Bio Statistics

Introduction
Any science needs precision for its development. For precision, facts, observations or measurements have to be expressed in figures. It has been said when you can measure what you are spea ing about and express it in numbers, you now something about it, but when you cannot express it in numbers your nowledge is of meagre and unsatisfactory ind.! everything depends on measurement. &.g. you have to measure or count the number of missing teeth '( measure the vertical dimension and express it in number so that it ma es sense. Statistic or datum means a measured or counted fact or piece of the information stated as a figure such as height of one person, birth weight of a baby etc. Statistics or data is plural of the same. Statistics is the science of figures. Bio statistics is the term used when tools of statistics are applied to data that is derived from biological sciences such as medicine. " #ord $elvin %imilarly in medicine, be it diagnosis, treatment or research

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

)*+,

Applications and uses of bio statistics as a science

In physiology and anatomy
/ 0o define the limits of normality for variable such as height or weight or 1lood .ressure etc in a population. / 2ariation more than natural limits may be pathological i.e abnormal due to play of certain external factors. / 0o find correlation between two variables li e height and weight.

In pharmacology
/ 0o find the action of drugs / 0o compare the action of two drugs or two successive dosages of same drug / 0o find the relative potency of a new drug with respect to a standard drug

In medicine
/ 0o compare the efficiency of a particular drug, operation or line of treatment / 0o find association between two attributes such as cancer and smo ing / 0o identify signs and symptoms of disease

In community medicine and public health

/ 0o test usefulness of sera or vaccine in the field / In epidemiologic studies the role of causative factors is statistically tested
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 3*+,

 In research
/ It helps in compilation of data , drawing conclusions and ma ing recommendations.

For students
/ 1y learning the methods in biostatistics a student learns to evaluate articles published in medical and dental 4ournals or papers read in medical and dental conferences. / 5e also understands the basic methods of observation in his clinical practice and research.

6ommon %tatistical 0erms

Constant
/ 7uantities that do not vary e.g. in biostatistics, mean, standard deviation are considered constant for a population

Variable
/ 6haracteristics which ta es different values for different person, place or thing such as height, weight, blood pressure

Population
/ .opulation includes all persons, events and ob4ects under study. it may be finite or infinite.

Sample
/ -efined as a part of a population generally selected so as to be representative of the population whose variables are under study
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8*+,

 Parameter
/ It is a constant that describes a population e.g. in a college there are +9: girls. 0his describes the population, hence it is a parameter.

Statistic
/ %tatistic is a constant that describes the sample e.g. out of 399 students of the same college +,: girls. 0his +,: will be statistic as it describes the sample

Attribute
/ A characteristic based on which the population can be described into categories or class e.g. gender, caste, religion.

%ource of data
0he main sources for collection of data / &xperiments / %urveys / (ecords

Experiments
/ &xperiments are performed to collect data for investigations and research by one or more wor ers.

Surveys
/ 6arried out for &pidemiological studies in the field by trained teams to find incidence or prevalence of health or disease in a community.
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics +*+,

 Records
/ (ecords are maintained as a routine in registers and boo s over a long period of time / provides readymade data.

0ypes of data
-ata is of two types

ualitative or discrete data

In such data there is no notion of magnitude or si;e of an attribute as the same cannot be measured. 0he number of person having the same attribute are variable and are measured e.g. li e out of )99 people <, have class I occlusion, ), have class II occlusion and )9 have class III occlusion. 6lass I II III are attributes , which cannot be measured in figures, only no of people having it can be determined

uantitative or continuous data

In this the attribute has a magnitude. both the attribute and the number of persons having the attribute vary &.g Freeway space. It varies for every patient. It is a =uantity with a different value for each individual and is measurable. It is continuous as it can ta e any value between 3 and + li e it can be 3.)9 or 3.,, or 8.9< etc.

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

,*+,

-ata presentation
%tatistical data once collected should be systematically arranged and presented / 0o arouse interest of readers / For data reduction / 0o bring out important points clearly and stri ingly / For easy grasp and meaningful conclusions / 0o facilitate further analysis / 0o facilitate communication 0wo main types of data presentation are / 0abulation / >raphic representation with charts and diagrams

!abulation
It is the most common method -ata presentation is in the form of columns and rows It can be of the following types / %imple tables / Fre=uency distribution tables

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

?*+,

%imple 0able
@umber of patients at $I-%, 1gm Aan 9? Feb 9? Darch 9? 3,B99 ),C99 ),<,9

Fre=uency distribution table

In a fre=uency distribution table, the data is first split into convenient groups E class interval F and the number of items E fre=uency F which occurs in each group is shown in ad4acent column. @umber of 6avities 9 to 8 8 to ? ? to C C and above @umber of .atients <B ?< 83 )?

Charts and dia"rams

Gseful method of presenting statistical data .owerful impact on imagination of the people 0hey are
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics <*+,

 1ar chart 5istogram Fre=uency polygon Fre=uency curve #ine diagram 6umulative fre=uency diagram or ogive %catter diagram .ie chart .ictogram %pot map or map diagram

1ar chart
#ength of bars drawn vertical or hori;ontal is proportional to fre=uency of variable. suitable scale is chosen bars usually e=ually spaced 0hey are of three types #simple bar chart #multiple bar chart two or more variables are grouped together #component bar chart bars are divided into two parts each part representing certain item and proportional to magnitude of that item
300 250 200 150 100 N um be r o f C D P a tie nts

Biostatistics Dr Shilpi Gilra 50 -epartment of .rosthodontics

0 1s t Qtr 2nd Qtr 3 rd Q tr 4th Qtr

B*+,

%imple 1ar 6hart

400 350 300 250 200 150 100 50 0 1st Qtr 45 320 250

370 280 220 180 95

390

290 CD Patients RPD Patients FPD Patients 40

80

2nd Qtr

3rd Qtr

4th Qtr

Dultiple 1ar 6hart

3 000 2 500 2 000 1500 1000 1500 500 0 1s t Q tr 2nd Q tr 3rd Qtr 4th Q tr 300 450 P a tie nts to pro s tho 200 1850 14 00 2100 P a tie nts to o the r D e pa rtm e nts 500

6omponent 1ar 6hart

5istogram
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics C*+,

 pictorial presentation of fre=uency distribution consists of series of rectangles class interval given on vertical axis area of rectangle is proportional to the fre=uency
80 70 60 50 40 30 20 10 0 Number o !arious "esions 45 40 32 22 43 34 29 38 75 0 to 3 3 to 6 6 to 9 9 to 12 12 to 15 15 to 18 18 to 21 21 to 24 24 to 27

Fre=uency polygon
obtained by 4oining midpoints of histogram bloc s at the height of fre=uency by straight lines usually forming a polygon

Fre=uency curve
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics )9*+,

 when number of observations is very large and class interval is reduced the fre=uency polygon losses its angulations becoming a smooth curve nown as fre=uency curve

#ine diagram
line diagram are used to show the trends of events with the passage of time
90 80 70 60 50 40 30 20 10 0 0 1 2 3 4 5 10 25 60 Patients # ith $eriodontitis 85

6umulative Fre=uency -iagram

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics ))*+,

 graphical representation of cumulative fre=uency . it is obtained by adding the fre=uency of previous class

100 90 80 70 60 50 40 30 20 10 0

90 70 40 45 55 Pre&a"en!e o Denta" Caries ' in $er!ent(

25

35

0 to 10 to 20 to 30 to 40 to 50 to 60 to 10 20 30 40 50 60 70 %rs %rs %rs %rs %rs %rs %rs

%catter or -ot diagram

shows relationship between two variables If the dots are clustered showing a straight line, it shows a relationship of linear nature
14 12 10 8 6 4 2 0 0 5 10 15 Carious "esion )u*ar +,$osure

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

)3*+,

.ie chart
In this fre=uencies of the group are shown as segment of circle -egree of angle denotes the fre=uency Angle is calculated by / class $re%uency & '() total observations

70- 11.

30- 5. 200- 31. PR/)01/ C/N)/ P+R2/ /R01/ P+D/ 150- 24.

180- 29.

.ictogram
.opular method of presenting data to the common man

%pot map or map diagram

0hese maps are prepared to show geographic distribution of fre=uencies of characteristics

Deasures of statistical averages or central tendency

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics )8*+,

 Average value in a distribution is the one central value around which all the other observations are concentrated Average value helps / to find most characteristic value of a set of measurements / to find which group is better off by comparing the average of one group with that of the other the most commonly used averages are / mean / median / mode

Dean
refers to arithmetic mean it is the summation of all the observations divided by the total number of observations EnF denoted by H for sample and I for population H J x) K H3 K H8 L. Hn * n Advantages / it is easy to calculate -isadvantages / influenced by extreme values

Dedian
Mhen all the observation are arranged either in ascending order or descending order, the middle observation is nown as median In case of even number the average of the two middle values is ta en Dedian is better indicator of central value as it is not affected by the extreme values

Dode
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics )+*+,

 Dost fre=uently occurring observation in a data is called mode @ot often used in medical statistics. &xample @umber of decayed teeth in )9 children 3,3,+,),8,9,)9,3,8,B Dean J 8+ * )9 J 8.+ Dedian J E9,),3,3,*+',8,+,B,)9F J 3K8 *3 J 3., Dode J 3 E 8 0imesF

0ypes of variability
0here are three types of variability / Biolo"ical variability / Real variability / Experimental variability &xperimental variability are of three subtypes / 'bserver &rror / Instrumental &rror / %ampling &rror

1iological variability
It is the natural difference which occurs in individuals due to age, gender and other attributes which are inherent 0his difference is small and occurs by chance and is within certain accepted biological limits
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics ),*+,

 e.g. vertical dimension may vary from patient to patient

(eal 2ariability
such variability is more than the normal biological limits the cause of difference is not inherent or natural and is due to some external factors e.g. difference in incidence of cancer among smo ers and non smo ers may be due to excessive smo ing and not due to chance only

&xperimental 2ariability
it occurs due to the experimental study they are of three types / 'bserver error the investigator may alter some information or not record the measurement correctly / Instrumental error this is due to defects in the measuring instrument both the observer and the instrument error are called non sampling error / %ampling error or errors of bias this is the error which occurs when the samples are not chosen at random from population. 0hus the sample does not truly represent the population

Deasures of variation or dispersion

1iological data collected by measurement shows variation
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics )?*+,

 e.g. 1. of an individual can show variation even if ta en by standardi;ed method and measured by the same person. 0hus one should now what is the normal variation and how to measure it. 0he various measures of variation or dispersion are (ange Dean or average deviation %tandard deviation 6o efficient of variation

(ange
It is the simplest -efined as the difference between the highest and the lowest figures in a sample -efines the normal limits of a biological characteristic e.g. freeway space ranges between 3"+ mm @ot satisfactory as based on two extreme values only

Dean deviation

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

)<*+,

 It is the summation of difference or deviations from the mean in any distribution ignoring the K or / sign -enoted by DD- J N E x / x F n H J observation H J mean n J no of observation

%tandard deviation
Also called root mean s=uare deviation It is an Improvement over mean deviation used most commonly in statistical analysis -enoted by %- or s for sample and O for a population -enoted by the formula %- J N E x / x F3 n or n") >reater the standard deviation, greater will be the magnitude of dispersion from mean %mall standard deviation means a high degree of uniformity of the observations Gsually measurement beyond the range of P 3 %- are considered rare or unusual in any distribution

Gses of %tandard -eviation

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics )B*+,

 It summari;es the deviation of a large distribution from its mean. It helps in finding the suitable si;e of sample e.g. greater deviation indicates the need for larger sample to draw meaningful conclusions It helps in calculation of standard error which helps us to determine whether the difference between two samples is by chance or real

6oefficient of variation
It is used to compare attributes having two different units of measurement e.g. height and weight -enoted by 62 62 J %- H )99 Dean and is expressed as percentage

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

)C*+,

@ormal distribution or normal curve

%o much of physiologic variation occurs in any observation @ecessary to / -efine normal limits / -etermine the chances of an observation being normal / 0o determine the proportion of observation that lie within a given range @ormal distribution or normal curve used most commonly in statistics helps us to find these #arge number of observations with a narrow class interval gives a fre=uency curve called the normal curve It has the following characteristics 1ell shaped 1ilaterally symmetrical Fre=uency increases from one side reaches its highest and decreases exactly the way it had increased 0he highest point denotes mean, median and mode which coincide Dean KQ ) %- includes ?B.3<: of all observations . such observations are fairly common Dean K" 3 %- includes C,.+,: of all observations i.e. by convention values beyond this range are uncommon or rare. 0here chances of being normal is )99 / C,.+, : i.e. only +.,,.:. Dean K" 8 %- includes CC.<8:. such values are very rare. 0here chance of being normal is 9.3<: only

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

39*+,

 0hese limits on either side of measurement are called con$idence limits the loo of fre=uency distribution curve may vary depending on mean and %- . thus it becomes necessary to standardi;e it. &g" 'ne study has %- as 8 and other has %- as 3,thus it becomes difficult to compare them 0hus normal curve is standardi;ed by using the unit of standard deviation to place any measurement with reference to mean. 0he curve that emerges through this procedure is called standard normal curve

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

3)*+,

Properties o$ standard normal curve

smooth bell shaped perfectly symmetrical based on infinite number of observations thus curve does not touch H axis mean is ;ero %- is always ) total area under the curve is ) mean median mode coincide the unit of %- here is relative or standard normal deviate and is denoted by R R J 'bservation / Dean % Mith the help of R value we can find the area under the curve from a table 0his area helps to give the . value

%ampling
It is not possible to include each and every member of population as it will be time consuming, costly , laborious . therefore sampling is done %ampling is a process by which some unit of a population or universe are selected for the study and by sub4ecting it to statistical computation, conclusions are drawn about the population from which these units are drawn 0he sample will be a representative of entire population only
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 33*+,

 It is sufficiently large It is unbiased %uch sample will have its statistics almost e=ual to parameters of entire population 0wo main characteristics of a representative sample are .recision Gnbiased character

.recision
.recision depends on a sample si;e 'rdinarily sample si;e should not be less than 89 .recision J Sn*s n J sample si;e , s J standard deviation .recision is directly proportional to s=uare root of sample si;e, greater the sample si;e greater the precision Also greater the %-, less will be the precision 0hus in such cases to obtain precision, sample si;e needs to be increased

Gnbiased character
0he sample should be unbiased i.e. every individual should have an e=ual chance to be selected in the sample. 0hus a standard random sampling method should be used @on sampling errors can be ta en care of by / Gsing standardi;ed instruments and criteria / 1y single , double , triple blind trials / Gse of a control group

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

38*+,

-etermination of sample si;e

For 7uantitative -ata

0he investigator needs to decide how large an error due to sampling defect is allowable i.e. allowable error # &ither the investigator should start with assumed %- or do a pilot study to estimate %sample si;e J + %-3 * #3 Dean pulse rate of population is <9 beats per min with standard deviation of B beats. Mhat will be the sample si;e if allowable error is P) n J + H B H B * ) H ) J 3,? If # is less n will be more i.e. larger the sample si;e lesser is the error.

For =ualitative data

In such data we deal with proportion %ample si;e J n J + p = #3 p J proportion of positive character = J proportion of negative character = J )"p or E)99"p if expressed in percentF # J allowable error usually )9: of p

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

3+*+,

 e.g. incidence rate in last influen;a was found to be ,: of the population exposed what should be the si;e of the sample to find incidence rate in current epidemic if allowable error is )9:T p J ,: = J C,: l J )9 : of p J 9.,: nJ + H , H C, * 9., H 9., J <?99

.robability or p value
6oncept of probability is very important in statistics .robability is the chance of occurrence of any event or permutation combination. It is denoted by p for sample and . for population In various tests of significance we are often interested to now whether the observed difference between 3 samples is by chance or due to sampling variation. 0here probability or p value is used . ranges from 9 to ) 9 J there is no chance that the observed difference could not be due to sampling variation ) J it is absolutely certain that observed difference between 3 samples is due to sampling variation 5owever such extreme values are rare. . J 9.+ i.e. chances that the difference is due to sampling variation is + in )9 'bviously the chances that it is not due to sampling variation will be ? in )9
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 3,*+,

 0he essence of any test of significance is to find out p value and draw inference If p value is 9.9, or more it is customary to accept that difference is due to chance Esampling variationF . 0he observed difference is said to be statistically not significant. If p value is less than 9.9, observed difference is not due chance but due to role of some external factors. 0he observed difference here is said to be statistically significant. ,rom shape o$ normal curve Me now that C,: observation lie within mean P 3%- . 0hus probability of value more or less than this range is ,: ,rom probability tables p value is also determined by probability tables in case of student t test or chi s=uare test By area under normal curve 5ere ;J standard normal deviate is calculated 6orresponding to ; values the area under the curve is determined EAF .robability is given by 3E9., " AF

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

3?*+,

0ests of significance
Mhatever be the sampling procedure or the care ta en while selecting sample, the sample statistics will differ from the population parameters Also variations between 3 samples drawn from the same population may also occur i.e. differences in the results between two research wor ers for the same investigation may be observed 0hus it becomes important to find out the significance of this observed variation ie whether it is due to chance or biological variation Estatistically not significantF '( due to influence of some external factors E statistically significantF 0o test whether the variation observed is of significance, the various tests of significance are done. 0he test of significance can be broadly classified as ). Parameteric tests 3. -on parametric tests

.arameteric tests
.arametric tests are those tests in which certain assumptions are made about the population / .opulation from which sample is drawn has normal distribution / 0he variances of sample do not differ significantly
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 3<*+,

0he observations found are truly numerical thus arithmetic procedure such as addition, division, and multiplication can be used

%ince these test ma e assumptions about the population parameters hence they are called parameteric tests . 0hese are usually used to test the difference 0hey areU / %tudent t testE paired or unpairedF / A@'2A / 0est of significance between two means

@on parametric tests

In many biological investigation the research wor er may not now the nature of distribution or other re=uired values of the population. Also some biological measurements may not be true numerical values hence arithmetic procedures are not possible in such cases. .n such cases distribution $ree or non parametric tests are used in /hich no assumption are made about the population parameters e0"0 Dann Mhitney test 6hi s=uare test .hi coefficient test Fischers &xact test %ign 0est Freidmans 0est

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

3B*+,

 0est of significance can also be divided into one tailed or 3 tailed test

0wo tailed test

0his test determines if there is a difference between the two groups without specifying whether difference is higher or lower It includes both ends or tails of the normal distribution %uch test is called 0wo tailed test &g when one wants to now if mean I7 in malnourished children is different from well nourished children but does not specify if it is more or less

'ne tailed test

In the test of significance when one wants to specifically now if the difference between the two groups is higher or lower ie the direction plus or minus side is specified. 0hen one end or tail of the distribution is excluded eg if one wants to now if mal nourished children have less mean I7 than well nourished then higher side of the distribution will be excluded %uch test of significance is called one tailed test

Sta"es in per$ormin" test o$ si"ni$icance

%tate the null hypothesis %tate the alternative hypothesis Accept or re4ect the null hypothesis Finally determine the p value

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

3C*+,

%tate the null hypothesis

@ull hypothesis It is a hypothesis of no difference between statistics of a sample and parameter of the population or between statistics of two samples It nullifies the claim that the experimental result is different from or better than the one observed already

%tate the Alternative hypothesis

It is hypothesis stating that the sample result is different ie larger or smaller than the value of population or statistics of one sample is different from the other

Accept or re4ect the null hypothesis

@ull 5ypothesis is accepted or re4ected depending on whether the result falls in ;one of acceptance or ;one of re4ection If the result of a sample falls in the area of mean P 3%& the null hypothesis is accepted. 0his area of normal curve is called ;one of acceptance for null hypothesis If the result of sample falls beyond the area of mean P 3 %& null hypothesis of no difference is re4ected and alternate hypothesis accepted 0his area of normal curve is called ;one of re4ection for null hypothesis

Finally determine the p value

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 89*+,

 . value is determined using any of the previously mentioned methods If pV 9.9, the difference is due to chance and not statistically different but if p W 9.9, the difference is due to some external factor and statistically significant

0ypes of error
Mhile drawing conclusions in a study we are li ely to commit two types of error. / 0ype I error / 0ype II error

0ype I error
0his type of error occurs Mhen we conclude that the difference is significant when in fact there is no real difference in the population ie we re4ect the null hypothesis when it is true -enoted by X

0ype II error
0his type of error occurs Mhen we say that the difference is not significant when in fact there is a real difference between the populations i.e. the null hypothesis is not re4ected when it is actually false It is denoted by Y
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8)*+,

0ests of significance for large samples

0hese tests are used for sample si;e greater than 89 0he test used is R test R is standard normal derivate and has been discussed under normal distribution R J observation / mean * % 5owever in R test standard deviation is replaced by standard error In R test, R J observed difference * standard error Me now that standard deviation measure the variation within a sample %tandard error is the measure of difference in values occuring / between a sample and population / between two samples of the same population %tandard error used in R test can be / Standard error o$ mean / Standard error o$ proportion / Standard error o$ di$$erence bet/een * means / Standard error o$ di$$erence bet/een * proportions If in the R test the RV3 i.e. if the observed difference between the 3 means or proportion is greater than 3 times the standard error of difference p W 9.9, according to the given table 1 p ).? 9.) 3.9 9.9, 3.8 9.93 3.? 9.9)

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

83*+,

0hus the difference is not due to chance and may be due to influence of some external factor i.e. the difference is statistically significant

%tandard error of mean

Gsed for =uantitative data %tandard error of mean is the difference between sample mean and population mean given by %& x J %- of %ample * Sn also population mean will be sample mean P 3 standard error of mean limits of population mean 5ere RJsample mean / population mean * %& of mean In a random sample of )99 the mean blood sugar is B9 mg : with %? mg: . Mithin what limits the population mean will be T Mhat can be said about another sample whose mean is B3: %& J ? * S)99 J ? * )9 J 9.? 0hus the population mean will be B9P 3 H 9.? J <B.B to B).3 A sample with B3: mean is not within limits of population mean thus it does not seem to be drawn from the same population 0his will enable us to now whether the sample mean is within the

%tandard error of difference between 3 means

Gsed for =uantitative data It is the difference between means of two samples drawn from the same population
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 88*+,

 It helps to now what is the significance of difference obtained by 3 research wor ers for the same investigation %& EH) / H3F J S %-)3 * n) K %-33 * n3 &g.Find the significance of difference in mean heights of ,9 girls and ,9 boys with following values >irls 1oys SE Dean )+<.+ ),).? 2 3 4(0(5* 67) 8 2 90*: 12observed di$$erence 6 SE 1 2 9790( 9;<0; 6 90*: 2 '0*( %ince R value is more than 3 ,p will be less than .9, 0hus difference is statistically significant and it can be concluded that boys are taller than girls 4(0'5* 6 7) %?.? ?.8

%tandard error of proportion

In case of =ualitative data where character remains same but its fre=uency varies we express it in proportion instead of mean .roportion of individual having special character p = is number of individual not having the character .K= J) or )99 if expressed in :age

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

8+*+,

 %tandard error of proportion is the unit which measures variation in proportion of a character from sample to population %& of proportion J S p H = * n pJproportion of positive character =Jproportion of negative character nJsample si;e Also proportion of population J proportion of sample P 3 %&. 0hus one can determine whether the proportion of sample is within limits of population proportion .roportion of blood group 1 among Indians is 89:. If in a sample of )99 individuals it is 3,: what is your conclusion about the group %&. J S p H = * n J S 3, H <, * )99 J +.88 R J observed diff * %& J 89 " 3, * +.88 J ).), %ince ; is W 3 ,p will be more .9, thus the difference is not significant.

%tandard error of difference between 3 proportion

Deasures the difference in proportion of a character from sample to sample %& Ep)"p3F J S p) =) * n) K p3 =3 * n3 If typhoid mortality in a sample of )99 is 39 : and other sample of )99 is 89: then is this difference in mortality rate significant T p) J 39 U =) J B9 U n) J )99 p3 J 89 U =3 J <9 U n3 J )99 %&Ep)"p3F J ?.9B R J 89 / 39 * ?.9B J ).?+
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8,*+,

 RW 3 , pW.9, thus difference observed is not significant

0est of significance for small samples

In case of samples less than 89 the R value will not follow the normal distribution 5ence R test will not give the correct level of significance . In such cases students t test is used It was given by M% >ossett whose pen name was student 0here are two types of student t 0est ). Gnpaired t test 3. .aired t test

Gnpaired t test
Applied to unpaired data of observation made on individuals of 3 separate groups to find the significance of difference between 3 means %ample si;e is less than 89 e.g. difference in accuracy in an impression using two different impression materials %teps in unpaired t 0est are 6alculate the mean of two samples 6alculate combined standard deviation 6alculate the standard error of mean which is given by %&D J %- S)*n) K )*n3 6alculate observed difference between means H) / H3
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8?*+,

 6alculate t value J observed difference * %tandard error of mean -etermine the degree of freedom which is one less than no of observation in a sample En ")F 5ere combined degree of freedom will be J En) / )F K En3 / )F (efer to table and find the probability of the t value corresponding to degree of freedom .W 9.9, states difference is significant .V 9.9, states difference is not significant In a nutritional study )8 children in group A are given usual diet along with vitamin A and vitamin - while )3 children in group 1 ta e the usual diet. 0he gain in weight in pounds for both groups after )3 months is shown in the table Is vitamin A and - responsible for gain in weightT
>roup A , 8 + 8 3 ? 8 3 8 ? < , 8 >roup 1 ) 8 3 + 3 ) 8 + 8 3 3 8 "

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

8<*+,

 Dean of group A J + Dean of group 1 J 3., 0otal %- J ).8< 0otal %& J 9.,+B tJ 'bserved difference * %& t J + / 3., * 9.,+B J 3.<+ 6ombined degree of freedom J n) K n3 / 3 )3 K)8 " 3 p 2alue is chec ed corresponding to the t value at 38 d.f. from the t table It is W 9.93 0hus difference is statistically significant And accounted to role of vitamins AZ-

.aired t test
It is applied to paired data of observation from one sample only . Gsed in sample less than 89 0he individual gives a pair of observation i.e. observation before and after ta ing a drug
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8B*+,

 0he steps involved are 6alculate the difference in paired observation i.e. before and after J x) / x3 J y 6alculate the mean of this difference J y 6alculate % 6alculate %& J %- * S n -etermine t J y * %& -etermine the degree of freedom %ince there is one sample df J n") (efer to table and find the probability of the t value corresponding to degree of freedom .W 9.9, states difference is significant .V 9.9, states difference is not significant &g.%ystolic 1. of a normal individual before and after in4ection of hypotensive drug is given in the table. -oes the drug lower the 1.T
1. before giving drug H) )33 )3) )39 )), )3? )89 )39 )3, )3B 1. after giving drug H3 )39 ))B )), ))9 )33 )89 ))? )3+ )3, -ifference H)"H3 J y 3 8 , , + 9 + ) 8

Dean of difference y J N y * n J 3< * C J 8 %- J S N E y " y F3 *n") J ).<8 %& J %- * n J ).<8 * C J 9.,B t J y * %& J 8 * 9.,B J ,.)< -egree of freedom to n / ) J C / ) J B
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics 8C*+,

 p value corresponding to t J ,.)< and d.f. B is W 9.99) 0hus highly significant 0hus decrease in 1. is due to the -rug

6hi s=uare test

6hi s=uare test unli e ; and t test is a non parametric test 0he test involves calculation of a =uantity called chi s=uare . 6hi s=uare is denoted by X3 It was developed by $arl .earson 0he most important application of chi s=uare test in medical statistics are 0est of proportion 0est of association 0est of goodness of fit 0est of proportion Gsed as an alternate test to find the significance of difference in 3 or more than 3 proportions 0est of association 0o measure the probability of association between 3 discreet attributes e.g smo ing and cancer 0est of goodness of fit 0ests whether the observed values of a character differ from the expected value by chance or due to play of some external factor
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics +9*+,

X3 J [ E ' / & F 3 * & X3 denotes 6hi s=uare ' J 'bserved 2alue & J &xpected 2alue

%teps in 6hi %=uare 0est

%tate the null hypothesis -etermine the 6hi s=uare value Find the degree of freedom (efer the 6hi s=uare table to find the probability value corresponding to the degree of freedom #et us consider the following example Me are ma ing a field trial of 3 vaccines 0he results of field trial are 2accine A 1 0otal Attac ed 33 )+ 8? @ot Attac ed0otal ?B C9 <3 B? )+9 )<? Attac (ate 3+.+: )?.3:

2accine 1 seems to be superior to 2accine A Me perform 6hi %=uare test to verify if the vaccine 1 is superior to vaccine A or is it merely due to chance

%tate the null hypothesis

It states that the vaccines have e=ual efficacy

-etermining the 6hi %=uare 2alue

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics +)*+,

 Find total attac and non attac rates 0otal Attac rate J 8? * )<? J 9.39+ 9.<C, 0otal @on Attac (ate J )+9 * )<? J

2accine A EnJC9F

Attac ed ' J 33 & J 9.39+ H C9 J)B.8? ' " & J K 8.?+ ' J )+

@ot Attac ed ' J ?B & J 9.<C, H C9 J <).,, ' " & J " 8.,, ' J <3 & J 9.<C, H B? J ?B.8< ' " & J K 8.?8

1 EnJB?F

& J 9.39+ H B? J )<.,+ ' " & J "8.,+

X3 J N E ' / & F 3 * & J E8.?+F3 *)B.8? K E8.,,F 3 * <).,, K E8.,+F 3* )<.,+ K E8.?8F 3 * ?B.8< J 9.<3 K 9.)< K 9.<) K 9.)C J ).<C Find the -egree of Freedom J Ec")F Er")F c J number of 6olumns r J number of (ows d.f. J E3")FE3")F J ) Find the p value 'n referring to 6hi s=uare table with one degree of freedom the p value was more than 9.9,.

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

+3*+,

 5ence the difference is not statistically significant and the null hypothesis of no difference between vaccines is accepted.

A@'2A
Analysis of variance Investigations may not always be confined to comparison of 3 samples only e.g. we might li e to compare the difference in vertical dimension obtained using 8 or more methods li e phonetics, swallowing, niswongers method In such cases where more than 3 samples are used A@'2A can be used Also when measurements are influenced by several factors playing there role e.g. factors affecting retention of a denture, A@'2A can be used. A@'2A helps to decide which factors are more important (e=uirements -ata for each group are assumed to be independent and normally distributed %ampling should be at random 'ne way A@'2A Mhere only one factor will effect the result between 3 groups 0wo way A@'2A Mhere we have 3 factors that affect the result or outcome Dulti way A@'2A
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics +8*+,

 0hree or more factors affect the result or outcomes between groups

F test
F J Dean %=uare between %amples * Dean %=uare within %amples F J variance ratio 0he values of Dean s=uare are seen from the analysis of variance table if we have the values of sum of s=uares and degree of freedom E which are calculated F Dean %=uare between %amples / It denotes the difference between the sample mean of all groups involved in the study EA, 1, 6 etcF with the mean of the population Dean %=uare within %amples / it denotes the difference between the means in between different samples 0he greater both these value more is the difference between the samples 0he F value observed from the study is compared to the theoretical F value obtained from the 0ables at ): and ,: confidence limits. 0he results are then interpreted. If the observed value is more than theoretical value at ): , the relation is highly significant. If the observed value is less than the theoretical value at ,: it is not significant.
Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics ++*+,

 If the observed value is between ) and ,: of theoretical value it is statistically significant. .resented by -r %hilpi >ilra

Biostatistics Dr Shilpi Gilra -epartment of .rosthodontics

+,*+,