Welcome

to the
 Biostatistics 1
Course instructor: Dr. JMA Hannan

Class hours: Monay 6:00 pm – 9.00 pm

Cell: 01199248989

E-mail: jmahannan@northsouth.edu
 How to do well in this class?
1. Forget about your previous failure.
2. Attend lectures and take notes.
3. * Effort = Result.
4. Read the syllabus.
5. Read exam questions carefully.
6. Answer all parts of a given question.
7. Turn assignments in on time
8. Ask if you have questions.
 General Policy

Examination Marks

Midterm 1 20%
Midterm 2 20%
Final exam 40%
Class tests 10%
Assignment 5%
Class participation 5%

Total marks 100

 Grading Policy
Numerical Scores Letter Grade
93 and above
A
90 – 92
A-
87 – 89
B+
83 – 86 B
80 – 82
B-
77 – 79
C+
73 – 76
If you are absent in 3 consecutive
C classes you will be given “F”
70 – 72
 Topics
Lecture 1 : Introduction to Biostatistics – scope of Biostatistics in biology
and medical sciences. Data & presentation, Mean, Median and Mode; Rang,
Standard Deviation, Standard error and Coefficient of variation.
Lecture 2: Normal distribution , Test of hypothesis
Lecture 3 : z-test, t-test
Lecture 4 : One way ANOVA
1st Midterm Exam (July 10 - 15, 2008)
Lecture 5 : Post Hoc tests (Bonferroni, Duncan, Dunnet, LSD, Tukey test),
Repeated measure ANOVA
Lecture 6: Mann-whitney, Wilcoxon rank test & Kruskal-Wallis test (Tukey
test)
Lecture 7: Chi-square test, Relative risk, Odds ratio
Lecture 8: Simple Correlation & Rank Correlation
Lecture 9: Regression analysis.
Lecture 10-12: Introduction to SPSS and analysis of data using SPSS.
Lecture 13 - : Review class
Final Exam (September 10 – 15, 2008)
 Objective of this course

• To develop and understand the fundamental concepts of

statistics.
• To be knowledgeable about different application of
statistical methods in the MPH context.
• To enable students to conduct statistical analyses via a
user friendly software package like SPSS and to correctly
interpret the output.
• To be capable to correctly analyze simple data sets and to
report the results in a precise and concise way.
Textbook and reference books

• Text Book of Medical & Pharmaceutical Statistics –

Dr JMA Hannan
• Biostatistics : A Foundation for Analysis in the Health
Science, by Wayne W. Daniel.
• Medical Statistics by Michael J. Campbell, David
Machin.
 STATISTICS - HISTORICAL PERSPECTIVES

 Statistics seems to be derived from Latin word ‘Status’ or

Italian word ‘Statista’ or German word ‘Statistik’ or French
word ‘Statistique’ which all meaning ‘political state’.

 In ancient time the king used to collect information about

total population, land, wealth, soldiers of the country and
thus statistics served as an index of a country’s overall
condition. In olden days, statistics was regarded as ‘the
science of kings’.
 STATISTICS - HISTORICAL PERSPECTIVES

 In mid 17th century, the theoretical development

in modern statistics came with the introduction
of ‘Theory of Probability’ and ‘Theory of Games
and Chances’.

 Gambling, in the form of games of chance, led to

this theory of probability being originated by the
French mathematician Pascal (1623-1662).
Pascal
 STATISTICS - HISTORY PERSPECTIVES

 Francis Galton (1822-1921) introduced the

concept of regression line.
F. Galton
 Galton and his friend Karl Pearson later
introduced correlation analysis and chai-
square test which play an important role in
modern theory of statistics.
Karl Pearson
 W.S. Gosset (1876-1937), student of Karl
Pearson, introduced ‘Student t-test’ is the
basic tool of statistical analysis.

W.S. Gosset
 STATISTICS - HISTORY PERSPECTIVES

 Sir R.A. Fisher (1890-1962), known as the

father of statistics, introduced a number of
statistical procedures such as Analysis of
Variance (ANOVA) and design of experiments
and so on.

R.A. Fisher
 DEFINITION OF STATISTICS

Croxton and Cowden have given a very simple and

concise definition of statistics.

Statistics is the science of

• collection
• organization
• presentation
• analysis and
• interpretation of data
 DEFINITION OF BIOSTATISTICS

 BIOSTATISTICS is derived from Greek word Bios (Life) & Metron

(Measure).
 Thus biostatistics is the term used when tools of statistics are applied
to the data that derived from biological and medical science.

Biostatistics is the science of

• Collection
• Organization
• Presentation
• analysis and
• interpretation of data that is derived from biological sciences such as
medicine.
 Why use Statistics?

• Simplifies complexity
• Helps to compare
 APPLICATION OF OF BIOSTATISTICS

The concepts of statistics may be applied to a number of fields that include public
health, pharmaceutical company, business, psychology, agriculture etc.

In Medicine
In the field of medicine, statistical methods are used to evaluate effectiveness of a
new drug and method of treatment. A drug is given to animal or human to
explore whether the changes produced by the drug are due to the action of drug
or by chance, or to compare the action of two or more different drugs or different
dosages of the same drug are studied using statistical methods.

To find an association between disease and risk factors such as myocardial
infarction (MI) and alcohol intake, we need the help of statistics.

To define the normal range/limit of physiological and biochemical parameters for
example: the average systolic blood pressure is 120 mmgHg or random blood
glucose level is 6.7mmol/l but upto what limits it may be normal on either side of
average which may be established with appropriate statistical technique.
 Continuation……..

APPLICATION OF OF BIOSTATISTICS

In Community Medicine and Public Health

 In epidemiological studies – the role of causative factors is statistically tested.
For example, deficiency of iodine as an important cause of goiter in a
community is confirmed only after comparing the incidence of goiter cases
before and after giving iodized salt.

 To test usefulness of vaccines in the field – percentage of attacks or deaths

among the vaccinated subjects is compared with that among unvaccinated ones
to find whether the difference observed is statistically significant.

 Statistics play an important role in many decisions –making processes in public

health like:

What factors increase the risk that an individual will develop coronary hart disease?

 To address these issues and others, we rely on the methods of bio-statistics.

 What is data?
• The raw material of statistics is data.

• We may define data as numbers or observations usually obtained by

some process of counting or measurement.

• It is the outcome of
 facts (sex, occupation),
 events (birth, death, disease)
 measurements (height, weight)
About many individual i.e. when these happens for number of people then it
becomes data e.g.
 Sex: male/female,
 Birth: live birth/still birth
 Death: cause/age/sex
 Occupation: teacher/physician/labor etc
 Types of data

1. Qualitative data
» Nominal data
» Rank data

2. Numerical or Quantitative
» Discrete data
» Continuous data
 Qualitative Data
Nominal Data
• Nominal data are data that one can name.

• They are not measured but simply counted.

• They often consist of unordered ‘either-or’ type

observations,

• for example: Dead or Alive; Male or Female; Cured

or Not Cured; pregnant or Not pregnant
 Qualitative Data
Ranked Data
• If there are more than two categories of classification it
may be possible to order them in some way.
• For example, after treatment a patient may be either
improved, the same or worse; a woman may never have
conceived, conceived but spontaneously aborted, or give
birth to a live infant.
• In some situations we have a group of observations that
are first arranged from highest to lowest according to
magnitude and then assigned numbers correspond to each
observation’s place in the sequence. This type of data is
known as ranked data.
 Numerical/Quantitative data
Discrete Data
• Such data consist of counts which are only
isolated points.
• Example may be the number of deaths in a
hospital per year.

Continuous Data
• Such data are measurement that can, in theory
at least, take any value within a given range.
• Example: Diastolic blood pressure, which is
continuous, is converted into hypertension and
normotension.
 Collection of data

1. Interviewing or enumeration
2. Questionnaire
3. Experiments
Data from Physiology, Pharmacolgy and clinical pathology lab,
hospital ward, fundamental research etc
4. Surveys
Data of incidence/prevalence of health or disease situation in a
community such as incidence of malaria or prevalence of leprosy etc
5. Records
Records are maintained as a routine in register or books over along
period of time for still birth, death etc. Data are collected from these
records.
 Methods of presentation of data

Every study or experiment yields a set of data. Its

size can range from a few measurements to many
thousands of observations.
The principal object of data presentation, whether
tabular or graphical, is to convey the essential
features of the study to any reader of the final
publication.

1. Tabulation of data
2. Diagrammatic presentation
 Tabulation of data

A statistical table is a systematic organisation of data in

columns and rows in accordance with some characteristics.
Tabulation is the process of presenting data in tables.

Objectives of tabulation:
 To clarify the object of investigation.
 To simplify complex data.
 To facilitate comparison
 Rules for Tabulation of data

Construction of a good statistical table is a specialized art and requires

great skill, experience and common sense.

 The table should be simple and compact

 All title, subtitle, caption etc should be arrange in a systemic
manner.
 The unit of measurement should be clearly defined in the table.
 A table should be complete and self-explanatory.
 A table should be attractive to draw attention of readers.
 Accurate statistical analysis should be done.
 Abbreviation should be avoided
• If units of measurements are involved, such as mg/100 ml for the
serum cholesterol levels should be specified.
 Parts of tabulation
• Table number
• Title
• Caption
• Headings of columns and rows
• Body of the table
• Foot-note
Number & Title of the table
Row Caption Total
Heading
Col. Heading Col. Heading Col. Heading

Row sub
heading
Row sub Body
heading
Row sub
heading
The following Table Shows the consumption per person
among adolescent boys

Year Number of cigarettes

consumption per adolescent boy

1996 654

1997 700

1998 900

1999 1200

2000 1500

2001 1350
 Example: Tabulation of data

Table 2: Effects of propranolol on blood pressure in human

Group Blood pressure
Systolic BP Diastolic BP MAP

Control (n=10) 210±40 100±24 74±29

Propranolol treated (n=20) 120±30 65±20 60±23
t/p value (upaired t-test)

Control vs propranolol 4.23/0.01 3.12/0.02 2.13/0.05

Data are presented as mean±SD. Unpaired t-test was done as the test of
significance. *p<0.05, **p<0.01.
 Graphical presentation of data

A diagram is a visual form for presentation of data.

Complicated data through a diagram or graph can easily be
understood. It is convincing to the eye and mind.

Importance of diagrams:
 They are attractive and impressive.
 They save time and labour to understand
 They make data simple.
 They make comparison easy
 They provide more information than table
 Types of diagram

 Line diagram.
 bar diagram (simple & multiple)
 Pie diagram
 Histogram
 Scatter
 Line Diagram
Number of cigarettes consumption per adolescent
boy
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001
10
8
6
4
2
0
0 min 30 min 60 min 90 min 120 min

Glucose Diadetic food1

Fig: AUC and Glycemic index of diabetic food in rats.

Bar Diagram showing Number of cigarettes
consumption per adolescent boy

Number of cigarettes consumption per

adolescent boy

2000

1500

1000

500

0
1996 1997 1998 1999 2000 2001
 250
200
150
100
50
0
AUC Glycemic
Index
Glucose only Diabetic food

Fig: AUC and Glycemic index of diabetic food in rats.

Pie Diagram for Current Contraceptive
Use in Bangladesh(BDHS 2004)

19%
Pill
Injectable
2%
45% Condom
10% Sterilization
IUD and Norplant
7% Traditional

17%
 SUMMARIZING DATA: Measures of location

A measure of location or central tendency or average is

a single value used to represent a set of data.

Objective of average:
1.    To get single value that represent the entire data.
2.    To facilitate comparison between groups of data of similar nature.

Important measures of central tendency are:

1. Mean
2. Median
3. Mode
 Mean
Mean = sum of all the observation values ÷ number of observations

The mean x of ‘n’ observations x1 , x 2 , x3 ............isx ngiven by

x1 , x 2 , x3 ........x n
x
n
x
 x
n
where
x stands for an observed value.
n stands for the number of observations in the data set.
stands for the sum of all observed x values.
stands for the mean value of x.

Example: mean of 10, 20, 30, 25, 15 is (10±20±30±25±15)/5 = 20.

 Mean

Merits:
• It is the most popular average easy to understand and easy to calculate.
• It takes all the observation into account.
• The mean is used in computing other statistics (such as the variance, standard
deviation etc)

Limitation:
• Mean is affected by extremely high or low values.
• It is not a good measure of average in extremely asymmetric distribution
of observations.
 Median

Median = the middle value of a set of data.

When all the observations of a set of data are arranged in either

ascending or descending order, the middle observation is known as
median. If the number of observation is even, the mean of the two
central values is taken as the median.
 Median for group data

Example: Median of a grouped frequency distribution

 
 
Mark in test Frequency Cumulative Range of
frequency Cumulative frequency
5 - 9 12 12 < 12
9 - 13 8 20 12 - 20
13 - 17 15 35 20 - 35
17 - 21 19 54 35 - 54
21 - 25 14 68 54 - 68
25 - 29 7 75 68 - 75

75
Here n= 75, Therefore n/2 = 75/2 = 37.5. Looking at the cumulative range column in the table,
we find that n/2 (37.5) falls in the range 17 – 21. This means that median value lies between 17
and 21.
L = 17, F = 35, f = 19, c = 5.
n
Here F
Median  L  2 c
37.5  35
= 17 ± 5 = 17.66
f 19
Where, L = The lower limit of the median class (median class is that class which contains n/2 observations of the
series). N = Total number of observation
F = Cumulative frequency of the class just preceding the median class.
f = Frequency of the median class
c = The class interval of the median class.
 Median

Merits:
• Median is easy to understand and easy to calculate.
• It is not affected by extremely high or low values.

Limitation:
• It is not based on all the observations. It is a position average
and thus it is not determined by each and every observation.
• It is less reliable average than mean when number of
observation is small.
 Mode

The mode is the value of a set data that occurs most

frequently. It is the typical or commonly observed value
which occurs maximum number of times.

Example: the mode of the observations 3, 6, 7, 9, 6, 8, 6

= 6.
 Mode

Merits:
• Mode is easy to understand and easy to calculate.
• Like median, mode is not at all affected by extremely high or low
values.
• When there is a large frequency in a distribution, mode happens to be
meaningful as an average.

Limitation:
• It is not based on all the observations.
• It is less reliable average than mean when number of observation is
small.
Since average is a single value representing a
group of values it must be properly interpreted
otherwise there is a possibility to wrong
conclusion.
 COMPARISON OF MEAN, MEDIAN & MODE
• The mode is useful for non-numeric data. It provides little information about the rest of the
values in the data.

• The mean can be seriously affected by the presence of outliers (When an observation is very
different from all other observations in a data set, it is called an outlier i.e very small or large
values, eg. 200) but the median is not.

5 7 8 8 12 15 19 21 23
median = 12, mean = 13.1
5 7 8 8 12 15 19 21 23 200
median = 13.5, mean = 31.8

• The median (a position average) does not alter because it is only dependent on the middle
observation's value. The mean does change, however, because it is dependent on the average
value of all observations. So, in the above example, as the last value of the last observation
increases, so too does the mean.

• Outliers can sometimes occur as a result of error or deliberate misinformation. In these cases,
the outliers should be excluded from the measure of central tendency. Other times, outliers just
show how different one value is, and this can be a very useful piece of data.
 COMPARISON OF MEAN, MEDIAN & MODE Cont’d

3. Half of the data lies below the median and half of the data lies above it. This will be
approximately true for the mean when the data is symmetric. If the data is skewed, then the
median may differ significantly from the mean and usually the median would be used.

4. By choosing a wrong measure of central tendency, one can mislead people with statistics. In fact,
this is commonly done.
 SUMMARIZING DATA: Measures of variation

Measure of Dispersion (variation) is the measure of

extent of deviation of individual value from the central
value (average). It determines how much
representative the central value is. Dispersion is small
if the values are closely bunched about their mean and
it is large if the values are scatted widely about their
mean.

The median and mean mark for both tests are 20 but data A is more spread out
than data B.
Important measures of dispersion are:
1. Range
2. Variance & standard deviation
3. Standard error of Mean
4. Co-efficient of variation.
 Range

Range is the absolute difference between the highest value

and the lowest value in a series of observations.
Range = largest value - smallest value

Example: the weight of 10 students are:

25, 28, 33, 36, 40, 45, 49, 52, 55, 57.
Range is 57 – 25 = 32.

• The range is the simplest measure of dispersion.

• It is a rough measure of dispersion as its measure depends upon
the extreme items and not on all the items.
• It does not tell us anything about the distribution of values in the
series.
 Range

Application:
 Range is used in medical science to define the normal limits of biological
characteristics.
 Example: normal ranges of systolic and diastolic blood pressure are 100 – 140
mm and 80 –90 mm respectively. Ordinarily observations falling within a
particular range are considered normal and those falling outside the normal
range are considered as abnormal.
 Range for a biological character such as blood cholesterol, fasting blood sugar,
hemoglobin, bilirubin etc is worked out after measuring the characteristics in
large number of healthy persons of the same age, sex, class etc.
 Range

Merits:
• It is simple to compute and understand.
• It gives a rough but quick answer

Limitation:
1. It is not a satisfactory measure as it is based only on two
extreme values, ignoring the distribution of all other
observations within the extremes. These extreme values vary
from study to study, depending upon the size and nature of
sample and type of study.
 Variance & Standard deviation

• Karl Pearson introduced the concept of Standard Deviation in 1893.

• The standard deviation is a statistic that tells us how tightly all the
values are clustered around the mean in a set of data.

The mean of the squares of the deviations of every observation from

their mean is a measure of spread and is called the variance. The
standard deviation is the square root of the variance.

Variance 
 ( x  x ) 2

S .D. ( ) 
 ( x  x ) 2

n 1 n 1

It is computed as the root of average squared deviation of each number from its
mean. For example, for the numbers 1, 2, and 3 the mean is 2 and the standard
deviation is:
SD = 0.667 = 0.44
 Standard deviation

Merits:
• It is the most important and widely used measure of dispersion.
• It is based on all the observations and the actual sign of deviations
are used.
• Standard deviation provides the unit of measurement for the
normal distribution.
• It is the basis for measuring the coefficient of correlation, sampling
and statistical inference.

Limitation:
• It is not easy to understand and difficult to calculate
• It is affected by the value of every item in the series.
 Calculations of SD:

= 20 = 20

In these two groups, means are same (20) but their variation (SD) is different (SDA, 8.2 and SDB, 5.5).
Calculations of SD with alternative formulas:
Greater SD, greater is variation of observation.

Mean is presented with SD as ….. Mean±SD.

 Standard Error of Mean

The standard error of a sample mean is just the sample standard deviation
divided by the square root of the sample size.
SD
SE 
n

 If we draw a series of samples from same population and calculate the mean of
the observations in each, we have a series of means. The series of means, like
the series of observations in each sample, has a standard deviation. The SE of
the mean of one sample is an estimate of the SD that would be obtained from
the means of a large number of samples drawn from the population.
 Another thing is if we draw random samples from the population their means
will vary from one to another. This variation depends on the variation of
population and size of samples. We do not know the variation of population so
we use the variation of the sample as an estimate of it. This is expressed in SD
and if we divide SD by squire root of the number of observations in the sample
we have an estimate of SE of mean, SEM = SD/n
 Advantage of SE

• To determine the significant difference of two means of different variables.

x  
z 
s
n

• To calculate the size of sample. If SD is known.

 
SE  = n
n SE
Greater SE, greater is variation of observation.

Mean is presented with SE as ….. Mean±SE.

 Co-efficient of variation (C.V.)

Relative measure of variation is called Co-efficient of

variation (C.V.).
 
C.V. is defined as the S.D. divided by the mean times 100.

SD
C.V .   100
Mean

It is useful in comparing distribution whose units or characters may

be different e.g. height in cm in one and in inches in the other.
 Co-efficient of variation (C.V.)

Example: Height (cm) of adult and children are given in the table
Mean SD CV

Adult 160 cm 10 cm 6.25%

Children 60 cm 5 cm 8.33%
 

It means though height in adult shows greater variation in SD, but real
thing is that children is greater variation.
 Population & Sample

Population
• All possible values of a variable or all possible objects whose characteristics
are of interest in any particular investigation or enquiry.
• If the income of the citizen of country is of interest to us, the aggregate of
all relevant incomes will constitute the population.

Sample
• A sample is a part of population.
• Although we are primarily interested in the properties of a population or
universe, it is often impracticable or even impossible to study the entire
universe.
• Thus inferences about a population are usually drawn on the basis of a
sample. It represents the population.
 Normal Distribution

• The normal distribution was first introduced by the French mathematician

La Place (1749-1827).

• It is highly useful in the field of statistics. The graph of this distribution is

called normal curve or bell-shaped curve.

• In normal distribution, observations are more clusters around the mean.

Normally almost half the observations lie above and half below the mean
and all observations are symmetrically distributed on each side of the
mean.

• The normal distribution is symmetrical around a single peak so that mean

median and mode will coincide. It is such a well-defined and simple shape,
a great deal is known about it. The mean and standard deviation are the
only two values we need to know o be able to describe a normal curve
completely.
Normal Distribution
 Normal Distribution

Characteristics :

• The curve is symmetrical

• It is a bell shaped curve.
• Maximum values at the center and
decrease to zero symmetrically on each side
• Mean, median and mode coincide
Mean = Median = Mode
 It is determined by mean and standard deviation.
Mean1SD limits, includes - 68% of all observations
Mean  2SD - ,, ,, - 95% ,, ,,
Mean  3SD - ,, ,, - 99% ,, ,,
 Normal Distribution

• Almost all statistical tests (t-test, ANOVA etc)

assume normal distributions. These tests work
very well even if the distribution is only
approximately normally distributed.

• Some tests (Mann-whitney U test, Wilcoxon W

test etc) work well even with very wide deviations
from normality.
 Normal Distribution

Group Distribution is normal Distribution is not normal

(Parametric tests) (Nonparametric tests)

One Mean±SD Median (Range)

Two t-test   Non-parametric t-test (or Rank Test)

 Unpaired t-test  The Mann-Whitney U test

 Paired t-test  The Wilcoxon Matched-Pairs Signed-
Ranks Test
Three or more  
 One Way ANOVA  The Kruskal-Wallis One-way ANOVA
by Ranks
 The Repeated Measures
ANOVA  The Friedman’s Test

Relationship
 The Correlation  The Spearman Rank Correlation Coefficien
between two
Coefficient
variables
 Nonparametric Regression Analysis
 Simple Linear Regression