2020-2022

Measures of agreement: the

methods of Bland and Altman
HME 712

2020-2022
Prepared and presented by:
BV Girdler-Brown
©University of Pretoria Faculty of Health Sciences, 2020. All rights reserved

Introduction
Focus on the methods of Bland and Altman
In the previous slide show we covered the logic behind using Kappa statistics to assess agreement when we have
categorical data

We now move on to the logic behind the method of Bland and Altman for when we have numerical data

If we have two sets of measurements of the same variable on the same participants; and the measurements agree

Then on average we would expect the difference between the two measurements to be zero;

And we would expect this to be true across the range of measurements

Bland and Altman suggest we plot the differences against the averages …… and then examine the plot

HME 712 Week 1: 2020

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 2020-2022

A Bland and Altman plot with good agreement

Measures of blood haemoglobin levels in Grams/100 ml
1

COMMENTS:
Difference between the two readings

For the data set that was used to generate this graph,
.5

The mean difference = zero line (dashed)

the mean difference was -0.005 which is almost = zero.

Notice the “zero” line and the line for diff = -0.005 are
0

almost on top of one another

The mean difference = -0.005 line
-.5

This is good because it shows that the readings differ

very little overall and in an unbiased way
-1

As the mean of the two sets gets higher (over 18) the
12 14 16 18 20
Mean differences also seem to get larger
Mean of the two readings

HME 712 Week 1: 2020

A Bland and Altman plot with poor agreement

Measures of blood haemoglobin levels in Grams/100 ml
COMMENTS:
2

This graph shows a number of poor quality issues:

Difference between the two readings

Double-headed arrow indicates the interval of the 95% reference range

1

Difference = zero line (dashed)

The mean difference is now -0.61 which is a large difference
from zero; this shows the two methods used did not agree well
0
-1

The 95% Reference range is the range that would envelop 95%
Average = -0.61 line
of the differences between the two readings.
-2

The range is from -3 to + 1.8 which is a very big range of

-3

Possible differences.
The 95% Reference range is from -3.00 to +1.78
-4

Finally, the differences appear to increase in magnitude as the

12 14 16 18 20
Average readings increase.
Average of the two readings

HME 712 Week 1: 2020

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Thank You