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Palliative Medicine 2001; 15: 69–75
Issues in research
Describing the subjects in a study
RM Pickering Lecturer in Medical Statistics, Medical Statistics Group, University of Southampton
Introduction
Most articles reporting the analysis of data will at
some point use statistics to describe background or
socio-demographic features of the subjects included
in the study. An important reason for doing this is
to give the reader some idea of the extent to which
the findings from a study can be generalized to their
own local situation. Sometimes it is appropriate to
report the findings from a study entirely in descrip-
tive terms as well.
The production of descriptive statistics is a rela-
tively straightforward matter, most statistical pack-
ages produce all the statistics one could possibly
desire, and usually more. Some choice has to be
made concerning the most pertinent statistics to
present in a particular situation, and these then have
to be included in the paper in a manner that is easy
for the reader to assimilate. There may be con-
straints on the amount of space available, and it is
in any case a good idea to make statistical display
as concise as possible.
The purpose of this article is to provide a brief
review of widely used descriptive statistics, and to
give some guidance as to how they may be incor-
porated into text or tables in the context of some
examples from Palliative Medicine.
Address for correspondence: Dr RM Pickering, Medical Statistics
Group, Health Care Research Unit, South Academic Block,
Southampton General Hospital, Tremona Road, Southampton
SO16 6YD, UK. E-mail: rmp@soton.ac.uk
© Arnold 2001
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Describing data
Descriptive statistics aim to give an idea of the vari-
ability seen in a measurement taken across a group
of subjects: another name for this variability is the
distribution of values. A more complete impression
of variability can be conveyed by a graph, but this
takes up considerable space and so key features of
the distribution are presented using only one or two
summary statistics. The two features that are usually
felt to be of most interest are where the centre of
the distribution lies and how spread out it is. The
centre of a distribution is usually given as the mean
or the median, while the spread of the distribution
may be expressed as the standard deviation (SD),
the range or the inter-quartile range (IQR). Defini-
tions and properties of these techniques are given
in standard statistics books.1
Figure 1a shows a typical symmetric distribution
for a quantitative variable. The mean might be used
here to describe where the centre of the distribution
lies and the standard deviation to give an idea of its
spread around the central value. Standard devi-
ations are particularly useful where the distribution
is approximately symmetrical around its mean and
follows a bell-shaped (Normal) distribution, in
which case around 95% of subjects will be included
within the range 2SD below and above the mean.
Another reason for presenting standard deviations
is that they are required in calculations of sample
size, and descriptive statistics for a particular vari-
able may be used from published reports to plan
future studies.
0269–2163(01)PM403OA
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70 RM Pickering
Figure 1 Centre and spread of a distribution
There is an obvious interest in presenting the
minimum and maximum values obtained in a sample,
that is the range of values. In describing the spread
of subjects’ ages, for example, knowing that the
study included people aged between 42 and 83 years
is more immediately helpful than knowing that the
standard deviation of age was 10.8. If data values
have been incorrectly recorded, there may be im-
possibly high or low values and examination of the
range can give the first indication that there are
errors in the data.
When a distribution is skewed (Figure 1b) things
are more complicated. The mean will be overly
influenced by the tail of values to the right, and just
one or two extreme values (or ‘outliers’) may have
the effect of pulling the mean substantially to the
right of what seems visually to be the centre of the
distribution. An alternative is to present the median,
which is defined as having 50% of values falling
above it and 50% below. Figure 1b suggests that the
value for which the curve is at its highest may also
be useful in locating the centre of the distribution,
but in practice this can prove awkward: there may
be no single most frequent value. The median is
often recommended as the preferred statistic for
locating the centre of the distribution when data are
skewed, but sometimes the mean can be more
helpful. If the attribute being displayed takes only
a limited number of values, such as a scale com-
prising a sum of subitems, it can happen that the
majority of subjects take the same value. In such a
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situation the medians of two groups may fall in the
same category even though differences in the tails
of the distribution suggest that, overall, one group
takes higher values than the other. The mean would
be sensitive to such differences in distribution. An-
other example where the mean might be chosen to
locate the centre of a skewed distribution is where
an economic evaluation is planned, for example in
comparing lengths of stay between groups. If unit
cost (assumed equal over days) is applied to a re-
duction in mean length of stay, then cost savings can
be estimated per given number of subjects.
It is also more difficult to decide which measure
of spread to use in the context of a skewed distri-
bution. It is clear from Figure 1b that no single
number can adequately describe the spread of data
around the central value, because there is greater
spread to the right than to the left. One straight-
forward indication of spread that could be used
is the range, the minimum to maximum values
obtained in the study. Another possibility is the
inter-quartile range, or IQR, which covers the cen-
tral 50% of the distribution. One disadvantage of
using the IQR is that it is not as widely known as
other statistics, but many statistical packages now
produce it. Standard deviations may be presented
when variables follow a distribution which is skewed,
and again can form the basis of approximate power
calculations for future studies.
There are statistics that emphasize other aspects
of a distribution, such as the degree of skew, and
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Issues in research 71

these may be presented if they are particularly rele- Table 1 Characteristics of outpatients in three palliative care
vant to the research question. Generally, however, settings in Wales, number (%), unless otherwise stated
(n=36) 3
statistics describing the distribution of quantitative
variables tend to be limited to measures of central Site
tendency and spread. Holme Tower 15 (42%)
Velindre 14 (39%)
Llandough 7 (19%)

Descriptive statistics in text Sex

Male 17 (47%)
Female 19 (53%)
Sometimes only one or two characteristics may be
important, or available, in describing the character- Marital status
Married 26 (72%)
istics of subjects in a study, in which case descriptive Widowed 4 (11%)
statistics can be included in the text, for example: Divorced 3 (8%)
Single 2 (6%)
The sample comprised 33 (52%) men, and 30 (48%) Unknown 1 (3%)
women. Ages ranged from 55 to 80 years, with a mean
age of 71 years. Figure 1 depicts the marital status and Number of children
Figure 2 shows carer status of those in the sample.2 None 4 (11%)
1 6 (17%)
An alternative here would be to include statistics 2–4 15 (41%)
describing the age and gender distributions along >4 5 (14%)
Unknown 6 (17%)
with frequencies for marital and carer status in a
table. Living arrangement
Live alone at home 9 (25%)
Live with family 24 (67%)
Unknown 3 (8%)
Descriptive statistics in tables
Primary cancer
Often there are too many characteristics to be con- Breast cancer 11 (31%)
Prostate cancer 7 (19%)
veniently described in text, or the need to compare Gastrointestinal cancer 4 (11%)
several subgroups of subjects makes a tabular pre- Gynaecological cancer 3 (8%)
sentation more convenient. An example of such a Lung cancer 2 (6%)
Head and neck cancer 2 (6%)
presentation is shown in Table 1, which summarizes Others 6 (16%)
the distribution of six categorical variables and two Missing 1 (3%)
quantitative variables in a sample whose size is stat-
Age (years)
ed in the title to be 36.3 The categorical variables, Mean (SD) 64 (10.81)
so called because they represent a characteristic that Range 42–83
can be one of several types or categories, are best
Months since diagnosis
described by presenting the number (and then per- Mean (SD) 61 (55.7)
centage) for each category. As the categorical vari- Range 2–228
ables are in the majority in Table 1, the title
indicates that numbers (%) are being presented
unless indicated otherwise. It is best to give numbers
first and then percentages, unless the study is very
large, to emphasize the numbers available. For 1, or just the number (%) where a symptom, for
example, only four subjects in the study described example, is present.
in Table 1 had no children, and primarily to state the There are some subjects in the study described in
frequency as a percentage, 11%, gives a false sense Table 1 where information on a categorical variable
of precision (the 95% confidence interval around is unknown, and the authors have treated this as a
the estimated percentage lies from 4% to 26%). category in its own right. Alternatively, the per-
Where a categorical variable represents only two centages could have been calculated only amongst
types it is possible to present either numbers (%) for cases where the information was known, in which
each one, as is done for males and females in Table case the numbers could have been presented over

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72 RM Pickering
the denominator of cases available, for example
4/30 (13%) of subjects with no children. A footnote
to the revised table could have expanded on the
missing information. Particularly where a high per-
centage of cases have unknown values, it may be
best to leave ‘unknown’ as a category in the table,
as done in Table 1.
The two quantitative variables in Table 1 are de-
scribed by mean (SD) and range: the statistics being
presented are indicated in the left-hand column of
the table. Were a table to include the same descrip-
tive statistics for several quantitative variables, then
the statistics being used could be indicated in the
column headings or the title. Different statistics for
each quantitative variable can easily be incorpora-
ted if the table is constructed as Table 1, although
the reader might wonder why this had been done.
If there are subjects who have been excluded from
the calculation of descriptive statistics for a quanti-
tative variable because of missing information, this
can be clarified by including an additional row
under Mean (SD) and Range, labelled ‘n’ which
gives the number of subjects for whom information
is available.
In the distributions described in Table 1, the age
distribution would appear to be symmetrical with its
mean falling close to the centre of its range and its
mean ± 2SD extending close to the limits of the
range, while the distribution of months since diag-
nosis is clearly skewed to the right. Mean months
since diagnosis is much closer to the lower than the
upper extreme of its range, and its mean minus 2SD
extends to negative values. Distributions of lengths
of time often follow this pattern.
A choice arises when describing the distribution
of an ordered variable taking a limited number of
values, such as a scale constructed from subitems or,
for example, number of children in Table 1. Such
variables can be described either in terms of central
value and a measure of spread, or as a categorical
variable, by presenting numbers (%) for frequently
occurring categories and combining categories with
lower frequencies. The latter approach was chosen
for number of children in Table 1. Sometimes this
type of variable may be grouped into only two cate-
gories, if, for example, scores above a particular
value are conventionally accepted as indicating an
‘abnormal’ state. Some scales usually extend from
the minimum to the maximum values that are theo-
retically available even in quite small samples, and
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stating the range alone is not helpful is distin-
guishing between the distributions in different
situations. Alternative ways of describing the dis-
tribution of a variable put different emphases on
the data and will be more or less illuminating in dif-
ferent circumstances.
When scales constructed from subitems are being
described, it is helpful to be able to interpret the
findings in the light of the minimum and maximum
values that the scale can theoretically assume and
the clinical meaning of these extremes. This type of
information often appears in the Methods section
of a paper, where the use of the tool is described,
but it is useful to state the potential range either as
a footnote or along with the name of the scale in any
tables where it appears.
Graphical displays
A picture tells a thousand words – and displaying a
distribution in graphical form rather than by sum-
mary statistics alone does convey a more complete
impression of variability in data. Figure 2 displays
the distribution of Karnofsky status from subjects
entered into a randomized controlled trial. In the
original paper4 Karnofsky status was presented as
number (%) for each value in a table of socio-
demographic and medical characteristics. Figure 2a
displays the same information as a bar chart, from
which a tendency for the distribution to be skewed
to the left is apparent, which was not so obvious
from the original tabular presentation. In Figure 2b
the distribution is shown in the form of a box and
whisker plot. The central horizontal line indicates
the position of the median of the distribution; the
‘box’ covers the IQR, that is the central 50% of the
distribution; while the ‘whiskers’ extend to the mini-
mum and maximum values recorded in the study.
The skew to the left is also apparent in Figure 2b.
Were there any degree of bi-modality (two peaks)
in the distribution, this would be evident from the
bar chart but not from the box and whisker plot.
Displaying a distribution graphically takes up more
space than summary statistics and so is better
reserved for the main findings from a study. In par-
ticular, more space might be devoted to describe a
difference in a primary outcome variable between
two groups than in describing the distribution of
baseline characteristics.
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Issues in research 73

Figure 2 Distribution of Karnofsky status (n = 363) in a randomized controlled trial comparing comprehensive palliative care
to conventional care4

Describing loss of subjects to a study of a study5 comparing methods of assessing symp-

toms, and then details the impact of eligibility cri-
In order to assess the generalizability of results it is teria in reducing the numbers available. Amongst
useful to see how the subjects included in the even- patients entered into the trial there was a further
tual analysis relate to the patient base from which loss of subjects. It is important to recognize that the
they were drawn. The means by which subjects were eligibility criteria resulted in 85/121 (70%) of the
selected is clearly important and should be stated in
the Methods section of a paper. The impact of
eligibility criteria and refusal rates in reducing the Table 2 Study recruitment and attrition rates to a study
number of available cases could usefully be shown, comparing patient and proxy symptom assessments in
advanced cancer patients5
and there may be further loss of subjects during the
study. This can be described in text, as in this excerpt, Frequency
which describes refusal rates to a needs assessment Patient attrition rates
study in chronic obstructive airways disease: Patients consecutively sampled 121
One-hundred-and-fifty-one people with COAD were Patient ineligibility
contacted and asked to take part in the study. Sixty-three Unablea 28
Deceased 4
(42%) individuals agreed to participate and were inter- Other 3
viewed. Five (3%) individuals were too ill to participate Refused 1
and three (2%) had recently died. Eighty (53%) declined
over the telephone or did not respond to the letter.2 Patients entered 85
Patient attrition
Only two types of refusal and recent death were rel- Unablea 9
evant and this was easy to explain in text. When Discharge 5
greater numbers of subjects are lost to the study or Death 4
Not completed in specified time frame 15
the patterns or reasons for loss are more compli- Otherb 3
cated it is easier to assimilate the information if Patients completed 49
shown in tabular format or as a flow chart. Table 2 a
Patient unable to participate due to impaired cognitive func-
starts by stating the total number of patients admit- tioning, language barrier or deterioration in condition.
b
ted to an acute unit during the recruitment period Assessments could not be completed by all three raters (n=3).

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74 RM Pickering

total patient base being entered, and that some
findings relate to only 49/121 (40%). Examining the
reasons stated in Table 2, it would seem likely that
the loss of subjects resulted in analyses being per-
formed on a more favourable subgroup, and this
may typically be the case.
Guidelines concerning the information that
should be included when reporting randomized
controlled trials6 have recommended that the pro-
gress of patients through a trial should be presented
as a flow chart. These charts are so obviously help-
ful that they are being included more widely in an
increasing variety of studies. For example, Figure 3
shows the information contained in Table 2 as a flow
chart. The chart may take up more space than
tabular presentation but it is easier to see at a
glance how subjects are lost. The chart can easily be
adapted to situations in which subjects are lost at
more than two stages or from several sub-groups.
In addition to the complete loss of subjects ex-
pressed by attrition rates, there may be information
on specific variables that is unavailable as, for exam-
ple, shown in Table 1, and this will further reduce
the number of subjects available for analysis in which
these variables feature. This is particularly pro-
blematic where many factors are being controlled
statistically. Although individual factors may only be
missing in a few cases, the numbers mount up so

Figure 3 Study recruitment and attrition rates to a study comparing patient and proxy symptom assessments in advanced
cancer patients5

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12PM403 9/1/01 4:02 pm Page 75
that there may be a substantial reduction in numbers
available when all factors are taken into account. It
may be that several analyses are being reported, all
based on different numbers of cases depending on
which variables are involved. The reader should be
able to establish how many cases each reported
analysis was based on. As with subjects who are
excluded altogether from a study, those for whom
information is unavailable on a sporadic basis often
comprise a less favourable subgroup.
Comparing baseline characteristics
between groups
In reports of randomized trials, tables describing
baseline characteristics in each arm of the trial have
the additional role of demonstrating whether or not
randomization has been successful in producing
similar groups, and thus whether treatment com-
parisons are likely to be confounded by other dif-
ferences. Statistical tests of significance should not
be used to decide whether such differences need to
be taken into account.1 If treatment allocation is
properly randomized we know that any difference
in baseline characteristics must be due to chance,
and that is the only question a significance test is
addressing. The question facing the researcher is
whether or not the magnitude of any difference is
sufficient to confound treatment comparisons, and
this depends on the strength of the relationship
between the characteristic in question and the out-
come, as well as the difference it exhibits between
treatment groups. A statistical test for baseline dif-
ferences does not address this question, and there
may be insufficient numbers available to achieve
significance even when taking a baseline charac-
teristic into account. This may materially alter the
conclusions drawn. It is better to use descriptive
statistics to judge whether there are any clinically
important differences in baseline characteristics,
and if so compare outcome in controlled analyses,
or alternatively make allowance for known prog-
nostic factors irrespective of the differences they
exhibit at baseline. The same issues arise when the
groups being compared are not based on random
allocation, only in this case there are more likely to
be other differences confounding any comparison.
Statistical significance tests are used to address the
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Issues in research 75
primary objective of the study, such as whether or
not an outcome differs depending on a subject
characeristic, or a treatment received, not to estab-
lish whether or not a factor can safely be ignored
when other comparisons are being drawn.
Conclusions
Describing the subjects in a study is the first step in
most papers reporting analysis of data. It is impor-
tant in establishing the generalizablity of research
findings and, in the context of comparative studies,
flags the need for comparisons to be made taking
account of differences between groups. The objec-
tive is to describe the main features of the distri-
bution, while alerting the reader to problematic or
unusual features of the data. Usually the space
available in a paper constrains the presentation of
several alternative statistics for location or spread
and, in any case, too many statistics can confuse
rather than offer further insight. The attrition of
subjects during a study should also be described and
gives a more direct method of relating study subjects
to the patient base from which they were drawn.
References
1 Altman DG. Practical statistics for medical research.
London: Chapman & Hall, 1991.
2 Skilbeck J, Mott L, Page H, Smith D, Hjelmeland-
Ahmedzai S, Clark D. Palliative care in chronic
obstructive airway disease: a needs assessment.
Palliat Med 1998; 12: 245–54.
3 Pratheepawanit N, Salek MS, Finlay IG. The
applicability of quality-of-life assessment in palliative
care: comparing two quality-of-life measures. Palliat
Med 1999; 13: 325–34.
4 Jordhøy MS, Kaasa S, Fayers P, Øvreness T,
Underland G, Ahlner-Elmqvist M. Challenges in
palliative care research; recruitment, attrition and
compliance: experience from a randomized
controlled trial. Palliat Med 1999; 13: 299–310.
5 Nekolaichuk CL, Bruera E, Spachynski K,
MacEachern T, Hanson J, Maguire TO. A
comparison of patient and proxy symptom
assessments in advanced cancer patients. Palliat Med
1999; 13: 311–23.
6 Altman DG. Better reporting of randomised
controlled trials: the CONSORT statement. Br Med J
1996; 313: 570–71.