
1) When doing a "before and after" comparison in each subject or comparing two treatments in each
2) In matched case-case control studies it is sometimes possible to make comparisons in pairs. [See
case-control study by Herbst et al.: Adenocarcinoma of the vagina: association of maternal stilbesterol
appearance in young women, N. Engl. J. Med 1971; 284:878-883.]

A paired t-test relies on the following assumptions:

1) The data are quantitative.
2) The differences (e.g. after-before) are normally distributed.
3) The differences are independent of one another.
 Main Menu

ass index for the two groups to the left; group1 was untreated & group 2
at was treated with a regimen of diet and exercise for 4 months. There is
n. Values range from 22-34, and there is considerable overlap between the

40

an
he 35

30

25

20
0.8 1.8

hese were not two independent

40

but a single group whose

before and after the 4 month 35

rds, the data were "paired" in

erson acted as their own
variability" that we are dealing 30

wo independent groups is due

s substantial person-to-person
h. However, what we are really 25

ponse to treatment.

ke just about all subjects reduced their BMI somewhat, and if you
20

0.8 1.8

o-person differences, it looks like the treatment regimen had an

the null hypothesis is that the means are the same, but in a paired
hesis is that the mean difference between the pairs is zero.

specified just like an unpaired t-test,

meter is set to 1.

mparing two treatments in each in a clinical trial.

ake comparisons in pairs. [See the methods section in the
ciation of maternal stilbesterol therapy with tumor
mparing two treatments in each in a clinical trial.
ake comparisons in pairs. [See the methods section in the
ciation of maternal stilbesterol therapy with tumor
 The Unpaired T-Test Main Menu
Wayne W. LaMorte, MD, PhD,
MPH Copyright 2006

Unpaired t-tests (comparing two independent means):

For continuous data one is frequently asking the question "Is the mean different for these two groups?"
hypothesis is that the groups have the same mean. If the sample size is relatively large (>30) this can b
normal distribution. However, authors frequently use a t-test (even with large sample), and this is particu
size is small.

T-tests calculate a "t" statistic that takes into account the difference between the means, the variability in
observations in each group. Based on the "t" statistic and the degrees of freedom (total observations in
look up the probability of observing a difference this great or greater if the null hypothesis were true.

T-tests are based on several assumptions:

1) that the data are reasonably close to being normally distributed
2) that the two samples have similar variance & standard deviation
3) that the observations are independent of each other.

Consider the WBC counts (in thousands) in two groups of patients:

Group 1 Group 2 From a practical point of view Excel provides built in functions tha
4.5 4.2 cell C44 to see the function used for a t-test with equal variance.
5.0 7.2 • the cells where the first groups data is found,
5.3 8.0 • the cells where the second group's data is found,
5.3 3.5
• then whether it is a 2-tailed test or a 1-tailed test, and
6.0 6.3
• finally a "2" to indicate a test for equal variance.
6.0 5.1
7.6 4.6
If the variance is unequal, there is a modified calculations that one
7.7 4.8
the last parameter in the function (compare the formulae in cells C
6.4 2.0 thumb, if one standard deviation is more than twice the other, you
7.2 5.0 variance test.
7.0 5.4
5.6 Note also that the two groups do not have to have the same numb
8.4
8.3 Finally, note that in this case we are estimating the means in each
9.5 are different; consequently, it is appropriate to calculate SEM, whi
15 11 N square root of N.
6.7 5.1 Mean
2.10 2.77 Variance
1.45 1.66 SD
0.37 0.50 SEM (standard error of the mean)
0.02 Two-tailed p-value by t-test for equal variance
0.02 Two-tailed p-value by t-test for unequal variance
The t-test is a "parametric" test, because it relies on the legitimate use of the means and standard deviations, w
the parameters that define normally distributed continuous variables. If the groups you want to compare are cl
skewed (i.e. do not conform to a Normal distribution), you have two options:

1) Sometimes you can "transform" the data, e.g. by taking the log of each observation; if the log
are normally distributed, you can then do a t-test on the transformed data; this is legitimate.

2) You can use a "non-parametric" statistical test.

The t-test is a "parametric" test, because it relies on the legitimate use of the means and standard deviations, w
the parameters that define normally distributed continuous variables. If the groups you want to compare are cl
skewed (i.e. do not conform to a Normal distribution), you have two options:

1) Sometimes you can "transform" the data, e.g. by taking the log of each observation; if the log
are normally distributed, you can then do a t-test on the transformed data; this is legitimate.

2) You can use a "non-parametric" statistical test.

 W. LaMorte, MD, PhD,
Copyright 2006
Age Freq. faile
10-20 1
21-30
erent for these two groups?" In other words, the null 31-40 4
latively large (>30) this can be done using z scores and the 41-50
ge sample), and this is particularly appropriate if the sample 51-60 2
61-70 1

en the means, the variability in the data, and the number of 4.5
eedom (total observations in the two groups minus 2) one can
4
null hypothesis were true.
3.5
3
2.5
2
1.5
1
0.5
0
10-20 21-30 31-40 41-50 5
provides built in functions that make t-tests easy. Click on
a t-test with equal variance. One specifies:
ps data is found, failed ok
roup's data is found, 56 19
37 25
est or a 1-tailed test, and
57 38
for equal variance.
39
modified calculations that one can get by specifying "3" as 35
mpare the formulae in cells C44 & C45). As a rule of 40
more than twice the other, you should use the unequal 66
19
43.6 27.3
have to have the same number of subjects. 227.4 94.3
15.1 9.7
estimating the means in each group to test whether they
opriate to calculate SEM, which is SD divided by the 0.08

eans and standard deviations, which are

ups you want to compare are clearly

og of each observation; if the log values

s legitimate.
eans and standard deviations, which are
ups you want to compare are clearly

og of each observation; if the log values

s legitimate.
 Freq OK
1
1
1

Freq. failed
Freq OK

21-30 31-40 41-50 51-60 61-70

Mean
Variance
SD

Two-tailed p-value; ttest with unequal variance

 Correlation, Linear Regression, and the Line of Best Fit Main Menu
Example "X" "Y"
Weeks Savings Prediction
The "dependent" varia
1 200 50.88679 m= 515.32 savings and the indep
2 850 566.2075 b= -464.43
(X and Y values) are c
3 1300 1081.528 from B3 to C10. The a
4 1500 1596.849 r= 0.942109 several functions that
5 1578 2112.17 r2= 0.89 "m" is calculated in ce
8 3000 3658.132 N=? 8 "=SLOPE(C3:C10,B3:
t- specify where the data
9 3600 4173.453 6.882303
first.
10 5900 4688.774 p-value= 0.000235
The Y-INTERCEPT "b
7000 Excel function "INTER
the data block is spec
Savings

6000
values first. From thes
5000 specify the line of bes
4000
To calculate the correl
3000 relationship one would
2000
"=CORREL(B3:B10,C
Finally, in H7, I square
1000 calculate "r-squared",
0 of the variability in ear
0 2 4 6 8 10 12
Weeks
I used the graphing tool to plot the individual data points (blue diamonds) and
the line of best fit (pink line).
Main Menu

The "dependent" variable (outcome of interest) here is

savings and the independent variable is time. The data
(X and Y values) are contained in the block of cells
from B3 to C10. The analysis is performed using
several functions that are built into Excel. The SLOPE
"m" is calculated in cell H3 using the Excel function
"=SLOPE(C3:C10,B3:B10) " . So basically you need to
specify where the data is, with the "Y" values specified
first.

The Y-INTERCEPT "b" is calculated in H4 from the

Excel function "INTERCEPT(C3:C10,B3:B10); again,
the data block is specified, given the location of the "Y"
values first. From these two parameters, one can now
specify the line of best fit using the form Y=b + mX.

To calculate the correlation coefficient for this

relationship one would use the Excel function
"=CORREL(B3:B10,C3:C10)" which is located in H6.
Finally, in H7, I squared what I got in H6 in order to
calculate "r-squared", which indicates what percentage
of the variability in earnings is explained by time.
In order to perform analysis of variance you must first intall the Excel "Analysis Tool-Pak". Click on "Tools" (above) and then o
Pack" and "Analysis Tool-Pak - VBA"; then click "Ok". After installation, when you click on "Tools," you will see a new selection
Tools menu. When you select "Data Analysis" you will see options for analysis of variance and other procedures.

Analysis of Variance Main Menu

Controls (ANOVA)
Aortoiliac Fem-AK Pop Fem-Distal The columns of data to the left are serum creatinine le
factor analysis of variance can be performed to determ
0.7 1.1 1.5 1.2
differences in the means of these groups.
1.2 1.3 1.1 0.8
1.1 0.9 0.8 0.7 Select the block of data (including column labels) from
0.7 0.7 0.9 0.7 select "Tools", then "Data Analysis", then "Single Facto
1.0 0.8 1.1 8.4 for labels, and specify the Output Range as G12. The
0.5 1.4 0.9 1.8
1.6 0.5 7.0 0.8 The p-value (0.0764) indicates differences in means th
0.8 1.1 1.4 1.0 criterion for statistical significance.
0.6 2.0 0.8 0.7
0.6 0.8 1.1 2.8 Anova: Single Factor
0.6 0.7 0.6 1.5
1.3 1.4 1.2 0.6 SUMMARY
0.5 1.1 0.6 1.3 Groups Count
1.0 1.5 1.2 0.5 Controls 25
1.0 1.0 0.6 1.2 Aortoiliac 25
0.8 0.9 0.8 8.2 Fem-AK Pop 25
0.8 0.9 0.8 0.4 Fem-Distal 25
0.6 0.6 1.3 0.6
0.5 0.9 1.3 1.6
0.9 0.9 1.5 0.5 ANOVA
0.7 1.2 1.5 11.4 Source of Variation SS
0.7 1.2 0.4 0.8 Between Groups 30.3779
0.7 1.3 12.9 0.7 Within Groups 412.2632
0.7 0.4 1.1 0.6
1.1 0.7 8.6 0.9 Total 442.6411
Means: 0.828 1.012 2.040 1.988
ick on "Tools" (above) and then on "Add-Ins" and select "Analysis Tool
ools," you will see a new selection ("Data Analysis") at the bottom of the
nd other procedures.

Wayne W. LaMorte, MD, PhD, MPH

Copyright 2006

to the left are serum creatinine levels among 4 groups of subjects. A one-
riance can be performed to determine whether there are significant
eans of these groups.

ata (including column labels) from B2:E27. Then, from the upper menu,
Data Analysis", then "Single Factor Analysis of Variance". Check the box
fy the Output Range as G12. The result is shown in the box below.

) indicates differences in means that do not quite meet the alpha=0.05

al significance.

Sum Average Variance

20.7 0.828 0.07626667
25.3 1.012 0.1261
51 2.04 8.77333333
49.7 1.988 8.20193333

df MS F P-value F crit
3 10.12597 2.35794221 0.0764786914 2.699393
96 4.294408

99
 S u rv iv a l P ro b a b ility
Survival Curves Main Menu
(Adapted from Kenneth Rothman's "Episheet".)
In the blue cells enter the initial # of subjects at risk (C8), and then the # of events and
losses to follow up for each period.

1.00
0.90
Risk
Initial No. at

No. at Risk
0.80

Cumulative
Surv. Prob.

95% Lower

95% Upper
Follow-up
0.70

Effective

sum q/pL
Survival
Lost to
Events

Bound

Bound
Period

Prob.
0.60

Risk
0.50
0.40
0 100 6 4 98.0 0.0612 0.9388 0.9388 0.8728 0.9716 0.000665 0.30
1 90 6 5 87.5 0.0686 0.9314 0.8744 0.7931 0.9267 0.001507 0.20
2 79 3 2 78.0 0.0385 0.9615 0.8408 0.7535 0.9012 0.002020 0.10
3 74 5 7 70.5 0.0709 0.9291 0.7811 0.6854 0.8540 0.003102 0.00
4 62 4 7 58.5 0.0684 0.9316 0.7277 0.6254 0.8106 0.004357 1 2 3 4
5 51 5 2 50.0 0.1000 0.9000 0.6550 0.5459 0.7498 0.006579 Tim
6 44 3 6 41.0 0.0732 0.9268 0.6070 0.4947 0.7091 0.008505
7 35 0 3 33.5 0.0000 1.0000 0.6070 0.4947 0.7091 0.008505
8 32 7 3 30.5 0.2295 0.7705 0.4677 0.3493 0.5899 0.018271
9 22 5 4 20.0 0.2500 0.7500 0.3508 0.2364 0.4854 0.034938
10 13 6 7 9.5 0.6316 0.3684 0.1292 0.0517 0.2879 0.215389
11 0
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
S u rv iv a l P ro b a b ility

Survival Curve

1.00
0.90 Cumulative Surv.
Effective Size

0.80 Prob.
0.70
95% Lower
0.60
Bound
0.50
0.40 95% Upper
98.0000
0.30 Bound
95.3235
0.20
0.10
93.7696
0.00
90.3081
1 2 3 4 5 6 7 8 9 10 11
85.8686
80.0720 Time Period
76.1161
76.1161
62.2871
52.9724
31.2817
Case-Control Analysis from Ken Rothman's "Episheet.xls" (with permission)
This sheet enables you to perform crude and/or Mantel-Haenszel stratified analysis with up to 12 substrata.
It also computes a MH p-value, testing the null hypothesis OR=1, and it computes a p-value for the chi square test for homogen

Unexposed

Unexposed

Unexposed
Instructions

Exposed

Exposed

Exposed
1. Enter frequencies in the yellow

Total

Total
cells of 2x2 tables; check against
crude table below; CTL-e to clear. Cases 31 14 45 65 12 77
2. Click button to the right to adjust
column width if necessary. Controls 1700 1700 3400 1700 1700 3400
3. The results appear in red. Scroll Total 1731 1714 3445 1765 32 1797
down or right if needed. RR= 2.2143 RR= 5.4167
Cases
Controls
1 Total
0.9 P-value Function
P-value

0.8 Cases
0.7 Controls
0.6 Total
0.5
0.4 Crude Data RRmh = 4.2051
0.3 Cases 96 26 122 90% Conf. Interv. = 2.8496
0.2 Controls 3400 3400 6800 95% Conf. Interv. = 2.6449
0.1 Total 3496 3426 6922 99% Conf. Interv. = 2.2868
0
Crude RR = 3.6923 P-value testing RR = 1: 0.5444
0.1 Relative1Risk 10
P-value for homogeneity: 0.0326

P-value Function Data series

Y X
z valu p-va low/upper bd vert bar
2.9 0 2 0 1 0
2.8 0 2 0 1 1
2.7 0 2 0
2.6 0 2 0
2.5 0 2 0
2.4 0 2 0
2.3 0 2 0
2.2 0 2 0
2.1 0 3 0
2 0 3 0
1.9 0.1 3 0.1
1.8 0.1 3 0.1
1.7 0.1 3 0.1
1.6 0.1 3 0.1
1.5 0.1 3 0.1
1.4 0.2 3 0.2
1.3 0.2 3 0.2
1.2 0.2 3 0.2
1.1 0.3 3 0.3
1 0.3 3 0.3
0.9 0.4 3 0.4
0.8 0.4 3 0.4
0.7 0.5 4 0.5
0.6 1 4 1
0.5 1 4 1
0.4 1 4 1
0.3 1 4 1
0.2 1 4 1
0.1 1 4 1
0 1 4 1
0.1 1 4 1
0.2 1 4 1
0.3 1 5 1
0.4 1 5 1
0.5 1 5 1
0.6 1 5 1
0.7 0.5 5 0.5
0.8 0.4 5 0.4
0.9 0.4 5 0.4
1 0.3 5 0.3
1.1 0.3 5 0.3
1.2 0.2 6 0.2
1.3 0.2 6 0.2
1.4 0.2 6 0.2
1.5 0.1 6 0.1
1.6 0.1 6 0.1
1.7 0.1 6 0.1
1.8 0.1 6 0.1
1.9 0.1 7 0.1
2 0 7 0
2.1 0 7 0
2.2 0 7 0
2.3 0 7 0
2.4 0 7 0
2.5 0 8 0
2.6 0 8 0
2.7 0 8 0
2.8 0 8 0
2.9 0 8 0
chi square test for homogeneity.

Unexposed
Exposed

G=ad/t
table
Total

Total
RR A E V
1 2.214285714
### 22.61103048 11.10600133 15.29753266
2 5.416666667
### 75.62882582 2.54954008 61.49137451
3
4
5
6
7
8
9
10
11
12
Tot ### 98.2398563 13.65554141 76.78890717
2.8496 - 6.2055
2.6449 - 6.6856 MH chi = -0.60612988170105
2.2868 - 7.7326 Var(ln(RRMH)) = 0.055960656159942
0.5444
0.0326
 Q=(b+c)/T
P=(a+d)/T

GQ+HP
H=bc/t

ln(RR)
HQ
GP
6.908563135 0.502467344 0.497532656 7.686510603 11.08234942 3.437235766 0.794929875
11.35225376 0.982192543 0.952698943 60.39636951 69.73286647 10.81528015 1.68948062

18.26081689 1.484659887 1.450231599 68.08288012 80.81521589 14.25251592

612988170105
960656159942
 var(ln(RR))

chisq het
0.104863107 3.922818633
0.099894419 0.641668673

4.564487306
df = 1
Cohort Cumulative Incidence Analysis from Ken Rothman's "Episheet.xls" (with permission)
This sheet enables you to perform crude and/or Mantel-Haenszel stratified analysis with up to 12 substrata.
It also computes a MH p-value, testing the null hypothesis RR=1, and it computes a p-value for the chi square test for homogen

Unexposed

Unexposed
Instructions

Exposed

Exposed

Exposed
1. Enter frequencies in yellow cells

Total

Total
of 2x2 tables; check against crude
table below; CTL-e to clear. Cases 31 14 45 90 15 105
2. Click button to the right to adjust Non-cases 1969 1986 3955 1910 1985 3895
column width if necessary.
3. The results appear in red. Scroll Total 2000 2000 4000 2000 2000 4000
down or right if needed. RR= 2.214285714 RR= 6
References: RD= 0.0085 RD= 0.0375
1. Modern Epidemiol, 3rd Ed., Ch. 15
2. Sato T, Biometrics 1989;45:1323-4 Cases
Non-cases
Total

1 P-value Function

0.9 Cases
P-value

0.8 Non-cases
0.7 Total
0.6
0.5
0.4 Crude Data RRmh = 4.1724
0.3 Cases 121 29 150 90% Conf. Interv. =
0.2 Non-cases 3879 3971 7850 95% Conf. Interv. =
0.1 Total 4000 4000 8000 99% Conf. Interv. =
0
0.1 1 10
Crude RR = 4.1724 P-value testing RR = 1:
Relative Risk Crude RD = 0.0230 P-value for homogeneity:

P-value Function Data series RDmh = 0.0230

Y X 90% Conf. Interv. =
z va p-va low/upper bd vert bar 95% Conf. Interv. =
2.9 0 2 0 1 0 99% Conf. Interv. =
2.8 0 2 0 1 1
2.7 0 2 0 P-value testing RD = 0:
2.6 0 2 0 P-value for homogeneity:
2.5 0 2 0
2.4 0 3 0
2.3 0 3 0
2.2 0 3 0
2.1 0 3 0
2 0 3 0
1.9 0.1 3 0.1
1.8 0.1 3 0.1
1.7 0.1 3 0.1
1.6 0.1 3 0.1
1.5 0.1 3 0.1
1.4 0.2 3 0.2
1.3 0.2 3 0.2
1.2 0.2 3 0.2
1.1 0.3 3 0.3
1 0.3 3 0.3
0.9 0.4 3 0.4
0.8 0.4 4 0.4
0.7 0.5 4 0.5
0.6 1 4 1
0.5 1 4 1
0.4 1 4 1
0.3 1 4 1
0.2 1 4 1
0.1 1 4 1
0 1 4 1
0.1 1 4 1
0.2 1 4 1
0.3 1 4 1
0.4 1 5 1
0.5 1 5 1
0.6 1 5 1
0.7 0.5 5 0.5
0.8 0.4 5 0.4
0.9 0.4 5 0.4
1 0.3 5 0.3
1.1 0.3 5 0.3
1.2 0.2 5 0.2
1.3 0.2 5 0.2
1.4 0.2 6 0.2
1.5 0.1 6 0.1
1.6 0.1 6 0.1
1.7 0.1 6 0.1
1.8 0.1 6 0.1
1.9 0.1 6 0.1
2 0 6 0
2.1 0 6 0
2.2 0 7 0
2.3 0 7 0
2.4 0 7 0
2.5 0 7 0
2.6 0 7 0
2.7 0 7 0
2.8 0 7 0
2.9 0 8 0
 M1N1N0/T^2 - ab/T
e chi square test for homogeneity.

var(ln(RR))
Unexposed

Unexposed
Exposed

ln(RR)
aNo/T

bN1/T
table
Total

Total
RD RR A E V
1 0.009 2.21 31 22.5 11.13 15.5 7 11.1 0.795 0.1027
2 0.038 6 90 52.5 25.57 45 7.5 25.9 1.792 0.0768
3
4
5
6
7
8
9
10
11
12

Tot 121 75 36.69 60.5 14.5 37.1

2.9755 - 5.8508 df =
2.7890 - 6.2421 MH chi = 7.59386681387112
2.4578 - 7.0831 Var(ln(RRMH)) = 0.042238814477059
0.0000

0.0177 Var(RDMH) = 9.13125E-06

0.0180 - 0.0280
0.0171 - 0.0289
0.0152 - 0.0308

0.0000
0.0000
 (aN0 - bN1)/T
RR chisq het

RD chisq het
Sato Qk
Sato Pk

var(RD)
N1N0/T

3.909023 1000 8.5 -4.25 11.1415 1.11E-05 18.932

1.718743 1000 37.5 -18.75 25.9125 2.52E-05 8.3402

5.627766 2000 46 -23 37.054 27.272

1
Cohort Incidence Rate Analysis from Ken Rothman's "Episheet.xls" (with permission)
This sheet enables you to perform crude and/or Mantel-Haenszel stratified analysis with up to 12 substrata.
It also computes a MH p-value, testing the null hypothesis RR=1, and it computes a p-value for the chi square test for homogen

Unexposed

Unexposed
Instructions

Exposed

Exposed

Exposed
1. Enter events and person-time in

Total

Total
yellow cells of tables on the right;
check entries against crude table
below; CTL-e to clear. Cases 32 2 34 104 12 116 206
2. Click button to the right to adjust Person-time 52407 18790 71197 43248 10673 53921 28612
column width if needed. RR= 5.73663823535 RR= 2.138811814 RR=
3. The results appear in red. Scroll RD= 0.00050416586 RD= 0.0012804031 RD=
down or right if needed.
Ref: Mod. Epid. 3rd ed. Ch. 15 Cases 102 31 133
Person-time 5317 1462 6779
RR= 0.90473041431
P-value Function
RD= -0.00202008013
1 Cases
0.9
Person-time
P-value

0.8
0.7
0.6
0.5 Crude Data RRmh = 1.4247
0.4 Cases 630 101 731 90% Conf. Interv. =
0.3 Person-time 142247 39220 181467 95% Conf. Interv. =
0.2
99% Conf. Interv. =
0.1
0 Crude RR = 1.7198 P-value testing RR = 1:
0.1 Relative1 Risk 10 Crude RD = 0.0019 P-value for homogeneity:

P-value Function Data series RDmh = 0.0011439

Y X 90% Conf. Interv. =
z va p-va low/upper bd vert bar 95% Conf. Interv. =
2.9 0 1 0 1 0 99% Conf. Interv. =
2.8 0 1 0 1 1
2.7 0 1 0 P-value testing RD = 0:
2.6 0 1 0 P-value for homogeneity:
2.5 0 1 0
2.4 0 1 0
2.3 0 1 0
2.2 0 1 0
2.1 0 1 0
2 0 1 0
1.9 0.1 1 0.1
1.8 0.1 1 0.1
1.7 0.1 1 0.1
1.6 0.1 1 0.1
1.5 0.1 1 0.1
1.4 0.2 1 0.2
1.3 0.2 1 0.2
1.2 0.2 1 0.2
1.1 0.3 1 0.3
1 0.3 1 0.3
0.9 0.4 1 0.4
0.8 0.4 1 0.4
0.7 0.5 1 0.5
0.6 1 1 1
0.5 1 1 1
0.4 1 1 1
0.3 1 1 1
0.2 1 1 1
0.1 1 1 1
0 1 1 1
0.1 1 1 1
0.2 1 1 1
0.3 1 1 1
0.4 1 1 1
0.5 1 2 1
0.6 1 2 1
0.7 0.5 2 0.5
0.8 0.4 2 0.4
0.9 0.4 2 0.4
1 0.3 2 0.3
1.1 0.3 2 0.3
1.2 0.2 2 0.2
1.3 0.2 2 0.2
1.4 0.2 2 0.2
1.5 0.1 2 0.1
1.6 0.1 2 0.1
1.7 0.1 2 0.1
1.8 0.1 2 0.1
1.9 0.1 2 0.1
2 0 2 0
2.1 0 2 0
2.2 0 2 0
2.3 0 2 0
2.4 0 2 0
2.5 0 2 0
2.6 0 2 0
2.7 0 2 0
2.8 0 2 0
2.9 0 2 0
square test for homogeneity.
Unexposed

Unexposed
Exposed

table
Total

Total
RD RR A E
28 234 186 28 214 1 0.0005041659 5.7366382354 32 25.02686911
5710 34322 12663 2585 15248 2 0.0012804031 2.138811814 104 93.03922405
1.468240099 RR= 1.356059837 3 0.0022960986 1.4682400991 206 195.07045044
0.002296099 RD= 0.003856741 4 0.003856741 1.3560598369 186 177.72048793
5 -0.0020200801 0.9047304143 102 104.31641835
6
7
8
9
10
11
12
Tot 630 595.17344988
1.1944 - 1.6994
1.1547 - 1.7578 MH chi =
1.0810 - 1.8776 Var(ln(RRMH)) =
0.0009
0.0340
Var(RDMH) =

0.0006349 - 0.0016529
0.0005375 - 0.0017504
0.0003472 - 0.0019407

0.0009
0.0000
 M1PT1PT0/T^2

RR chisq
aPT0/T

bPT1/T
G=ad/t

H=bc/t
V
6.6049815381 8.4452996615 1.4721687712 6.6049815381 8.4452996615 1.4721687712 3.6522151216
18.415972224 20.585523266 9.6247473155 18.415972224 20.585523266 9.6247473155 1.7760455491
32.45301183 34.271312861 23.341763301 32.45301183 34.271312861 23.341763301 0.0223562547
30.129030778 31.532660021 23.253147954 30.129030778 31.532660021 23.253147954 0.0593063549
22.497507542 21.997934799 24.314353149 22.497507542 21.997934799 24.314353149 4.9017361112

110.10050391 116.83273061 82.00618049 110.10050391 116.83273061 82.00618049 10.411659392

3.31906534265252
0.011491538987477
df = 4

9.57372904933489E-08
 num of VarRD
PT1PT0/T

RD chisq
WmhRD
13831.025605 6.97313089035 3.3124868945 23.636285138
8560.4106749 10.96077595 11.794298357 0.1157396089
4760.0524445 10.92954956 25.160064332 1.1955071883
2146.7638379 8.27951206716 24.656777197 1.3755452387
1146.6962679 -2.3164183508 23.814780406 0.5527425286

30444.94883 34.8265501168 88.738407186 26.875819702

 Direct Standardization (Birth Defects in Minnesota vs. Illinois)
Suppose a study was conducted in Illinois to investigate the hypothesis that birth defects occurred more often in Illinois as
Example: in this new study the authors thought that the type of water consumed could be related to birth defects. They wanted to a
defects in the two states for water type. Data from the two studies are compared as below.

Distribution of Minnesota
the Combined Number of Number of Proportion
e.g. age Stratum Populations % Events Subjects or "Rate" SE
Well water 1 0.29 0.76 93 3379 0.02752 0.00281
City water 2 0.09 0.20 27 874 0.03089 0.00585
Bottled wa 3 0.62 0.05 5 206 0.02427 0.01072
Totals 1.00 1.00 125 4459
Crude Rate 0.02803
Standardized Proportion or "Rate" 0.02580 Crude RR
Standard Error 0.00674 Adjusted RR
95% CI for Standardized Rate 0.01259 0.03901

Distribution of Illinois
the Combined Number of Number of Proportion
Stratum Populations Events Subjects or "Rate" SE
1 0.29 0.01 2 100 0.02000 0.01400
2 0.09 0.03 6 200 0.03000 0.01206
3 0.62 0.96 145 7293 0.01988 0.00163
Totals 1.00 153 7593
Crude Rate 0.02015
Standardized Proportion or "Rate" 0.02082
Standard Error 0.00430
95% CI for Standardized Rate 0.01238 0.02925
Illinois) Main Menu
d more often in Illinois as compared to Minnesota. However,
defects. They wanted to adjust (standardize) the rates of

0.00794493 0.00000066
0.00275294 0.00000027
0.01510244 0.00004451
0.02580031 0.00004544

1.39
1.24 Suppose that after this publication came out, another study was conducted in Illinois to inv
occurred more often in Illinois as compared to Minnesota. However, in this new study the a
consumed could be related to birth defects. They wanted to adjust (standardize) the rates o
Data from the two studies are compared as below.

Births by state and water type Minnesota Pesticide Appliers Illinois Pesticide Appliers Norm
Water Type (#) (#) rate* (#) (#) rate* Well water only 3379 93 26.8 100 2 ____ City water on
0.00577332 0.00001633 206 5 23.7 7293 145 ____ Total 4456 125 28.0 7593 153 ____ * per 1000 live births a. calcu
0.00267342 0.00000116 specific rates for Illinois. Briefly describe how these two states compare in crude rates of bi
0.01237103 0.00000103 number of live births as a standard, calculate a standardized rate (standardized for water ty
0.02081777 0.00001852 how these standardized rates compare with each other and reasons why they may or may n
nducted in Illinois to investigate the hypothesis that birth defects
r, in this new study the authors thought that the type of water
(standardize) the rates of defects in the two states for water type.

Pesticide Appliers Normal With anomalies Normal With anomalies

100 2 ____ City water only 874 27 30.0 200 6 ____ Bottled water only
1000 live births a. calculate the crude rate and the water-type
pare in crude rates of birth anomalies. (4 pts) b. Using the combined
tandardized for water type) for each of the states. Briefly describe
s why they may or may not agree with the crude rates. (6 pts)
 Binomial Probability Calculator
Enter the # of trials (observations) in A4, the number of "Successes" in B4, and the probability of success
E and F use the Excel function =BINOMDIST to compute the probability of "x" successes and the cumulat

# Trials (n) # 'Successes' (x) Probability (p)

5 1 0.04
esses" in B4, and the probability of success in any one trial in C4. Columns
probability of "x" successes and the cumulative probability.

Probability of x SuccessesCumulative Probability

0.169869312 0.9852420096
 Normal Probability Calculator

Enter the Mean and Std. Dev. for a population and an observed value (X) from the
population. The function returns the probability of values less than the observed value.
This can also be used to interpreted as the "percentile" for the observed value.

Mean Std. Dev. X Cumulative probability

29 6 35 Example 0.841344746068543

Enter your values Err:502

Percentile Value Calculator

Enter the desired probability (percentile), e.g., for 90th percentile enter 0.90. Then
enter the mean and standard deviation for the population. The function will return the
value representing that percentile.

Value at the Desired

Percentile Mean Std. Dev Percentile
0.9 28 7 Example 36.9708609588122

Enter your values Err:502

Poisson Calculator

The Poisson distribution is useful when events typically occur at with an expected average frequency although with some rando
variability about this mean. The Poisson equation lets you compute the probability that events will occur at a specified frequenc
example, suppose you typically get 4 spam emails per day, and you want to compute the probability that tomorrow you will rec
spam emails. Enter 4 as the mean and 5 as "X"; the Poisson probability is 15.6%.

Value at the Desired

m X Percentile
4 5 Example 0.156293451850532

Enter your values Err:502

cy although with some random
ccur at a specified frequency. For
y that tomorrow you will receive 5