POTENTIAL ERROR IN

EPIDEMIOLOGIC STUDY
EPIDEMIOLOGIC RESEARCH

BIAS
Exposure CONFOUNDING
A CHANCE

Exposure
B

Conclusion
Decision
OBJECTIVES
 Recognize the possible research error
 Understand the difference between
 Random error
 Bias
 Confounding

 Cope with any potential error

 Minimize error  improve accuracy
SCREENING, VALIDITY &
RELIABILITY
“TO ERROR IS HUMAN”

Any epidemiologic study presents many, many

opportunities for error in relation to:

Selection of study participants

Classification and measurement
Comparison and interpretation

We need to consider validity

RESEARCH QUESTION

What is the prevalence of coronary arterial disease

among post-graduate students of UNPAD?

How will you conduct the research?

Design?
Measurement?
Result?
NATURAL HISTORY OF THE DISEASE

Susceptible Subclinical Clinical Recovery condition,

host disease disease disability or death

Point of Onset of
exposure Symptoms
SCREENING PROCESS

Population
Screening

Test -ve Test +ve

Clinical exam
Unaffected Affected

Re-test intervene
EXAMPLES OF SCREENING TESTS
 Questions

 ClinicalExaminations
 Laboratory tests

 Genetic tests

 Radiologic examination
CONCLUSION OF EPIDEMIOLOGIC
RESEARCH
RESULT
Outcome Total
CAD (+) CAD (-)
Screening ECG + a b
ECG - c d
Total

 Will we use this result?

 Can we be sure that (a/a+b) of our patient with ECG(+) will
suffer CAD(+)?
 When will we use this result for caring our patients?
 Validity?
 Reliability?
VALIDITY

The degree to which a measurement

or study reaches a correct
conclusion ~ accuracy
The observed measurements will be
compared with accepted (gold)
standard
VALIDITY OF SCREENING TEST
Key Measures
 Sensitivity

 Specificity

 Positive Predictive Value

 Negative Predictive Value

SENSITIVITY
Outcome Total
CAD (+) CAD (-)
Screening ECG + a b
True Positive False Positive
ECG - c d
False Negative True Negative
Total

 Proportion of individuals who HAVE the disease with

positive screening result
 The ability of the test to identify those WITH disease

Sensitivity = a/a+c
SPECIFICITY
Outcome Total
CAD (+) CAD (-)
Screening ECG + a b
True Positive False Positive
ECG - c d
False Negative True Negative
Total
 Proportion of individual who DO NOT have the disease
with negative screening result
 The ability of the test to identify those WITHOUT
disease

Specificity = d/b+d
PREDICTIVE VALUE
 Measure whether or not an individual, who
got a result of a screening test, actually has
a disease

 Affected by
 Specificity
 Prevalence
 sensitivity
POSITIVE PREDICTIVE VALUE
Outcome Total
CAD (+) CAD (-)
Screening ECG + a b
ECG - c d
Total

 Proportion of individuals whose test is positive and have

the disease

 PPV = a/a+b
NEGATIVE PREDICTIVE VALUE
Outcome Total
CAD (+) CAD (-)
Screening ECG + a b
ECG - c d
Total

 Proportion of individuals whose test is negative and do

not have the disease

 NPV = d/c+d
EXERCISE
Outcome Total
CAD (+) CAD (-)
Screening ECG + 36 15 51
ECG - 14 35 49
Total 50 50 100
 Please calculate:
 Sensitivity
 Specificity
 PositivePredictive Value
 Negative Predictive Value

 Explain the meaning of each measurement

SCREENING (AS ALSO OTHER
EPIDEMIOLOGIC RESEARCH)
WILL NOT BE FREE OF RISK
Especially in a big population, we need a good
validity
VALIDITY WITHIN THE POPULATION

 Internal validity
 The degree to which the observed results of the
study are true
 Inferences are correct regarding the participants in
the study
 Internal validity
VALIDITY
SAMPLE SAMPLE

Selection bias

E+ E-
POPULATION

Measurement &
confounding bias

Chance

Out
External validity come
(generalizability)
CONCLUSION
 External Validity
 Generalizabilityof the result
 Inferences are correct regarding the population
at risk
STUDY VALIDITY
AN APPROACH
The observed results IF:
(conclusion) occurred  the role of chance is
because: small
 Chance
 bias can be reasonably
 Random error
excluded
 Bias
 confounding is
 Systematic error
 Confounding addressed
 Truth THEN
the study is internally
valid
VALIDITY, PERFORMANCE OF
MEASUREMENTS
 Content validity:
 Measurement includes all the dimension
 Construct validity:
 Measurement is related in a coherent way
 Criterion validity:
 Measurement predict a directly observable
phenomenon
RELIABILITY
 Consistency of Measurement
Reproducibility over time
Consistency between different
coders/observers
Consistency among multiple indicators
 Estimates of Reliability
Statisticalcoefficients that tell use how
consistently we measured something
FOUR ASPECTS OF RELIABILITY:
1. Stability
 Consistency across time: repeat measurements
2. Reproducibility
 Consistency between observer
3. Homogeneity
 Consistency between different measures of the same
concept: use different items to get a conclusion of the same
concept
4. Accuracy
 Lack of mistakes in measurement: good concept of
definition and procedures
 Dedicated observers: training, motivation, concentration
RELATIONSHIP OF RELIABILITY TO
VALIDITY

 Reliability is a necessary condition for validity

 If it is not reliable it cannot be valid
 Reliability is NOT a sufficient condition for validity
 If it is reliable it may not necessarily be valid
RELATIONSHIP OF RELIABILITY TO
VALIDITY

Not reliable, nor valid

Reliable AND valid

Reliable BUT NOT Valid