Biostatistics

Aldrin Riel Tabuyan Boyano, RM, MPH

Biostatistics

Bio- Life, such as the study of life sciences e.g biology, medicine and public health

Statistics- Collection, organization, analysis and interpretation of numerical data.

Application of statistics to biological problems

⮚ Public health
⮚ Medicine
⮚ Ecological and environmental
⮚ Agriculture

Why do we need statistics?

Variation

● Tendency of measurable characteristics to change with respect to person, place and

time.
● E.g. weight, age, height, ect.
● Necessary to analyze variability in order to describe certain characteristics or make valid
conclusions

Uses of statistics

● Data reduction technique

● Objective appraisal and evaluation
● To in the decision making process

Roles of statistics in research

Aids the researcher in:

1. Designing a research project

 2. Processing, organizing, and summarizing research data.
3. Quantifying variability
4. Interpreting results and drawing valid conclusions

Why study statistics?

1. Knowledge of statistics is essential for people gaining into research, management or

graduate study
2. A course in statistics should help one know when, and for why, a statistical should be
consulted

Steps in the paradigm of public health

● Define the problem

● Measure the magnitude
● Understand the key determinants
● Develop intervention/prevention strategies
● Set policy/priorities
● Implement and evaluate

Branches of statistics

1. Descriptive statistics
⮚ Statistical techniques for summarizing and presenting data in a form that will
make them easier to analyze and interpret
⮚ Counts, proportions, tabulates, graphs, summary measures ect.
⮚ Described data
2. Inferential statistics
⮚ Concerned with making estimates, predictions, generalizations and conclusions
about a target population based on information from sample
⮚ Studies a sample of the same data.
a. Estimation
⮚ Estimating prevalence of leptospirosis in the Philippines
b. Hypothesis
⮚ Testing the efficacy of a new drug in reducing the cholesterol levels

Nature of statistical data

1. Expressed numerically
2. Treated as a mass or group of observations
3. Subjected to variation
Constant

● Measurement or phenomenon
● The value that remains the same from person to person, time to time or from place to place
● Mostly from the physical sciences

Variable

● Measurement or characteristics
● The value of which varies from one individual to another or within the same individual at
different periods of time.

Types of variable

Qualitative variables

● Variables whose categories are simple used as labels to distinguish one group from one another
● Numerical representation of the categories are for labelling/coding and not for comparison
(greater or less)
● E.g sex, religion, place of residence, disease status

Phenomenon o variation

The tendency of a measurable characteristics to change

● From one individual/setting to another

● Within the same individual/setting a different periods of time
● Statistics is necessary to analyze variability by studying variables.

Quantitative variables

● Values indicate a quantity or amount and can expressed numerically

● Values can be arranged according to magnitude
● E.g age, height, weight, blood pressure

Variables may be discrete

● Can assume only integral values, or whole numbers

● E.g number of children in the family, number of beds in the hospital

Continuous

● Can attain any value including fractions or decimals

● E.g height and weight
Levels of measurements

1. Nominal
● A classification scale where the categories are used as labels only (does not represent
quantity)
● Number or name which represent a set of mutually exclusive and exhaustive classes to
which individuals or objects (attributes) may be assigned
● E.g sex (male, female), race, blood groups, seatbelts in car, psych diagnosis, patient ID
no.
2. Ordinal
● Same characteristics as the nominal scale
● Additional feature: categories can be ordered or ranked; however the distance between
the two categories cannot be clearly quantified.
● E.g. likert scales, age groups (infant ,child, teenager, adult), psychosocial scales (strongly
disagree, disagree, agree, strongly agree)
3. Interval
● Same characteristics as the ordinal scales
● Additional features: distances between all adjacent classes are equal
● Conceptually, these scales are infinite, in that they have neither beginning nor ending.
● Zero point is arbitrary and does not mean absence of the characteristics.
● E.g temperature;IQ
4. Ratio
● Same characteristics as for ordinal scale
● A meaningful zero point exists
● Ratio of two numbers can be meaningfully computed and interpreted
● E.g weight, blood pressure, height, doctor visits, number of DMF teeth.

Demography

The mathematical and statistical study of the size composition and spatial distribution of
human populations and of changes over time in these aspects though the operation of five
process of:

1. Fertility

2. Morality

3. Migration

4. Marriage
5. Social mobility

Three Foci of demography

1. Population size

2. Composition of the population

3. Distribution of the population

Uses of demography

●To determine the number and distribution of a population in a certain are for planning,
priority starting and for purposes of fund allocation

●To determine growth (or decline) and dispersal of population in the past

●To predict future developments and their possible consequences

Tools of demography

1. Counts

Absolute numbers of a population or any demographic event occurring over a specified

period area and time.

Ex. Population size

Number of children aged at most 14 years old in a barangay--27 children

2. Ratio

A single number that represents the relative size of two numbers

Form: a/b (k)

Where:

a= count

b= count

k= factor size

Example:

In a Dental clinic there are 9 male patients and 11 female patients

Int: There are 9 males for every 11 patients in the clinic.

Early neonatal mortality ratio

●Defined as the number of deaths of infants under 1 week during a year per 1,000 live
births during the same year.

Early neonatal mortality ratio= no: of infant deaths of under 1 week of age among a
population in a year/ number of LBs in the same population in the same year (1,000)

3. Proportion

●Special type of ratio in which the numerator is part of the denominator.

Form: (a/a+B) k

Where:

a = count

b= count

k= factor size

Example

a- 9 male

b- 11 female

K- 100%

Int: There are more female than male in the clinic

4. Rate

●Measures the amount of change (no. of new events) in a given period time

Where

a= count

N= number of participants

t=amount of time

k= factor size
Incidence rate= total number of new cases of a specific disease during a given time/ total
population at risk during the same time period × 100n

Prevalence rate= All new and pre- existing cases of a specific disease during a given time
period/ Total population during the same time period × 10n

Sources of demographic data

1. Census

2. Sample Surveys

3. Registration system

●Vital registration

●Continuing population registers

●Other recording systems

Census

●The total process of collecting, compiling and publishing demographic, economic and
social data pertaining to all persons in a country at specified times.

Frequency: once every 5 or 10 years (most countries including the Philippines). (1995, 2000,
2007, 2010, 2015, 2020)

Subject: all residents of all households and other dwelling units to include military
installations, merchant ships in ports, hospitals, prisons, college dormitories, and other
institutional places of residence.

Information obtained in a Census

1. Geographic

●Region, province, municipality/City, barangay (village)

2. Household or family information

●No. of households, no. of household members

3. Person characteristics

●Sex, age, martial status, place of birth, citizenship, educational attainment

Census disadvantages

●Infrequent, limited and depth of topics/variables

●Subject to response, error due to proxy respondents

●Completeness of coverage suffers in highly, mobile population

●Costly and massive

Sample survey

●Obtaining information from only a subset of the entire population.

Example:

- National Demographic and health Survey

●Provides info in various demographic and maternal and child health issues in the
Philippines

●Technical and financial assistance provided by international agencies

Sample survey

●National nutrition survey

●Labor force survey

●Family income and expenditures survey

Sample survey Advantages

●Administratively easier

●Less time consuming

●Wide range of socio-economic variables/ greater topical flexibility

●Interview situation easier to control

Sample survey Disadvantages

●Estimates for local areas not possible

●Subject to sampling error

●Non- household population excluded

Registration systems

●Vital registration systems

●Continuing population registers

●Other recording system

Vital registration systems

Refer to the continuous recording systems of vital events such as births, stillbirth deaths,
marriage, divorces, annulments and adoptations as they occur in the population.

Examples:

●Birth registration

●Death registration

●Marriage registration

Vital Registration systems advantages

●Good geographical coverage

●Estimates not subject to sampling error

●Frequent updating of indicators possible

●Institutional continuity

Vital Registration systems disadvantages

●Subject to response errors since it rely heavily on the informers

●Limited range and depth of topic

●Inflexible to change in content

●Incompleteness due to reporting problems

Demography

Population size - population composition - population distribution

Population size
 ●Pertains to the frequency count of members in a population

●It is affected by natality, mortality and migration

●Changes in the population can be described using

A. Absolute changes

B. Rate of changes

C. Trends

Population composition

Refers to measurable characteristics of the population

●Age

●Sex

●Marital status

●Occupation

●Religion

Population distribution

Refers to the location of the population in the geographic subdivisions of a given are

●"where do people live? "

Describing the population composition

Sex composition

●Sex ratio

●Sex structure

Age composition

●Median age

●Dependency ratio

Age and sex composition

 ●Population pyramid

Sex composition

1. Sex ratio

Compares the number of males to the number of females

2. Sex structure

Compares the sex ratio across different categories/levels of another characteristics

Ex. Sex structure across urban-rural classification if across different age groups

Age composition

●Median age the wide-most age in a population arranged from youngest to eldest l

●Indicates whether the population is young or old

Examples

●Median age= 16, 50% or half of the population is 16 years or below and the other half is
over 16 years old. Note, increasing median age indicates that the population as a whole is
becoming slightly older.

Age composition

Dependency ratio

●Relates the size of the dependent segment of the population the economically productive
age group of the population

●Interpreted as the number of dependents that need to be supported by every 100 person
in the economically active age groups

Age dependency ratio= number of persons 0-14 y.o + number of persons 65y.o and over/
number of persons 15-65y.o

●Age composition in the year 2010, 61 economically dependent people are supported by
100 economically productive people.

Limitation of age- dependency ratio

●All children below 15 years old and persons 65 years old and over are assumed to be
economically unproductive
 ●All persons 15 years to 64 years old are assumed economically productive

Factors affecting age composition

Fertility level

●Population with high fertility level will consequently be young since the population will be
composed mostly of children peace and order situation

●Immediate postwar are usually followed by a baby boom, thereby causing the population
to become young.

Age composition factors affecting age composition Urban-Rural differences in fertility level

●Urban populations tend to have an older age composition than in rural areas

Cultural practices

●Age at marriage

●Age pattern of childbearing

Types of population Pyramid

Stage 1- expanding

Stage 2- expanding

Stage 3- stationary

Stage 4- contracting

Types of popolution pyramid

Type 1

●Broad base and slightly sloping sides typical countries with high rates of the birth and
death

●Population is characterized as having low median age and high dependency ratio

Type 2

●Broader than type 1, sides bow much more sharply

●Typical of countries that are beginning to grow rapidly because of marked reduction in
infant and child mortality, but are not yet reducing their fertility
 ●Repidly increasing population, the median age decreaseing

Type 3

●Beehive form

●Typical of countries with levels of birth and death rates found in Western European
countries low birth rate, median age is the highest and dependency ratio is lowest.

●The dependents are mostly elderly

Type 4

●Bell- shaped, transitional type of pyramid represents population which after 100 years of
declining birth and death rate, has reversed the trend in fertility while maintaining the death
rate at low levels.

Type 5

●Pentagon-like form

Represents population which is experiencing a marked decline in fertility population is

characterized by usually low death rate and has reduced its birth rate very rapidly

Consequences of age and sex structures

Basic services

●Young population--food and education

●Old population--medical care and social service

Death rate

●Young population--lower crude rate and patterns of migration

●Young adults are more mobile than middle - aged and elderly persons

●Power structure old population--more Conservative

Other population characteristics

●Life expectancy at birth

●Average numbers if years an infant is expected to live under the mortality conditions foe
given year marital status
 ●Religious composition educational attainment

●Various economic characteristics

●Occupation

●Income

Population distribution

1. Rural- urban distribution - distribution of the population according to place of residence

classified into rural and urban areas

2. Population density--measures the average number of persons per unit area or space

3. Crowding index- more specific measure density

Example: crowding index of a household--total number of persons in the household divided

by the number of rooms in the house

Comparison of incidence measures

Incidence density rate

●Frequency with which new events occur in a population

●Reported as number of events per 100000 persons per year

●Answers the question "how frequently a disease occurs in a population?"

Incidence proportion

●Proportion of individuals who become diseased during a specified period of time

●Ranges from 0-1.0

●Answers the question "what is the risk that an individual will develop over given a time
interval?"

Prevalence

●Proportions of persons in a population who have a health-related event of interest at a

point in time or over a specified period of time

●The numerator includes both old and new cases of a health-related event

●Direct proportional to (1) incidence of disease, and (2) duration of the disease or survival
Prevalence= all old (or pre-existing) and new cases of a disease in a defined population during
a given time period/ population during the same time period× 10n

Types

Point prevalence

●Proportion of persons with a particular disease or attribute at a point in time (i.e day)

●Period prevalence proportion of persons with a particular disease or attribute at any time
during a specified interval.

Prevelence of a disease= All new and pre-existing cases during a given time period/
population during the same time period × 10n

Prevalence of an attribute= persons having a particular attribute during a given time period/
population during the same time period ×10n

Prevalence

Properties

●Prevalence is based on both the incidence and duration (continued)

●How do you interpret a low prevalence of a disease?

-low incidence (or risk) of disease

-rapidly fatal disease process

-rapid racovery from the disease any combination of the above

●Prevalence is often measured for chronic diseases which have long duration and dates of
onset that are difficult to ascertain.