Nature of Biostatistics, Sources and Characteristics Inference

of Data ➢ A conclusion reached on the basis of

evidence and reasoning
Bio – life ➢ An educated guess

Statistics Inferential Biostatistics

• Science dealing with the collection, ➢ Refers to methods involved in making
organization, analysis and interpretation of generalizations and conclusions about a
numerical data target population based on results from a
sample
Statistics
➢ Refers to a set of data or mass of Descriptive Statistics
observation ➢ Concerned with describing the target
➢ Example: population
o Public Health Statistics ➢ Organize and present data in a meaningful
1. Vital Statistics manner
2. Health Statistics ➢ Final results are shown in tables, bars,
a. Hospital and Clinic graphs, charts
Statistics ➢ Describe data already known
b. Service Statistics ➢ Ex: Bar graph of the 10 leading causes of
morbidity in Manila
Public Health Statistics ➢ Ex: Mean age of Filipinos smoking vape
• Quantitative data needed as basis for ➢ Ex: Average BMI of NUCD students in this
planning, monitoring and evaluation of current term
health services
Inferential Statistics
Health Statistics ➢ Makes inferences from the sample and
• Covers data on: generalize them to the whole population
o Morbidity ➢ Compares, test and predicts future outcome
o Hospital and Clinic Statistics ➢ Final result is the probability scores
o Service Statistics ➢ Tries to make conclusion about the
population beyond the data available
Statistics Singular Form ➢ Ex: Probability of Translacion participants
• Refers to body of methods or techniques for adding to the number of COVID cases in the
the organization and analysis of collected Philippines next week
information ➢ Ex: Testing the association between
drinking black coffee to having dental caries
2 Branches of Statistics ➢ Ex: Comparison bet. young children with
1. Descriptive caries and those without caries to school
2. Inferential performance

Descriptive Biostatistics Variation

➢ Refers to the different methods used to ➢ Tendency of a measurable characteristic to
summarize and present data in a form which change from one individual/instant of time
will make them easier to analyse and or one setting to another.
interpret
Biostatistics deals with data which can either be Socio-economic Status
constants or variables • Lower class
• Middle class
Constant • Upper class
➢ Value remains the same from person to
person, time to time or place to place Interval
➢ Ex: Number of seconds in a minute ➢ Zero point is arbitrary
➢ Ex: Value of Pi ➢ Ex: Temperature
➢ Ex: Number of starts in a Big Dipper ➢ O degrees Celsius does not mean absence of
any temperature at all
Variable • 32 degrees Fahrenheit
➢ Value cannot be predicted with certainty • 273.15 degrees Kelvin
➢ Can either be Qualitative or Quantitative
➢ Ex: Signs and symptoms of disease Ratio
➢ Ex: Socio-demographic status in a ➢ Zero point is fixed
population ➢ Example: Weight
➢ O kg or pound will always mean absence of
Qualitative Variable weight.
➢ Uses labels to distinguish one group from
another Quantitative Variable
➢ Categories can be measured and ordered
Types of Qualitative Variable according to quantity of amount
a) Nominal ➢ Can be expressed numerically
b) Ordinal,
c) Interval 2 Types of Quantitative Variable:
d) Ratio 1. Discrete
2. Continuous
Nominal
➢ Variables are classified according to the Discrete
scale of measurement ➢ Assume only integral values or whole
numbers
Normal Vs Abnormal ➢ Example:
Employed Vs Unemployed o Hospital bed capacity
Healthy Vs Unhealthy o Household size

Ordinal Continuous
➢ Variables are ranked or ordered ➢ Assume any value including fractions or
decimals
Ex. Severity of disease: ➢ Example
• Mild, Moderate and Severe o Waist circumference
o Weight
Nutritional Status Underweight Fact:
• Normal • Other variables can be both Quantitative and
• Overweight Qualitative
• Obese • Example:
1. Height
2. Weight
Sources of Data Civil Registration
1. Registries of vital events
General Types of Data Philippine Statistics Office

Primary Data 2. Birth, changes in civil status and death

➢ Collected by the investigator to help him
answer specifically the purposes of his 3. Done on de facto basis (events are registered
study. in the place of occurrence)

Secondary Data Reports of Occurrence of Notifiable Diseases

➢ Derived from already existing sources that
may have other objectives for collecting the
data
Secondary data is more problematic since the user
does not have control over how it was collected, the
objective behind the data collection
• Provide information regarding the morbidity
status of the community
• Reporting done on a weekly basis and
required for the purpose of surveillance and
monitoring
• Examples of notifiable diseases: measles,
typhoid fever, diphtheria

Examples of Data Sources According To Data Type Registers for Certain Diseases Deemed to Be of
Public Health Importance Nationally or Regionally
Primary Data • Ex. Tuberculosis, Cancer, Leprosy, Malaria,
COVID-19
Query
a. Interviews Characteristics of Data
b. Questionnaires
c. Focus group discussions Desired Qualities of Statical Data:

Observation Timeliness
a. Direct observation ➢ Refers to interval between date of
b. With measuring tools occurrence of the different events
considered and time the data is ready to be
Secondary Data used or disseminated

Surveillance data Factor:

a. Census a) number of forms to be filled up by health
b. Registries workers
c. Hospital records b) Transportation problems
d. Insurance records c) Communication problems
e. School records
Accuracy
Census • How close the measurement or the data is to
➢ Complete enumeration of the population its true value
• Best source of population size and • Do the data reflect the true situation?
distribution according to age, sex,
geographic location and other demographic
variables.
Precision
• Not Synonymous to Accuracy
• Refers to extend to which similar
information is obtained when a
measurement is performed or an observation
is made more than once.
• Synonymous to Repeatability, Consistency
of the information collected
Relevance
• Consistency of the data produced with the
needs of the data users.
• Have a well-defined objective for data
collection to attain relevance?
Adequacy
• Do the collected data provide all the basic
information needed to meet the requirements
of the user?
Health Indicators
Indicator
➢ provide a direct estimate of an underlying
condition of interest
➢ Tools which are used to measure objectively
a specific health concept
➢ Usually, numeric measures which help
describe the health of a population
Oral Health
Plaque Index
Criteria for Classifying Debris
1. No debris or stain present
2. Soft debris covering not more than one third
of the tooth surface, or presence of extrinsic
stains without other debris regardless of
surface area covered
3. Soft debris covering more than one third, but
not more than two thirds, of the exposed
tooth surface
4. Soft debris covering more than two thirds of
the exposed tooth surface
Caries Prevalence DMFT/DMFS
DMFT and DMFS describe the amount the
prevalence of dental caries in an individual. DMFT
and DMFS are means to numerically express the
caries prevalence and are obtained by calculating
the number of
• Decayed (D)
• Missing (M)
• Filled (F)
• teeth (T) or surfaces (S)
D+M+F
Community Periodontal Index (CPI)
Three indicators of periodontal status are used for
this assessment:
• gingival bleeding
• calculus
• periodontal pockets
• Healthy
• Bleeding observed, directly or by using
mouth mirror, after probing
• Calculus detected during probing, but all the
black band on the probe visible
• Pocket 4 - 5 mm (gingival margin within the
black band on the probe)
• Pocket 6 mm or more (black band on the
probe not visible)
• X Excluded sextant (less than two teeth
present)
• 9 Not recorded
Uses of Health Students
1. Define public health problems at a specific
point in time
2. Indicate changes over time in the level of
health of an individual or a population
3. Assess extent to which objectives of a
program is being reached
4. Inform, educate and empower people about
health issues.
Computing Health Indicators
Absolute Number
• A simple count of the number of persons,
houses or events being considered.
• Very easy to understand but difficult to
interpret especially when making
comparisons among groups with different
sizes
Ratio
• Result of dividing one number by another
• In the language of indicators, the term
“ratio” is reserved for measures wherein
numerator is not part of the denominator
• numerator is not part of the denominator
Proportion
• Special kind of ratio wherein numerator is
part of the denominator
• Value varies from 0 to 1 and mostly in
decimal form.
• When proportion is multiplied by 100, it is
called a percentage.
• Most indicators in public health are in the
form of proportions
• Numerator is part of denominator
Formula for Rates, Ratios and Proportions
• a = count or number of persons/events being
considered
• b = size of the group to which the number in
the numerator is being related to
• k = factor to make the resulting number
easier to interpret.
• We will use either 100 or 1,000
(crude/specific rates) 3. According to the time covered by the events

Types of Health Indicators
1. According to the aspect of health being
measured
a. Health status indicators
o measures health outcomes and
their risk factors
b. Health service performance indicators
o measure aspects of the
performance of health services or
utilization, accessibility, quality
of health programs.
2. According to the group referred to
a. Crude Rates
o rate describes the total
population, which is used as the
denominator in the computation
b. Specific Rates
o rate describes only a specific sub
group of the total population
being considered; hence the
denominator includes only those
belonging to a specific age, sex,
occupational group
• Point in Time
o events included in the
computation refers only to those
which occurred during the
specific point in time (day)
• Period of Time
o events included in the
computation are those which
occurred over a period of time.
(weeks, months, years)
Conventional Health Status Indicators
Measures of Morbidity
a. Measures of Disease Frequency
o Measures the magnitude of the disease
in a given population
o Incidence vs Prevalence
b. Severity of the Disease (mild, moderate,
severe)
Measures of Mortality Measures of Disease Frequency
Mortality Denominator • Quantify how often a disease or condition occur
Indicator within a given population
Crude Death Total Risk of dying • Also called measures of occurrence
Rate (CDR) Population
Specific Death Population Types of Disease Frequency
Rate size in 1. Prevalence
specific
o measure of existing cases of a
groups of
disease at a point in time
interest
Proportionality Total Measures the 2. Incidence
Mortality number of relative o measures the occurrence of disease
Ratio (PMR) deaths importance of in a population over a period of time
the cause of
death being Step 1: Screening out prevalent cases at baseline
considered in
relation to other
causes
Case Fatality Total Measures the
Rate (CFR) number of virulence or
cases of the killing power of
disease a disease
being
considered

Step 2: Follow-up and re-evaluation to identify

cases that developed during the follow-up period

Types of Populations:

Closed Population
• Aka ‘COHORTS’
• The population gains no new members after
it is established
• Begin with a certain number of members
then shrink over time
• Uniform follow up for every member of the
population
Open Population
• The population add new members through
birth and immigration and lose members
through death and emigration
• Population grows, remain the same size or
shrink depending on the rate of inflow and
outflow of people.
• Varied follow up time

Prevalence Measures
Prevalence
• Quantifies the portion of individuals in a
population who has the disease at a specific
time
• Existing cases of a disease at a specific point
Entire Population at Risk Followed Up Uniformly
For the Specified Time Interval for The
Development of The Disease Is Not Always
Feasible
1. Enter same time but lost to follow up
2. Enter the study at different points over the
study period but common termination point
3. Enter at different points, terminate at
different points

Incidence Rate
• Dynamic Population

Computing for Total Person Time

• If individual person time is known
Incidence Measures
Sum of each individual’s time at risk or time each
• Numerator
person remained under observation and free from
o Measure of new events
disease
o Transition from a non-diseased to a
diseased state
• If individual person time is NOT known
• Denominator
o Any individual included in the • Total Person Time = Average of Population
denominator must have the potential to Size x length of the follow up period
become part of the group that is
counted in the numerator • Average Population Size
(Pop’n start + Pop’n end)/2
Research Research Objectives
• A careful, organized and well-planned
investigation of a problem. General Objectives
• Entails objectivity, critical analysis and • provide the overall direction of the study
logical reasoning • Should be answerable by the end of the
study
Key Features • To determine the effectiveness of nutrition
• Systematic education program for school children.
• Objective
• Reproducible Specific Objectives
• Must be specific enough to guide the
Health Research research planning
• Generation of new knowledge pertaining to • Measurable
health to support better health care delivery • To determine and compare the level of
• Describes health-related problems and/or nutrition knowledge among school children
providing evidence-based solutions before and after the nutrition education
program
Steps in Conducting a Research
1. Problem Identification Formulation of Hypothesis
2. Formulating objectives • Hypothesis is an assertion or proposition
3. Review of Literature about the relationship between two or more
4. Research Design variables.
5. Data Collection • Define problem then formulate hypothesis
6. Data Processing and Analysis
7. Writing of Report Independent Variable
8. Dissemination of Findings • presumed to cause, to affect, influence or
9. Utilization of Result stimulate the outcome

Identifying a Research Problem Dependent Variable

• Interesting • output, outcome or response
• Novel
• Relevant Extraneous Variable
• Feasible • may produce an effect which may be
• Ethical mistaken to be the effect on the dependent
variable
Research Objectives
• Describes what the researcher hopes to
answer through the study
• To determine the relationship between
obesity and hypertension
• What is the relationship between obesity and
hypertension?

2 Types of Research Objectives

1. General Objectives
2. Specific Objectives
Review of Related Literature Final Steps
• Summarizes the present state of knowledge • Writing the research report
and identify gaps and unresolved issues • Disseminating the results
• To know more about previous studies done • Utilization of the results
related to research
• Establish the theoretical and conceptual
framework

Research Design
• Represents the strategy or the plan of attack
of the researcher in answering the research
objectives

Areas of Concern
• Methods of subject selection
• Sample size
• Strategies for the control and manipulation
of relevant variables
• Establishment of criteria to evaluate
outcomes
• Measuring instruments

Data Collection
• Commonly used tools are questionnaire,
interview, and forms
• Researcher may use existing forms or design
new one

Data Processing
• Raw data collected is transformed into
information
• involves coding, encoding and editing of
responses
• Prepares data for analysis

Data Analysis
• Use statistical methods to describe and
interpret data
• Designing plan for data analysis should be
done before data collection
• Involves quantification, description and
classification of data
• A good plan for data analysis involves
dummy tables
Measures of Central Tendency and Dispersion

Ways of presenting large data

a. Narrative
b. Tubular
c. Graphical method

Compressing it for better comprehension and

description by:
• Summarizing figures via measures of central
Mode
tendency and dispersion
• Is the most frequently occurring value in a
set of observation
Measures of Central Tendency
• Can be unimodal, bimodal or multimodal
• Mean, mode and median
• 'typical' values which may be utilized to
represent a series of observations

Mean
• Average
• Sum of the observations over number of
observations

Mean
• Sum of all values
Total number of values

Median
• Middle value (when the data are arranged in
order)

Mode
• Most common value

Median
• Middlemost observation in a set of
observations put in numerical order or in an
array
• If n is odd = middlemost observation
• If n is even = mean of the 2 middle most
observations
Measures of Dispersion/ Variation Standard deviation
• Range, variance, standard deviation • Square root of the variance
• Tools for describing the variability of
observations

Range
• Difference between the highest and lowest
value

Variance
• Measure of variability which takes the mean
as the reference point
• Average of the squared deviations from the
mean

Compute the variance of data

Sample Size for Estimation of Population
Proportion

Sample Size
• Sampling design used
• SRS, Systematic and Stratified Sampling-
same sample size
• Cluster Random sampling will have more
Estimation of Population Proportion
sample size
Where:
• P- population proportion. Value usually
Magnitude of the parameter being estimated
based from past experience or one's
• The rarer the condition being investigated,
knowledge
the larger the necessary sample size
• d- maximum error deemed acceptable by the
research
Variability of the parameter being estimated
• Z- normal deviate
• The more heterogenous the parameter is in
the population, the larger the sample size
needed

Level of precision desired Example: 1

• Usually expressed in terms of the maximum
permissible error that is desired.
• Lower the desired error, the larger the
sample size
Data analysis plan
• Multi variate vs Univariate
• Higher sample size if more independent
variable
• A survey is being planned to determine
proportion of families in a certain area are
medically indigent. It is believed that the
proportion cannot be greater than 0.35. A
95% confidence interval is desired with
d=.05. What is sample size of families to be
selected?
Proportion cannot be greater than 0.35

Margin Error A 95% confidence interval is desired with d= .05

• Level of precision you require. It is the
range in which the value that you are trying
to measure is estimated.
• A narrower margin of error requires lower
sample size.

Confidence Level
• Conveys the amount of certainty associated
with an estimate.
• → It is the chance that the confidence
interval will contain the true value that you
are trying to estimate.
• A higher confidence level requires a higher
sample size
Example: 2
• A survey is being planned to determine
dental clinicians' thoughts on the alternative
clinical training offered by all dental schools
in Metro Manila. It is believed that the
proportion cannot be greater than 0.30.

A 90% confidence interval is desired with d= .10

What is sample size of dental clinicians to be

selected for the study?

• It is believed that the proportion cannot be

greater than 0.30
• A 90% confidence interval is desired with
d= .01
TRUE OR FALSE: Variance is squared of standard
deviation
• True
Arrange the correct sequence in planning a research
from start until the end
1. Identifying the Research Problem
2. Stating the objectives of the study
3. Review of Related Literature
4. Identification of variables, sampling design
to use, number of participants in the study,
tool to use
5. Data collection
6. Data analysis
7. Writing of Report
Statement 1: Target population is a group from
which representative information is desired and to
which inferences will be made
Statement 2: Adequate sample size and feasibility
are the 2 most important features of research design
• Statement 1 is true. Statement 2 is false
Type of sampling wherein every member of the
sample has an equal chance of being selected are
chosen at a compound interval
• Systemic Random
Middlemost observation in a given array
• Median
Get the saliva sample of the first 30 students who
entered the library for your thesis is an example of
what type of NP sampling
• Haphazard
Type of sampling wherein members of the sample
are divided into groups (according to their same
characteristic) then each group are well represented
• Stratified
Caught someone cheating in the exam and then
letting them pinpoint those who where part of the
act is an example of what type of NP sampling
• Snowball
Sum of all observations divided by the total number
of observations
• Mean
Type of sampling wherein members are grouped per
their characteristic and then all members of that
particular group are selected as sample
• Cluster
Choosing the tenants in your building as part of the
sample as you can easily locate them is an example
of what type of NP sampling
• Haphazard
Type of sampling wherein every member of the
sample has an equal chance of being selected and
are chosen via draw lots
• Simple Random
Statement 1: Sampling design must be practical and
economical enough for easy execution
Statement 2: Probability sampling is best to use
when doing analytical/inferential studies
• Both statements are TRUE
Statement 1: Lower margin of error requires less
sample size
Statement 2: Lower confidence level requires higher
sample size
• Both statements are FALSE
Most frequently occurring value in a set of
observation
• Mode