Biostatistics

What is biostatistics
—  Statistics is a field of study concerned with
1- collection, organization, summarization and
analysis of data.

2- drawing of inferences about a body of data when

only a part of the data is observed.

—  Statisticians try to interpret and communicate the

results to others.
 What is biostatistics
Biostatistics:

—  The tools of statistics are employed in many fields:

business, education, psychology, agriculture,
economics, ... etc.

—  When the data analyzed are derived from the

biological science and medicine, we use the term
biostatistics to distinguish this particular
application of statistical tools and concepts.
 Why Biostatistics
—  to be able to effectively conduct research
—  to be able to read and evaluate journal articles
—  to further develop critical thinking and analytic
skills

—  to improve yourself as physician

—  to answer questions
 Component of biostatistics
—  Descriptive statistics deal with the enumeration,
organization and graphical representation of data
from a sample

—  Inferential statistics which use available

information in a sample to draw inferences about
the population from which the sample was selected
 Variation

—  Variation characterizes much of medicine

—  Humans differ in response to exposure to adverse
effects
Example: not every smoker dies of lung cancer
some non-smokers die of lung cancer
—  Humans differ in response to treatment Example:
penicillin does not cure all infections
—  Humans differ in disease symptoms Example:
Sometimes cough and sometimes wheeze are
presenting features for asthma
 Variable
—  Variable is the characteristic or the value that
change from one subject to another, from thing to
thing, or within the subject, or the thing itself.
 Types of variables

Continuous
Quantitative
Discrete

Variable
Categorical

Qualitative Binary

Ordinal
 Quantitative (numeric) variables

—  Continuous variables: weight, height, cholesterol

level

—  Discrete: family size, number of students in the

classroom, number of patient admitted to
infectious department
 Qualitative variables
—  Categorical Variables:- like blood groups, eye color,
race, nationality

—  Binary variables: Alive/dead, Male/female, answer

of yes or no

—  Ordinal variables: students grades, pain scale

sever, moderate, and mild, stages of malignant
diseases
 Population Vs Sample

—  A population is a set of persons (or objects) having

a common observable characteristic.

—  Note that the word population refers to data and

not to people

—  for example: The weights of all the children

enrolled in a certain elementary school.
 Population Vs Sample
—  A sample:
It is a part of a population. For example:

—  The weights of only a fraction of these children.

 Population Vs Sample
—  Parameter: is any summarization of the elements
of a population. Thus, if the average of the blood
pressures that make up a population is calculated,
the result is one example of a parameter.

—  Statistic: is any summarization of the elements of

a sample. Thus, if the average of the blood
pressures that make up a sample is calculated, the
result is one example of a statistic.
Population Vs Sample
Data, information, intelligence
—  Data: consist of discrete observations of attributes
or events that carry little meaning when consider
alone. Data need to be transformed to Information
by summarizing them and adjusting them for
variations, such as the age and gender so
comparisons over time and place are possible. It is
the transformation of information through
integration and processing with experience and
perceptions based on social and political values
that produces intelligence.
 Data, information,
intelligence
—  Male, 24, 120, 171, smoker, male , 40, non smoker,
150, 160, 33 , female, smoker, 150, 160 , male
non smoker 150, 171, 200, female 50, 177, 120,
non smoker, 66, female 159, 166 , 70.....etc
Data, information,
intelligence
Data, information,
intelligence
 Data, information,
intelligence
—  Components of data quality:
1- Accuracy and validity

2- Reliability
3- completeness

4- legibility
5- Timeliness

6- Accessibility

7- confidentiality and security

 Data Collection Methods

—  Observation
—  Face-to-face and self-administered interviews
—  Postal or mail method and telephone interviews
—  Using available information
—  Focus group discussions (FGD)
 Observation
—  Observation is a technique that involves
systematically selecting, watching and recoding
behaviors of people or other phenomena and
aspects of the setting in which they occur, for the
purpose of getting (gaining) specified information.

—  Advantages: Gives relatively more accurate data on

behavior and activities

—  Disadvantages: Investigators or observer’s own

biases, prejudice, desires, and etc. and needs more
resources and skilled human power
 Interviews and self-administered
questionnaire
—  Interviews and self-administered questionnaires are
probably the most commonly used research data
collection techniques. Therefore, designing good
“questioning tools” forms an important and time
consuming phase in the development of most
research proposals.
 Face-to-face and telephone interviews

—  have many advantages. A good interviewer can

stimulate and maintain the respondent’s interest,
and can create a rapport (understanding, concord)
and atmosphere conducive to the answering of
questions. If anxiety aroused, the interviewer can
allay it. If a question is not understood an
interviewer can repeat it and if necessary (and in
accordance with guidelines decided in advance)
provide an explanation or alternative wording.
 Mailed Questionnaire Method

—  Under this method, the investigator prepares a

questionnaire containing a number of questions
pertaining the field of inquiry. The questionnaires
are sent by post to the informants together with a
polite covering letter explaining the detail, the aims
and objectives of collecting the information, and
requesting the respondents to cooperate by
furnishing the correct replies and returning the
questionnaire duly filled in.
 Use of documentary sources

—  Clinical and other personal records, death

certificates, published mortality statistics, census
publications, etc.
 Uses of health information

—  1. measure the health status of the people and to quantify

their health problems and medical and health care needs
—  2. for local, national and international comparisons of health
status.
—  3. for planning, administration and effective management of
health services and programs

—  4. for evaluation: assessing whether health services are

accomplishing their objectives or not in term of effectiveness
and efficiency
—  5. for assess the satisfaction of the beneficiaries with health
care system
—  6. for Research
 Sources of health information

—  1- Population census: ‫التعداد السكاني‬

—  it is total process of collecting, compiling, and
publishing demographic, economic and social data
pertaining, at specified time to all persons in
community.
—  The primary function of census is to provide
demographic information like age and sex
distribution , and also data collected from census
provide frame of reference and baseline for
planning, action and research not only in medicine
but in the entire governmental system
 Sources of health
information
2- Registration of vital events: ‫السجل املدني‬
—  Registration of vital events ( births and deaths) keeps a
—  continuous check on demographic changes.
—  According to United Nation the vital statistics system’s
components are: (a) legal registration, statistical reporting of,
and collection, compilation and dissemination of statistics
pertaining to vital events.
—  The vital events of interest are: live births, deaths and fetal
deaths; and marriages, divorces, etc.
—  Registration of vital events has been the foundation of vital
statistics.
 Sources of health
information
—  3- Notification of diseases :-
—  Historically notification of infectious diseases was the
—  first health information sub-system to be established
—  the primary purpose of notification is to effective
prevention and control of disease. Also, it’s a valuable
source for morbidity data

—  Besides the international list of notifiable diseases, each

country has its own national list of notifiable diseases.
Notification of diseases in
Libya
‫االمراض الواجب االبالغ عنها خالل اسبوع ‬
‫‪one week‬‬
 Limitations of diseases
notification system
—  1. Notification covers only a small part of the total
sickness in the community

—  2. Underreporting
3. Missing subclinical and atypical cases
 4-Disease Registers ‫السجل القومي‬
‫لالمراض‬
—  The difference between Registration and notification of
disease:-
—  A register mean permanent record be established for
specific disease, that the cases can be followed up and
basic statistics can be prepared for both frequency and
survival
—  Examples: cardiovascular diseases, Cancer, congenital
defects etc..
—  In Libya Tuberculosis registry system is one of the most
effective registry in the country, that beside its work as
good health information resources, its help in disease
control
 5- Hospital Records

—  In developing countries, hospital data constitute a basic

and primary source of information about diseases in the
community .
—  Medical record department in each hospital is needed
Limitations :-
—  constitute only the tip of iceberg
—  Highly selective : the admission policy vary from
hospital to hospital
—  Population served by hospital (population at risk) cannot
be defined (provide only numerator)
 Sources of health information

—  6- Record linkage:- this include the medical records for

each citizen in the country.

—  7- Epidemiological surveillance: for endemic diseases

to report the occurrence of new cases

—  8- Environmental health data: data about air, water and

soil pollutions, industrial toxins and waste management

—  9- health manpower statistics: physician patient ratio,

number of nurses, technicians and pharmacists.

—  10- other health services records

“Wiring” Healthcare