Biostatistics (PubH-2101)

G2- Public Health

Kabtamu Tolosie (Ass. Prof. in biostatistics)
Email: [email protected]

Arsi University, College of Health Science,

Department of Public Health
Asella, Ethiopia
March, 2025
 Everything You Wanted to
Know about Biostatistics but
Were Afraid to Ask
Course Outline
▶ Introduction to Biostatistics

▶ Descriptive Biostatistics

▶ Demography and vital statistics

▶ Probability

▶ Discrete Probability Distributions

▶ Continuous Probability Distributions

▶ Sampling Theory

▶ Estimation
▶ Hypothesis Testing 3
 Reference Textbooks

1. Rosner, B., 2015. Fundamentals of biostatistics. Cengage learning.

2. Triola, M.M. and Triola, M.F., 2013. Biostatistics for the Biological and Health
Sciences with Statdisk: Pearson New International Edition. Pearson Higher Ed.
3. Daniel, W.W. and Cross, C.L., 2018. Biostatistics: a foundation for analysis in
the health sciences. Wiley.
4. Chan, B.K., 2015. Biostatistics for epidemiology and public health using R.
Springer Publishing Company.
5. Van Belle, G., Fisher, L.D., Heagerty, P.J. and Lumley, T., 2004. Biostatistics: a
methodology for the health sciences. John Wiley & Sons.

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Lesson 1: Introduction to Biostatistics
Lecture Outline

Introduction

Some basic concepts

Measurement and measurement scales

6
Introduction

7
Introduction

8
Introduction

9
Introduction

10
Definition of Statistics

11
Definition of Biostatistics

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Biostatistics

Biostatistics can be defined as the application of the

mathematical tools used in statistics to the fields of biological
sciences and medicine.
or
Biostatistics is the study of statistics as applied to biological
areas. Biological laboratory experiments, medical research
(including clinical research), and health services research all use
statistical methods.
or

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Cont’d

▶ The tools of statistics are employed in many fields—

business, education, psychology, agriculture, and
economics, to mention only a few. When the data
analyzed are derived from the biological sciences and
medicine, we use the term biostatistics to distinguish
this particular application of statistical tools and
concepts.
Uses of Biostatistics
➢ Hospital utility statistics, Resource allocation,
Vaccination uptake, Magnitudes of a disease/condition,
Assessing risk factors, Disease frequency, Making
diagnosis and choosing an appropriate treatment
(implicit/probability).

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Reasons to know about biostatistics

▶ Medicine is becoming increasingly quantitative.

▶ The planning, conduct and interpretation of much of

medical research are becoming increasingly reliant on
the statistical methodology.

▶ Statistics pervades the medical literature.

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CLINICAL MEDICINE

Documentation of medical history of diseases.

Planning and conduct of clinical studies.

Evaluating the merits of different procedures.

In providing methods for definition of “normal” and

“abnormal”.
Role of Biostatistics in patient care

▶ In increasing awareness regarding diagnostic,

therapeutic and prognostic uncertainties and providing
rules of probability to delineate those uncertainties

▶ In providing methods to integrate chances with value

judgments that could be most beneficial to patient

▶ In providing methods such as sensitivity-specificity and

predictivities that help choose valid tests for patient
assessment

▶ In providing tools such as scoring system and expert

system that can help reduce epistemic uncertainties

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PREVENTIVE MEDICINE

▶ Toprovide the magnitude of any health problem in the

community.

▶ To find out the basic factors underlying the ill-health.

▶ To evaluate the health programs which was introduced in

the community (success/failure).

▶ To introduce and promote health legislation.

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Role of Biostatics in Health Planning and Evaluation

▶ In carrying out a valid and reliable health situation

analysis, including in proper summarization and
interpretation of data.

▶ In proper evaluation of the achievements and failures of

a health programme

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Role of Biostatistics in Medical Research

▶ Indeveloping a research design that can minimize the

impact of uncertainties

▶ In assessing reliability and validity of tools and

instruments to collect the information

▶ In proper analysis of data

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Concerns of Biostatistics
Biostatistics is a field of study concerned with;

1) The collection, organization, summarization, and analysis of data.

(Descriptive Statistics)

2) The drawing of inferences (decision) about a body of data when only

a part of the data is observed. (Inferential Statistics)

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Cont’d

▶ Descriptive statistics
▶ Which summary statistics to use to organize and
describe the data?
•Proportion, mean, median, SD, percentiles
▶ Descriptive statistics do not generalize beyond the
available data
▶ Inferential statistics
▶ Generalize from the sample.
•Hypothesis testing, confidence intervals
–t-test, Fisher’s Exact, ANOVA, survival analysis
–Bayesian approaches
▶ Making decisions in the face of uncertainty

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General steps in a research process

What does Planning

Biostatistics
cover? Design
Data collection
Data Processing
Data Presentation
Data Analysis
Interpretation
Publication

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WHAT ARE THE ISSUES?

▶ Appropriately conducting and interpreting biostatistical

applications require attention to a number of important issues.

1. Clearly defining the objective or research question

2. Choosing an appropriate study design (i.e., the way in which

data are collected)

3. Selecting a representative sample, and ensuring that the

sample is of sufficient size

4. Carefully collecting and analyzing the data

24
Cont’d

5. Producing appropriate summary measures or statistics

6. Generating appropriate measures of effect or association

7. Quantifying uncertainty

8. Appropriately accounting for relationships among

characteristics

9. Limiting inferences to the appropriate population

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Stages in Statistical Investigation

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Some Basic Concepts

Population
▶ The average person thinks of a population as a collection of
entities, usually people.

▶ A population or collection of entities may, however, consist of

animals, machines, places, or cells.

▶ A population of values as the largest collection of values of a

random variable for which we have an interest at a particular
time/situation/study.
▶ Populations may be finite or infinite.
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Cont’d

If a population of values If, on the other hand, a

consists of a fixed number population consists of an
of these values, the endless succession of
population is said to be values, the population is an
finite. infinite one.

we are interested in the

weights of all the children
enrolled in a certain county
Example: elementary school system,
our population consists of
all these weights.

Target population: A
collection of items that
Study Population: The
have something in common
specific population from
for which we wish to draw
which data are collected.
conclusions at a particular
time.
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Sample

A sample may be defined simply as a part of a population.

Example:

▶ Suppose our population consists of the weights of all the

elementary school children enrolled in a certain county
school system. If we collect for analysis the weights of
only a fraction of these children, we have only a part of
our population of weights, that is, we have a sample.

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Cont’d
Generalizability: is a two-stage procedure: we want to
generalize conclusions from the sample to the study
population and then from the study population to the target
population.

Example: In a study of the prevalence of Kat chewing

among secondary students in Ethiopia a random sample of
Secondary students in Asella were taken.

▶TargetPopulation: All secondary students in Ethiopia

▶Study population: All secondary students in Asella

▶Sample: secondary students in Asella

▶Sampling: the process of taking sample from a population

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Sample vs. Population

Population Sample

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Cont’d

For each of the following situations, answer questions a

through d:
(a) What is the population?
(b) What is the sample in the study?
(c) What is the variable of interest?
(d) What is the type of the variable?

Situation A: A study of 300 households in a small southern

town revealed that if she has school-age child present.

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Cont’d

(a) Population: All households in a small southern town.

(b) Sample: 300 households in a small southern town

(c) Variable: Does households had school age child

present.

(d) Variable is qualitative nominal.

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Cont’d

Situation B: A study of 250 patients admitted to a hospital

during the past year revealed that, on the average, the
patients lived 15 miles from the hospital.

(a) Population: All patients admitted to a hospital during the

past year.
(b) Sample: 250 patients admitted to a hospital during the
past year.
(c) Variable: Distance the hospital live away from the
hospital
(d) Variable is Quantitative continuous.

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Parameter and Statistic

Parameter: A descriptive measure computed

from the data of a population. (Quantity
calculated from population).

Statistic: A descriptive measure computed from

the data of a sample. (Quantity calculated from
the sample).
Data

Data are numbers which can be obtained from measurements or by counting.

Example (measurements):

A nurse weighs a patient or takes a patient’s temperature, a measurement, consisting of

a number such as 150 pounds or 100 degrees or Fahrenheit, is obtained.

Example (counting):

A hospital administrator counts the number of patients—perhaps 20—discharged from

the hospital on a given day.

Each of the above three numbers is a datum, and the three taken together are data.
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Sources of Data

Data are usually available from one or more of the following

sources:

1. Routinely Kept Records

2. Surveys

3. Experiments

4. Reports

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Sources of Data (continue)

1. Routinely Kept Records

▶ It is difficult to imagine any type of organization that does

not keep records of day-to-day transactions of its
activities.

Example:
▶ Hospital medical records, for example, Hospital medical
records contain immense amounts of information on
patients, while hospital accounting records contain a
wealth of data on the facility’s business activities.

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Cont’d

2. Surveys

▶ If the data needed to answer a question are not available from

routinely kept records, the logical source may be a survey
Example:
▶ The administrator of a clinic wishes to obtain information
regarding the mode of transportation used by patients to visit
the clinic. If admission forms do not contain a question on
mode of transportation, we may conduct a survey among
patients to obtain this information.

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Sources of Data (continue)

3. Experiments
▶ Frequently the data needed to answer a question are available only
as the result of an experiment. A

Example:
▶ A nurse may wish to know which of several strategies is best for
maximizing patient compliance (medicine). The nurse might conduct
an experiment in which the different strategies of motivating
compliance are tried with different patients. Subsequent evaluation
of the responses to the different strategies might enable the nurse to
decide which is most effective.

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Cont’d

4.Reports
Example:
▶ The data needed may already exist in the form of
published reports, commercially available data banks, or
the research literature.
▶ In other words, we may find that someone else has
already asked the same question, and the answer
obtained may be applicable to our present situation.

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Types of Data

There are Two types of data (or numbers): constants and

variables.

1. Constants
▶ A constant, as its name suggests, is something that does
not vary or change (or that may not be susceptible to variation or
change).
▶ A constant has only one attribute or value.
▶ Any variable can be made into a constant by reducing its
expression to only one of its values.

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Cont’d

A constant has no use in statistics. That is, anything that is or

remains constant cannot be subjected to statistical analysis.

Example:

we could keep the temperature of a room constant at 35o C

during an experiment. In this case, temperature stops being a

variable.

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Types of Data (continue)

2. Variables
▶ If, as we observe a characteristic, we find that it takes on
different values in different persons, places, or things, we
label the characteristic a variable.

▶ A variable is a quantity that may vary from object to object.

Example:
▶ Blood pressure, heart rate, the heights of adult males, the
weights of preschool children, and the ages of patients seen
in a dental clinic.

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Types of Variable

There are Two types of a variable.

1) Quantitative Variable
2) Qualitative Variable

1. Quantitative Variable

▶ A quantitative variable is one that can be measured in the usual

sense.
▶ A quantitative variable has values that are intrinsically numerical.
▶ Measurements made on quantitative variables convey information
regarding amount/ quantity.

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Cont’d

Example: We can obtain measurements on;

▶ The heights of adult males
▶ The weights of pre-school children
▶ The ages of patients seen in a clinic
▶ The number of children in a family

2. Qualitative Variable
▶ A qualitative variable has values that are intrinsically non-
numerical (categorical).
▶ Measurements made on qualitative variables convey
information regarding attribute

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Types of Variable (continue)

Example: Qualitative (or categorical) variables and their

values are:

▶ Color of a person’s hair (black, gray, red, . . ., brown)

▶ Gender of child (male, female)

▶ Cause of death of newborn (congenital malformation,

asphyxia, . . . )

▶ Province of residence of a Ethiopia (…..)

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Random Variable

▶ Whenever we determine the height, weight, or age of an individual, the

result is frequently referred to as a value of the respective variable.
▶ When the values obtained arise as a result of chance factors, so that they
cannot be exactly predicted in advance, the variable is called a random
variable.
▶ Observations or measurements are used to obtain the value of a random
variable.

Example: Adult Height.

▶ When a child is born, we cannot predict exactly his or her height at

maturity.
▶ Attained adult height is the result of numerous genetic and environmental
factors.
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Types of Random Variable
A Random variable may be discrete or continuous.

1. Discrete Random Variable

▶ A discrete random variable is characterized by gaps or interruptions in

the values that it can assume.

▶ These gaps or interruptions indicate the absence of values between

particular values that the variable can assume.

Example:

▶ The number of daily admissions to a general hospital is a discrete

random variable since the number of admissions each day must be
represented by a whole number, such as 0, 1, 2, or 3. The number of
admissions on a given day cannot be a number such as 1.5, 2.997, or
3.333. 49
Types of Random Variable (continue)

2. Continuous Random Variable

▶ A continuous random variable does not possess the gaps or

interruptions characteristic of a discrete random variable.
▶ A continuous random variable can assume any value within a
specified relevant interval of values assumed by the variable.

Example:

▶ The various measurements that can be made on individuals such as

height, weight, and skull circumference. No matter how close together
the observed heights of two people, for example, we can, theoretically,
find another person whose height falls somewhere in between.
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Measurement and Measurement Scales

Measurement may be defined as the assignment of

numbers to objects or events according to a set of rules.

Measuring scales are different according to the degree of

precision involved.

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Measurement Scales

There are Four Measurement Scales result from the fact that
measurement may be carried out under different sets of rules.

1. The Nominal Scale

2. The Ordinal Scale

3. The Interval Scale

4. The Ratio Scale

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Measurement Scales (continue)

1. The Nominal Scale

▶ The lowest scale is the nominal scale.

• Categorical
• Qualitative
• No sense of order
– Can be stored with text, color or numeric code but code
do not assign an order.
▶ As the name implies it consists of “naming” observations or
classifying them into various mutually exclusive and
collectively exhaustive categories.

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Cont’d

▶ The practice of using numbers to distinguish among the

various medical diagnoses constitutes measurement on
a nominal scale.

Examples: include such dichotomies (contrasts or

oppositions) as male–female, well–sick, under 65 years
of age–65 and over, child–adult, and married–not
married.

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Measurement Scales (continue)

2. The Ordinal Scale

Whenever observations are not only different from category

to category but can be ranked according to some criterion,
they are said to be measured on an ordinal scale.

– May have meaningful order but Interval between the

values may not be equal.

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Cont’d

Example:
▶ Recovery of a patient may be characterized as unimproved,
improved, and much improved.

▶ Individuals may be classified according to socioeconomic status as

low, medium, or high.

▶ The intelligence of children may be above average, average, or

below average.

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Measurement Scales (continue)

3. The Interval Scale

▶ The interval scale is a more sophisticated scale than the

nominal or ordinal scale.

▶ Things can be measured rather classified or ordered.

▶ In the interval scale, it is possible to order

measurements, also the distance between any two
measurements is known.

▶ The interval scale unlike the nominal and ordinal scales

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is a truly quantitative scale.
Cont’d

▶ We know, that the difference between a measurement of 20

and a measurement of 30 is equal to the difference between
measurements of 30 and 40.
▶ The ability to do this implies the use of a unit distance and a
zero point, both of which are arbitrary.
▶ The selected zero point is not necessarily a true zero in that it
does not have to indicate a total absence of the quantity being
measured.
▶ Example: Temperature Scale The unit of measurement is the degree,
and the point of comparison is the arbitrarily chosen “zero degrees,”
which does not indicate a lack of heat.
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Measurement Scales (continue)

4. The Ratio Scale

▶ The highest level of measurement is the ratio scale.

• Things can be measured rather classified or ordered.

▶ The ratio scale is characterized by the fact that equality of ratios as

well as equality of intervals may be determined.

▶ Fundamental to the ratio scale is a true zero point.

▶ The measurement of such familiar individualities as height, weight,

and length makes use of the ratio scale.

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