BIOSTATISTICS

DR SHAKIL , MD RESIDENT NEUROLOGY BSMMU

FCPS PART 2 INTERNAL MEDICINE
BIOSTATISTICS

• Application of statistics to solve problem in biological science , health ,

medicine.

Example : Age related cancer incidence.

Research

• Scientific and systemic search for knowledge to solve problem /

answer question .

Type
a) descriptive / analytic
b) qualitative/ quantitative

SO, WHAT IS PROBLEM?

EXPECTATION / REALITY
VARIABLE / DATA
• VARIABLE - which varies.
- age, hair color , hair style , mood

DATA -
- what is your age?
- hair color?
- hair style?
Classification of variable based on relationship

1. Independent
2. Dependent
3. Intervening
4. Confounding
INDEPENDENT VARIABLE: Dependent variable

-influence dependent variable. - influenced by independent variable

- cause , input , exposure . - effect / output

SMOKING - LUNG CANCER

OBESITY - MI
INTERVENING
VARIABLE
• Variable through which independent variable influence dependent
variable.

FAT - ATHEROSCLEROSIS - MI

SALT - HYPERTENTION - STROKE

CONFOUNDING
VARIABLE
• Variable that distort the relationship between independent and dependent variable
• Being independently associated with both.

DM - DEMENTIA FAT - MI
OLD AGE HTN
 Classification of variable / data based on character
Quantitative / numerical
1.Varies in amount
2.Can be measured
3.Got scale of measurement
4.Obtaining by counting.
Type a) fixed / discrete
b)continuous
Qualitative / categorical
1.Categories are simply used to distinguish one
from another. Male / female hindu /
muslim
2.No magnitude
3.No scale of measurement .
4.May take numerical value which size is not
meaningful.( NID)
Type a) nominal
b) ordinal
 Quantitative / Numerical data
Continuous Discrete / fixed
• Expressed in fraction / range • Can not be expressed in fraction.
- height / weight / BP - family member / patient number .
Qualitative / categorical data
NOMINAL ORDINAL
Can not be expressed in order. Expressed in order

Male / female Pain – mild moderate severe

Black / white skin Income – good avg poor
Brown / blue eye
Previous question

• MI ST elevation in mm ? Quali / quanti

• BMDC reg number - quali / quantitative

Scale of measurement
SCALE ARYTHMETIC FEATURE EXAMPLES
ASPECTS

Nominal counting Categorize Religion

ordinal Counting Categorize Economical status
ranking ranking

Interval Counting + Temperature

Ranking Highest and lowest value
Addition Interval size is known and constant.
substraction Scale starts with arbitrary zero.
Measure either side of zero.

Ratio Counting + Height

Ranking Measures on one side of zero only. Weight .
Addition This is absolute zero.
Substraction
Multiplication
Division
Question
1. Temperature
2. Religion
Source of DATA
1. Experiment ( lab / hospital ward)
2. Survey
3. Record (register / book)
 STUDY DESIGN

• Scientific and ethical way of search valid and reliable information.

• Valid
• Reliable
Type of study design
1. Observational study 2. Experimental study
DESCRIPTIVE ANALYTIC
-clinical trial
- RCT ( randomized clinical trial)
1.Case study 1.Case control. - community interventional trial
- quasi experimental trial
2.Case series . 2.Cohort study

3.Cross sectional study 3.Cross sectional

EXAMPLE

PROSPECTIVE RETROSPECTIVE
Question
1. RCT
2. CASE CONTROL
3. COHORT
4. CASE SERIES
Concept of cross sectional and longitudinal study
Cross sectional Longitudinal study ( case control / cohort )

No follow up . Follow up

Example Example

1. Cause of jam 1. 50 smoker – follow up – lung cancer.

2. Arrange marriage. 2. Affair marriage
3. 50 obese patient – history of MI shahbag 3. 50 obese pt of shahbag – follow up – MI

CHARACTER

1.Prevalence (number of dengue case in 2019) 1.Incidence ( number of new case admitting in hospital)
2.Quick and inexpensive
3.No temporal relationship (cause – effect)
4.Prone to bias
5.Not good for rare diseases
Case control
1. Retrospective study

2. Example : 50 diarhoea (case) patient and 50 non diarrhoea(control) h person

- cause of diarrhoea

3.Appropriate for rare disease study ----- study of covid patient in china at the beginning.

4.Study from effect to cause./ temporal relation

5.Relatively quick result/ inexpensive.
6.Biasness less.( but patient may hide information – exposure history/foreign travel history in fever
pt )

Steps - case and control selection / matching / exposure measurement /analysis and interpretation
Cohort study
1. Prospective study.
2. Best – cause to effect
Example – exposed and unexposed group
smoker / non smoker – regular follow up – lung ca

4.Chance of drop out – died/lost

5.Lengthy so chance of missing follow up.
6.Time consuming / expensive.

It is done to test a precisely formulated hypothesis

QUESTION
• 3 DEFERENCE BETWEEN CASE CONTROLL AND COHORT STUDY
Randomised clinical trial

• Single blind study - participant blind

• Double blind study – participant and assessor blind
• Triple blind study - participant ,assessor and researcher blind

Reliable / valid Informed consent

Sometimes expensive
Ensure temporality Ethical constraints.
Non compliants

Example : diarrhoea patient – no antibiotic / azithromycin

Population / target population / sampling population/sampling unit/frame
Types of sampling
Probability / random /representative
sampling
1. Simple random sampling
2. Systematic random sampling
3. Cluster sampling
4. Multi staged sampling
5. Multi phased sampling.
4000 doctor among 1lack doc to
measure bp - random
Non probability / nonrandom /non
representative
1. Convenient sampling
2. Purposive / judgement sampling
3. Quota sampling
4. Snowball sampling
Or nonrandom .
QUESTION
• PROBILITY sampling example
Simple random sampling
• Raffle draw.
Systematic random sampling

Example : presence of HTN among 250 people in a outdoor .

3rd patient(random) – 23rd -43rd -63rd – continue
Stratified random

• 100 student
• U need 5 male stu and 5 female stu
• Make 2 group – one male , one female
• Then randomly select
Cluster sampling

• Example – health of garments worker .

• U visit 10 factory.(cluster)
• Examine 100 worker (population)
Multi staged sampling

• Example : percentage of tin shaded house in Bangladesh

Multiphase sampling

• Example : number of TB patient in shahbag

Convenient sampling

• Example – microcredit
Quota sampling
• Covid research – 2 doctor / 2 nurse / 2 imam
Snowball sampling
Example – health status about iaba abuser
Measures of location
• Central tendency – mean / median / mode
• Percentile / decile / quartile
Mean
Mode
Percentile / decile / quartile
Measures of dispersion
• Range
• Mean deviation
• Standard deviation
• Variance
• Co efficient of variance
Question
• Name the measures of dispersion
Mean deviation
 Standard deviation

• More acceptable.

• Negative sign is not ignored

( mean deviation ,neg sign is
ignored).
Character of normal curve

1. Bell shaped. 1. Mean +- 1 SD = 68% Coverage

2. Mean , median , mode lie centrally 2. Mean +- 2SD = 95% Coverage
3. Symmetrical 3. Mean +- 3SD = 99% Coverage
4. It has two inflation.
5. 50% value above and 50% value below the mean
6. Maximum value lie in the middle
Ques
• Normal curve
Data presentation

GRAPH – Quantitative data DIAGRAM – Qualitative data

1.HISTOGRAM 1.BAR DIAGRAM
- simple / compound /multiple

2.FREQUENCY POLYGON 2.PIE DIAGRAM

3.FREQUENCY CURVE 3.PICTOGRAM
NORMAL DISTRIBUTION CURVE

4.SCATTER / DOT DIAGRAM 4.MAP DIAGRAM

5. LINE CHART / GRAPH
GRAPH DIAGRAM
1.Need a graph paper . 1. Need a plain paper.

2.Very much used by statistician 2. Not so .

3.Less attractive. 3. More attractive.

4. For frequency distribution graph 4. Less appropriate .

is appropriate more.
Histogram - tuberculin reaction in mm/frequency
Scatter diagram
Simple bar diagram
Multiple bar diagram
Pie diagram
Pictogram
Map diagram
Hypothesis : statement of belief about the population parameter.

NULL HYPOTHESIS ALTERNATIVE HYPOTHESIS

1. No deference between two sample. 1. deference between two sample.

2. No difference between experimental value 2. difference between experimental value and

and control value. control value.
3. It nullifies the claim that – experimental 3. NULL hypothesis is rejected.
result is different from control value.

• Example – omeprazole /esomeprazole.

• More p value – possibility of NULL hypothesis more.
• Less p value – possibility of alternative hypothesis more.
Probability
• Measure of chance of occurance of an even by chance.
• Quantitative estimate of probability.
• 0 to 1
• P = 0 , means no chance of an event to occur. Exm – survival after
rabies.
• P =1 , 100 % chance of an event to occur. Exm – death of human.
• Probability less – less sampling error – significant result
• Probability more – sampling error more – result is not significant.

• Probability of ocurance of incorrect result

• P < 0.05
• P < 0.01
• P < 0.001
Sampling error

TYPE 1(ALFA) ERROR/ TYPE 2 ( BETA) ERROR/

FALSE POSITIVE FALSE NEGATIVE

1. Incorrect rejection of NULL 1. Incorrect acceptance of NULL

hypothesis. hypothesis.

2. Missing no significant deference. 2. Missing significant deference.

3. Equivalent to false positive. 3. Equivalent to false negative.
False positive / false negative
Specificity / sensitivity
 Test of significance =to find out P value.
- To accept or reject NULL hypothesis.
PARAMETRIC / QUANTITIVE NON PARAMETRIC / QUALITATIVE

1. Population are normally distributed. 1.Data are asymmetrically distributed.

2. Data to be numerical measured on interval or ratio scale. 2.When data is qualitative . measured in ordinal/rank scale.

EXAMPLE Example
1. Chi – square / X2 test
3. Student T test 2. Fisher exact probability test
4. Proportion Z test 3. Man whitney U test
5. F test / fishers test/ ANOVA 4. Wilcoxon rank sum test
6. r test / pearson correlation test 5. Proportion Z test
6. Kruskal Wallis test/Mc Nemar test/ logistic regression
7. Friedman test / spearman rank correlation
T Test = to find out the significance of difference between two means
1. Parametric test
2. For quantitative data
3. Random sample
4. Sample size less than 30
5. Variable must be normally distributed
Z test = difference between two proportion .
• Quantitative / numerical data
• randomly selected
• Sample size should be large. >60 = definite
• Normally distributed variable
• Exm – 80% success / 20 percent failed.
Chi – Squared test
1. Non parametric test
2. For qualitative / discrete data.
3. No mean median mode
4. To measure relationship between two qualitative variable.
5. Example – smoking / cancer, vaccine/ immunity.
Deference