A randomized, double blind placebo controlled trial

was conducted to study the effect of estrogen

replacement therapy after Ischemic stroke. Each
group had 104 patients and the primary outcome
(Event) was death or nonfatal stroke. The event rate
in the placebo group and the estradiol group were 25%
and 15% respectively.

Does this result gives enough evidence for an

association between estrogen replacement therapy
after ischemic stroke and the rate of death or nonfatal
stroke?
 Event
Treatment Total
Yes No

 
Estradiol 16 (15%) 88 104
Placebo 26 (25%) 78 104
Total 42 166 208
 Chi Square (χ2)
Situation

• Variables of interest are categorical

• To determine whether observed difference in

proportion between the study groups are
statistically significant

• To test the association or independence of 2

variables
 Chi Square (χ2)
Null hypothesis
  No association between estrogen replacement
therapy after ischemic stroke and the rate of
death or nonfatal stroke

Alternate hypothesis
There is an association between estrogen
replacement therapy after ischemic stroke and
the rate of death or nonfatal stroke
 Chi Square (χ2)

Event
Cells
Treatment Total
Yes No
Row
  Total
Estradiol 16 (15%) 88 104
Placebo 26 (25%) 78 104
Total 42 166 208
Column Total
 Chi Square (χ2)

Event
Treatment Total
Yes No

E = 21 E = 83
 
Estradiol 104
E = 21 E = 83
Placebo 104

Total 42 166 208

 Chi Square (χ2)

Event
Treatment Total
Yes No

  O = 16 O = 88
Estradiol E
D ==521 E
D==583 104

O = 26 O = 78
Placebo E
D ==521 E
D==583 104

Total 42 166 208

 Chi Square (χ2)

Test statistic

χ 
2 O  E 2

follows Chi square with (row-1)(column-1)degrees

of freedom
O =Observed frequencies
Row Total  Column Total
E = Expected frequencies 
Grand Total

(Chi-square for 1 df at 5% level = 3.84)

 2
χ (Calculated _ value)  3
2
χ1  3.84
 Chi Square (χ2)
SPSS Output
Chi-Square Tests

Asymp. Sig. Exact Sig. Exact Sig.

Value df (2-sided) (2-sided) (1-sided)
Pearson Chi-Square 2.983b 1 .084
Continuity Correctiona 2.417 1 .120
Likelihood Ratio 3.007 1 .083
Fisher's Exact Test .119 .060
Linear-by-Linear
2.969 1 .085
Association
N of Valid Cases 208
a. Computed only for a 2x2 table
b. 0 cells (.0%) have expected count less than 5. The minimum expected count is 21.
00.
 Chi Square (χ2)

Decision
•P > Desired level of significance
(Usually 0.05)
•Data support the null hypothesis.
Interpretation
Fail to establish an association between
estrogen replacement therapy and rate of
death.
 Chi Square (χ2)
Assumptions/ Requirements

•Randomly drawn sample

•Data must be reported in numbers
(frequencies or raw figures)
•Observed frequency should not be too
small
A new treatment is introduced for rheumatoid
arthritis patients. 300 subjects were treated
with new treatment and the remaining
patients out of 500 were not given new
treatment. The no. of patients cured from the
disease are respectively 230 and 145 for new
treatment group and other group (not
administered new treatment).

Use chi-square test for finding the effect of

new treatment (chi-square for 1 df at 5% level
= 3.84)
New Cured Not cured Total
treatment
Given

Not given

Total 500
Variable 2 Variable 1

Category 1 Category 2 Category 3 Category 4

Category 1

Category 2

Category 3
 Biostatistics: A foundation for analysis in the
health science. Wayne W Daniel

 Elise Whitley and Jonathan Ball. Statistics review

6: Nonparametric methods, Critical Care 2002,
6:509-513. http://ccforum.com/content/6/6/509

 Viv Bewick, Liz Cheek and Jonathan Ball. Statistics

review 10: Further nonparametric methods,
Critical Care 2004, 8:196-199
http://ccforum.com/content/8/3/196