Fundamentals of Biostatistics

Statistics and Public Health

Quantitative Methods:

-- Public health investigations use quantitative

methods, which combine the two disciplines of
epidemiology and biostatistics
-- Epidemiology is about the understanding of
disease development and the methods used to
uncover the etiology, progression, and treatment of
the disease
-- Information (data) is collected to investigate a
question and the methods and tools of biostatistics
are used to analyze the data to aid decision making
 Statistics should be used with care:
A Classical Public Health Example
-- Cholera outbreak in London, England, 1840s

-- No one knows the reason

-- Two competing theories (Maisma vs Contagion)

-- John Snow, a doctor in London, looked at the

relation between the districts in London and the
number of deaths from Cholera (652 cases,in 1848)
 Statistics should be used with care:
A Classical Public Health Example
-- His theory was that the worst hit districts would be
those nearest the river Thames into which a lot of
sewage was pumped(John Snow, Contagionist
camp)

-- William Farr, the registrar general, published his

own analysis looking at the relation between
number of deaths to variables, such as, elevation
above sea level, aver. number of people per
household. (belongs to Miasma camp)
 Statistics should be used with care:
A Classical Public Health Example
-- Both used statistics to support their claim

-- William Farr’s superior social status helped

authorities to convinced that air not the water was to
blame for the outbreak

-- Today we know that the Miasma theory was

wrong and water supply was the cause of Cholera
outbreak (data reanalyzed in 2004)
 Statistics should be used with care:
A Classical Public Health Example
-- Statistics are great and essential tool in public
health

-- However, they need careful handling and

interpretation, otherwise you will end up a William
Farr instead of a John Snow

-- UN Millennium Goals (2015) to sustainable

development (2030): from Poverty alleviation to halt
the spread of HIV/AIDS
Role of Statistics in 20th Century Top 10
Public Health Achievements:
1: Routine immunization of children

2: Motor-vehicle Safety

3: Declines in Deaths from Hearth Disease and

Stroke

4: Safer and Healthier Food

5: Recognition of Tobacco as a Health Hazards

Role of Statistics in 20th Century Top 10
Public Health Achievements:
6: Workplace Safety

7: Control of Infectious Diseases

8: Healthier Mothers and Babies

9: Family Planning

10: Fluoridation of Drinking Water

Elementary definitions in Statistics:
• Population: A collection of persons, thing, or
characteristics that we are interested to
investigate
• Sample: A sample is a subset of a population
• Parameter: Population characteristics of
interest
• Statistic: Sample characteristics of interest
Biostatistics Concepts:
 Data
• We may define data as figures. Figures result
from the process of counting or from taking a
measurement.

•For example:
• When a hospital administrator counts the
number of patients (counting).
• When a nurse weighs a patient (measurement)
 manufacturer model displ year cyl cty hwy class

1 audi a4 1.8 1999 4 18 29 compact

2 chevrolet c1500 suburban 2wd 6 2008 8 12 17 suv

3 chevrolet malibu 3.6 2008 6 17 26 midsize

4 ford mustang 4.6 2008 8 15 23 subcompact

5 honda civic 2 2008 4 21 29 subcompact

6 hyundai sonata 2.4 1999 4 18 26 midsize

7 jeep grand cherokee 4wd 3 2008 6 17 22 suv

8 land rover range rover 4 1999 8 11 15 suv

9 lincoln navigator 2wd 5.4 2008 8 12 18 suv

10 mercury mountaineer 4wd 5 1999 8 13 17 suv

11 nissan altima 2.4 1999 4 21 29 compact

12 pontiac grand prix 3.1 1999 6 18 26 midsize

13 subaru forester awd 2.5 1999 4 18 25 suv

14 toyota camry 2.2 1999 4 21 29 midsize

15 toyota corolla 1.8 1999 4 24 30 compact

16 toyota land cruiser wagon 4wd 4.7 1999 8 11 15 suv

17 volkswagen jetta 1.9 1999 4 33 44 compact

 Individuals and Variables
• Dataset: Measurements of all the sampled
individuals on all the variables of interest

• Individuals: Objects that are described by a

set of data. Individuals may be people or
things.

• Variables: Characteristics of individuals of a

data set that we are interested to measure
 * Sources of Data:
We search for suitable data to serve as the raw
material for our investigation.
Such data are available from one or more of the
following sources:

1- Routinely kept records (secondary source)

For example:
- Hospital medical records contain immense
amounts of information on patients.
- Hospital accounting records contain a wealth of
data on the facility’s business activities.
2- External sources (secondary source)
The data needed to answer a question may
already exist in the form of
published reports, commercially available data
banks, or the research literature, i.e. someone
else has already asked the same question.
3- Surveys (primary source)
The source may be a survey, if the data needed is about
answering certain questions.
For example:
If the administrator of a clinic wishes to obtain
information regarding the mode of transportation used
by patients to visit the clinic, then a survey may be
conducted among patients to obtain this information.
4- Experiments (primary source)
Frequently the data needed to answer a question
are available only as the result of an experiment.

For example:
If a nurse wishes to know which of several
strategies is best for maximizing patient
compliance,
she might conduct an experiment in which the
different strategies of motivating compliance
are tried with different patients.
 Types of
variables

Discrete Continuous

A discrete variable A continuous variable

is characterized by gaps or
interruptions in the
values that it can assume.
For example:
- The number of daily
admissions to a general
hospital
- The number of decayed,
missing or filled teeth per
child in an elementary
school.
can assume any value within a specified
relevant interval of values assumed by
the variable.
For example:
- Height
- weight
- skull circumference
No matter how close together the
observed heights of two people, we can
find another person whose height falls
somewhere in between.
 Types of
variables

Quantitative Qualitative

Quantitative Variables Qualitative Variables

It can be measured in the Many characteristics are not
usual sense. capable of being measured. Some
of them can be ordered or ranked.
For example: For example:
- the heights of adult males,
the weights of preschool - classification of people into socio-
children, economic groups,
- the ages of patients seen in - social classes based on income,
a dental clinic. education, etc.
 Levels of Measurement

• Nominal: difference
discrete
qualitative • Ordinal: difference, order

• Interval: difference, order, equivalence

continuous of intervals
quantitative • Ratio: difference, order, equivalence of
intervals, absolute zero
• Categorization (Hypertension vs
normotension, Obese vs Non-obese)