Variables and measurement scales

Kurnia Wahyudi

Department of Public Health

Faculty of Medicine Universitas Padjadjaran
2022 – 2023
Outline

• Variable • Observations
• Introduction • Independent
• Definition • Correlated
• Association between • Exercises
variables
• Coping with confounders
• Measurement scales
• Numeric
• Categorical
• Choosing a measurement
scale
• Measurement approaches
other features
Recommended reference

• Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G.,

& Newman, T. B. (2013). Designing clinical research (4th
ed.). Philadelphia: Lippincott.
• White, S. E. (2020). Basic and clinical biostatistics (5th
ed.). New York: Lange/McGraw-Hill.

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Introduction

• Measurements describe phenomena in terms that can be

analyzed statistically, and the validity of a study depends
on how well the variables designed for the study
represent the phenomena of interest
• Example:
• How well does a handheld glucometer measure blood glucose?
• How well does an insomnia questionnaire detect amount and
quality of sleep?
Introduction
Variable

• A variable is a characteristic of a statistical unit being

observed that may assume more than one of a set of
values to which a numerical measure or a category from
a classification can be assigned.
• Example:
• Height  180cm, 1.75m, 5’9”
• Weight  75kg, 167lbs
• COVID-19 spectrum  asymptomatic, mild, moderate, severe,
critical
• Type of burns  thermal, radiation, chemical, electrical, friction
• Treatment  new or standard
Variable

Suppose we have a research question as follow:

Does vaccination reduce the risk of SARS-CoV-2 reinfection during 2020 –
2022 in Bandung, West Java, Indonesia?
• Vaccination is a variable
• Unvaccinated
• Partially vaccinated
• Fully vaccinated
• Boosted
• SARS-CoV-2 reinfection
• No
• Mild
• Moderate
• Severe
• Critical
Variable

The study case was a resident of Bandung, with laboratory confirmed

SARS-CoV-2 infection reported in the period March 6, 2020 to
December 31, 2020, with confirmed reinfection from January 1, 2021
to January 31, 2022. The study control was a resident of Bandung, with
a laboratory-confirmed SARS-CoV-2 infection reported in the period
March 6 to December 31, 2020 and without laboratory confirmation of
reinfection from January 1, 2021 to January 31, 2022.
Exclusion:
• Age < 18 years
Note: laboratory confirmed SARS-CoV-2 infection, resident of Bandung,
and age < 18 years are not variables.
Association between variables
(scientific/analytic study)
• Independent/predictor variables
• Occurs first or it is more likely on biologic grounds to be causal
• Dependent/outcome variables
• Formal definition of endpoint of a study for each subject
• Should be mentioned clearly in the research question(s)
or objective(s) of the study
Association between variables
(scientific/analytic study)
• Confounders
• Make sure:
• It must be associated with the predictor
• It is also a cause of the outcome
• It must not be in the causal pathway between predictor and
outcome (i.e. the predictor is causally related to the confounder
and the confounder is causally related to the outcome)
• They do not need to be stated in title or research question(s).
• They are not applicable in descriptive studies.
• If they are considered in our study, we have to make sure that
they are observable.
Association between variables
(scientific/analytic study)
• Confounders (continued)
• Findings from previous studies  identify them at design phase
 valid information
• Age and gender are obvious potential confounders practically in
all studies
• Should also include socioeconomic status or place of residence
 proxy measures of more direct but unknown cause of the
outcome
• Should not be assessed by using a statistical test
Association between variables
(scientific/analytic study)
Suppose for the research question:
Does vaccination reduce the risk of SARS-CoV-2 reinfection
during 2020 – 2022 in Bandung, West Java, Indonesia?
considered confounders are:
• Age
• Gender (male vs female)
• Occupation (health care workers vs other)
• Comorbidities (0, 1, 2,  3)
Coping with confounders
• Design phase
• Specification
• Matching
• Opportunistic study design
• Analysis phase
• Stratification
• Statistical adjustment (modelling)
• Propensity scores
Measurement scales

• Choice  information content of the measurement

• Some types of variables are more informative
• Adding power or reducing the sample size requirements
• Revealing more detailed distribution patterns
• Type of measurement scales
• Numeric Variables: continuous and discrete
• Categorical Variables: dichotomous, nominal, and ordinal

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Numeric Variables

• Can be quantified with a number that express how much

or how many
• Frequently displayed in a variety of tables and graphs
(error bar, scatter plot, line graphs, etc.)
• To summarize (depends on distribution of the data):
• Mean and standard deviations
• Median and range/interquantiles range (IQR)
Numeric Variables – Continuous

• Quantify how much on infinite scale

• Limited only by the sensitivity of the measurement tools
• Rich in information
• Example: Body weight and height
Numeric Variables – Discrete

• Quantify how many on a scale with fixed units, usually

integers
• One that has a considerable number of possible values
can resembles continuous variables
• Example: Number of cigarettes/day
Categorical Variables

• Phenomena that are not suitable for quantification are

measured by classifying them into categories
• Type:
• Dichotomous
• Polychotomous
• Nominal
• Ordinal
Categorical Variables – Dichotomous

• Sometimes it is called binary

• Only have two possible categories
• Example: male or female, smoker or non smokers, case or
control, exposed or not exposed, treatment or placebo
• Generally described in terms of counts and proportions
and displayed in contingency tables and bar charts
Categorical Variables – Polychotomous

• Nominal
• Have more than two categories that are not ordered
• Example: blood type
• Generally described in terms of counts and proportions and
displayed in contingency tables, bar charts, and pie charts
Categorical Variables – Polychotomous

• Ordinal
• Have more than two categories that are ordered or a scoring
(with narrow range of values)
• Nominal < ordinal < discrete/continuous (in terms of
information content)
• Example: severity of pain, tumor staging, APGAR score (0 - 10),
GCS (3 - 15), etc.
• To summarize:
• Counts, proportions
• Median and range/interquantile range (IQR)
• To display:
• Contingency table
• Box plot
Measurement scales
Different approach

• Nominal scales (qualitative observations)

• Dichotomous or binary
• More than two categories
• Ordinal scales
• Numerical scales (quantitative observations)
• Continuous
• Discrete
Choosing a Measurement Scale

• With an appropriate measurement scales, we will obtain:

• Appropriate statistical methods for analyzing the data
• Appropriate sample size formula to estimate sample size
• Appropiate displays or presentations
• The process of classification and measurement, if done
well, can increase the objectivity of our knowledge,
reduce bias, and provide a means of communication
Choosing a Measurement Scale

• Numeric over categorical variables whenever possible

• Improve statistical efficiency due to additional information 
more power and/or a smaller sample size
• Example: In a study of predictors of low birth weight babies
should record actual birth weight rather than above or below the
conventional 2,500 g threshold. This leaves the analytic options
open, to change the cutoff that defines low birth weight, or to
develop an ordinal scale with several categories of birth weight
(e.g., >2,500 g, 2,000–2,499 g, 1,500–1,999 g, and <1,500 g)
Choosing a Measurement Scale

• Providing more response categories in an ordinal scales

• The results can later be collapsed into a dichotomy, but not vice
versa
• Example: How satisfied were you with the Introduction to
Clinical Medicine Course?
• Completely satisfied
• Mostly satisfied
• Neither satisfied or dissatisfied
• Mostly dissatisfied
• Completely dissatisfied
Choosing a Measurement Scale

• Discrete numerical ratings for some characteristics that

are difficult to describe with categories or numbers
• Many characteristics, particularly symptoms like pain or aspects
of lifestyle, are difficult to describe with categories or numbers.
• But these phenomena often have important roles in diagnostic
and treatment decisions, and the attempt to measure them is an
essential part of the scientific approach to description and
analysis.
• Example: Short Form (SF)-36, a standardized questionnaire for
assessing quality of life
Measurement Approaches other
Features
• Sensitive enough to detect differences in a characteristic
that are important to the investigator
• Specific or representing only the characteristic of interest
• Appropriate to the objective of the study
• A study of stress as an antecedent to myocardial infarction, for
example, would need to consider which kind of stress (psychological
or physical, acute or chronic) was of interest before setting out the
operational definitions for measuring it
Measurement Approaches other
Features
• Objective
• Should be designed in a way that minimizes subjective
judgments
• Produce a range of values
• A measure of functional status is most useful if it produces
values that range from high in some subjects to low in others.
• A major reason for pretesting is to ensure that the actual
responses do not all cluster around one end of the possible range
of responses
Measurement Approaches other
Features
• They should be broad but parsimonious, serving the
research question at moderate cost in time and money
• There is a tendency to keep adding items that are not central to
the research question but could be of interest.
• It is true that additional measurements increase the likelihood of
interesting findings, including some that were not anticipated at
the outset.
• Collecting too much information is a common error that can tire
subjects, overwhelm the team making the measurements, and
clutter data management and analysis.
Observations

• Independent
• Sometimes called unpaired observation
• Correlated
• Frequently called paired observation
Independent observations

• Knowing the values of the observations in one group tells

us nothing about the observations in the other group
• No statistical test can determine independence
• Best way to ensure  to design and carry out the study
properly
Correlated observations

• Knowing the values of an observations

• at the baseline/first measurement
• one subject in a cluster
• events in one area
• one subject in a matched pairs design
does tells us something about the values
• at the time of the second or more measurements
• of others within the same cluster
• of events in the adjacent area
• of his/her pair
• Tend to be ignored
Let’s discuss examples of variables and
their measurement scales
Variables
Sex (male/female)
Age classification
Income
Overcrowding (2 vs 2)
History of TB contact (Yes/No)
Body mass index (kg/m2)
Type and scale of measurement
Qualitative/categorical, nominal
Qualitative/categorical, ordinal
Qualitative/categorical, ordinal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Quantitative/numerical
Variables Type and scale of measurement
FBG results Qualitative/categorical, ordinal
-Normal
-Impaired
-Diabetes
Glucosuria Qualitative/categorical, nominal
-Yes
-No
The second article
Variables Type and scale of measurement
Sex (male/female) Qualitative/categorical, nominal
Age (years) Quantitative/numerical
History of TB contac (Yes/No) Qualitative/categorical, nominal
Previous treatment for TB (Yes/No) Qualitative/categorical, nominal
Variables
Duration (week)
Cough (Yes/No)
Hemopthysis (Yes/No)
Dyspnea (Yes/No)
Fever (Yes/No)
Night sweats (Yes/No)
Weight loss (Yes/No)
Symptom score >4 ( 4 vs 4)
BMI (kg/m2)
BCG scar present (Yes/No)
Type and scale of measurement
Quantitative/numerical
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Quantitative/numerical
Qualitative/categorical, nominal
Variables Type and scale of measurement
Severity of chest radiograph findings Qualitative/categorical, nominal
-Advanced (Yes/No)
-Cavity present (Yes/No)
Sputum microscopic examination Qualitative/categorical, nominal
result
-Positive (Yes/No)
Sputum culture result Qualitative/categorical, nominal
-Negative and/or contamination
-Positive
INH resistant (Yes/No) Qualitative/categorical, nominal
RIF resistant (Yes/No) Qualitative/categorical, nominal
MDR (Yes/No) Qualitative/categorical, nominal
Laboratory Test Results (all) Quantitative/numerical
Variables Type and scale of measurement
AFB negative (Yes/No) Qualitative/categorical, nominal
AFB positive (Yes/No) Qualitative/categorical, nominal
No sputum available, hospital Qualitative/categorical, nominal
transfer, and/or study default
(Yes/No)
Death (Yes/No) Qualitative/categorical, nominal
Culture result positive (Yes/No) Qualitative/categorical, nominal
Variables
Diabetes (FBG >126 mg/dl)
Study site Bandung (Yes/No)
Sex (male/female)
Age (years)
BMI (kg/m2)
Severe chest radiograph abnormalities
(mild or moderate vs severe)
Non-conversion at week 8 (Yes/No)
Type and scale of measurement
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Qualitative/categorical, nominal
Quantitative/numerical
Quantitative/numerical
Qualitative/categorical, nominal
Qualitative/categorical, nominal