I

ntr
oduct
ion
Thiscour
sehighli
ght
stheuseandi mport
anceofstati
sticsinheal
thcar
e
del
iver
y.I
tintr
oducesst
udentstobasicst
ati
sti
calpri
nciplesandmethods
usedinanaly
zingandpresent
ingdatai
nanempi r
icalst
udy .

Lear
ningobj
ect
ives
Af
tercompl
eti
ngt
hisCour
se,
thest
udentshoul
dbeabl
eto:
1.Def
ineSt
ati
sti
csandBi
ost
ati
sti
cs
2Di
scusst
her
oleofst
ati
sti
csi
nsci
enceandheal
thcar
e
3.Def
ineandi
denti
fyt
hediff
erentt
ypesofdat
aandunder
standwhywe
needt
oclassi
fyi
ngvar
iabl
es
4.Expl
ainbasi
cst
ati
sti
cal
concept
s,pr
inci
plesandmet
hods.
5.Uti
li
zesi
mpl
est
ati
sti
cal
met
hodsi
ngat
her
ing,
anal
yzi
ngandpr
esent
ing
data
6.I
nter
pretdat
apr
esent
edi
nav
ari
etyofst
udi
esusi
ngSPSSsof
twar
e.
Def
ini
ti
onofSt
ati
sti
cs/
Biost
ati
sti
cs
Stat
ist
icsisthescienti
ficstudyoft hemethodofcol l
ecti
ng, or
ganizing,
summar i
zing,anal
yzing,interpreti
ngandpr esenti
ngempi ri
caldataor
medicaldata,whil
eBiost ati
sticsisdefi
nedast hestati
sticalprocessesand
methodsappl i
edtothecol l
ection,anal
ysesandi nt
erpretati
onofbi ologi
cal
dataandespeciall
ydat ar el
atingtohumanbi ology,healt
h,nursingand
medici
ne.
Theter
m stat
ist
icscanal
sobeusedt
omeanei
therst
ati
sti
cal
dat
aor
st
ati
sti
calmethods.
St
ati
sti
caldat
a:Wheni
tmeansst
ati
sti
cal
dat
aitr
efer
stonumer
ical
descri
ptionsofthings.Thesedescr
ipti
onsmayt aketheform ofcount
sor
measur ements.Thusst ati
sti
csofmalari
acasesinoneofmal ari
a
detecti
onandt reatmentpostsofNigeri
aincl
udefevercases,numberof
positi
vesobtained,sexandagedistri
buti
onofpositi
vecases,etc.
NBEvent
houghst
ati
sti
cal
dat
aal
way
sdenot
efi
gur
es(
numer
ical
descr
ipt
ions)itmustber
emember
edt
hatal
l'
numer
ical
descr
ipt
ions'
are
notst
ati
stical
data.

Char
act
eri
sti
csofst
ati
sti
cal
dat
a
I
nor dert
hatnumer
ical
descri
pti
onsmaybecal
l
edst
ati
sti
cst
heymust
possessthefol
l
owi
ngcharacter
ist
ics:
i)Theymustconsi
stofaggr
egatesoffacts–Thismeansthatst
ati
stics
ar
emadeupofa' numberoffact
s.'
Asinglefact
,event
houghnumericall
y
st
ated,
cannotbecal
ledst
ati
sti
cs.
i
i)Theymustbeaf f ectedt oamar kedext entbyamul ti
pli
cit
yofcauses.
Thismeanst hatst at i
sti
csar eaggregatesofsuchf actsonlyasgr owoutof
a'variet
yofcircumst ances'.Thustheexpl osi
onofout breakisattri
butabl
e
toanumberoff actor s,Viz.
,Humanf actors,
parasi
tefactors,mosqui t
oand
envir
onment alfactor s.Al
l t
hesefactorsact i
ngjoi
ntlydeterminethe
severi
tyoftheout br eakandi ti
sv erydif
f i
cul
ttoassesst heindi
vi
dual
contri
buti
onofanyoneoft hesefactors.
i
ii)Theymustbeenumer atedoresti
mat edaccor dingt oar easonable
standardofaccuracy–St ati
sti
csmustbeenumer at edorest i
mated
accordingtoreasonablestandar
dsofaccur acy .Thismeanst hatif
aggregatesofnumer i
calfactsaretobecal l
ed' st
atistics't
heymustbe
reasonablyaccurat
e.Thisisnecessarybecausest atisti
caldataareto
serveasabasi sforstati
sti
cali
nvesti
gations.Ifthebasi shappenst obe
i
ncor r
ecttheresult
sareboundt obemi sleading.
i
v)Theymusthav ebeencol
lect
edinasy stemati
cmannerf ora
predet
erminedpurpose.Numericaldatacanbecal l
edstati
sti
csonlyi
fthey
havebeencompiledinaproperl
yplannedmannerandf orapurposeabout
whichtheenumeratorhadadefi
niteidea.Factscoll
ectedinan
unsyst
emat i
cmannerandwi t
houtacompl eteawarenessoftheobj
ect,
wi l
l
beconfusi
ngandcannotbemadet hebasi sofvali
dconclusi
ons.
v)Theymustbepl acedi
nr el
ati
ontoeachot her
.Thati s,
theymustbe
comparable.Numer i
cal
factsmaybepl acedinrelati
ontoeachot herei
ther
i
npointoft i
me,spaceorcondit
ion.Thephrase,‘
placedinrelat
iontoeach
other
'suggeststhatt
hefactsshouldbecompar able.
Alsoincludedi
nthi
svi
ewarethet echniquesfort
abularandgraphical
presentati
onofdat
aaswellasthemet hodsusedt osummar i
zeabodyof
datawithoneortwomeaningfulf
igures.Thisaspectoforganizati
on,
presentati
onandsummar
izati
onofdat aar el
abel
ledasdescriptiv
e
stati
sti
cs.
Onebr anchofdescr i
pti
vest ati
sticsofspecialrelevancei nmedicineisthat
ofvital statistics–v i
talev
ent s:birt
h,death,mar r
iage, di
vorce,andthe
occur r
enceofpar t
iculardisease.Theyar eusedt ochar acteri
zethehealth
statusofapopul ati
on.Coupl edwi thresul
tsofper i
odiccensusesand
otherspeci al enumer ati
onofpopul ati
ons,thedat aonv i
taleventsrel
ateto
anunder lyi
ngpopul ati
onandy iel
ddescr i
pti
vemeasur essuchasbi rt
hrates,
mor bidityrat es,mor t
ali
tyrates, l
i
feexpectancies, anddiseaseincidence
andpr ev alencer at
est hatper vadebothmedi cal andl ayli
terat
ure.

stati
sticalmet hods:Whentheterm' stat
ist
ics'isusedtomean' stat
isti
cal
met hods'itrefer
stoabodyofmet hodsthatar eusedforcollecting,
organizing,analyzi
ngandinter
pretingnumer icaldataforunderstandinga
phenomenonormaki ngwisedecisions.I
nt hi
ssensei tisabr anchof
scienti
ficmet hodthathel
psustoknowi nabet t
erwayt heobjectunder
study.
Thebr anchofmoder nst at
isti
csthatismostr el
evanttopubl i
chealthand
cli
nical medicineisstat
isti
calinf
erence.Thi sbranchofst at
isti
csdealswith
techniquesofmaki ngconclusionsaboutt hepopul ati
on.Inf
erenti
al
stati
sticsbuildsupondescr ipt
ivestat
istics.Theinferencesaredrawnf rom
parti
cul arpr
oper t
iesofsampl etoparticularproperti
esofpopul at
ion.These
arethet y
pesofst ati
sti
csmostcommonl yfoundinresearchpublicati
ons.
Def
init
ion:Whenthedi
ff
erentst
ati
sti
cal
met hodsareappl
iedi
nbi
ologi
cal
,
medicalandpubl
i
chealthdatat
heyconsti
tutethedi
sci
pli
neof
Bi
ostati
sti
cs.
Rat
ional
eofst
udy
ingst
ati
sti
cs
•St
ati
sti
csper
vadesawayofor
gani
zi
ngi
nfor
mat
iononawi
derandmor
e
for
mal basi
sthanr
ely
ingont
heexchangeofanecdot
esandper
sonal
exper
ience
•Moreandmor
ethi
ngsar
enowmeasur
edquant
it
ati
vel
yinmedi
ci
neand
publ
i
cheal
th
•Thereisagr
eatdeal
ofi
ntr
insi
c(i
nher
ent
)var
iat
ioni
nmostbi
ologi
cal
processes
•Publichealt
handmedi cinearebecomi ngincreasinglyquantit
ative.As
technologyprogresses,thephysicianencount ersmor eandmor e
quantit
ativer
atherthandescr i
ptiveinformation.I nonesense, statist
icsis
thelanguageofassembl i
ngandhandl ingquant i
tati
vemat eri
al.Ev eni f
one’sconcernisonl ywiththeresultsofot herpeople’smanipulationand
assembl ageofdata, i
tisimportantt oachievesomeunder standingoft his
l
anguagei nordertoi nt
erprett
heirr esult
spr operl
y.
•Thepl anning,conduct, andi nt
erpretati
onofmuchofmedi calresearchare
becomi ngincreasinglyreliantonst ati
sti
caltechnology.Ist
hisnewdr ugor
procedurebet t
erthant heonecommonl yinuse?Howmuchbet ter?What ,
i
fany ,aretherisksofsi deef fectsassociatedwi t
hitsuse?Intestinganew
drughowmanypat i
entsmustbet reated,andinwhatmanner ,i
nor derto
demonst rateit
swor th?Whati sthenor mal vari
ati
oninsomeclinical
measur ement ?Howr eliableandv alidisthemeasur ement?Whati st
he
magnitudeandef f
ectofl aboratoryandt echnicaler
ror
?Howdoesone
i
nterpretabnormal v
alues?
•Statist
icsperv
adest hemedicall
i
ter
atur
e.Asaconsequenceoft he
i
ncr easi
nglyquanti
tat
ivenatur
eofpubli
cheal
thandmedi ci
neandits
rel
ianceonst at
ist
icalmethodol
ogy,t
hemedical
li
teratureisrepl
etewit
h
reportsinwhichstati
sti
calt
echni
quesareusedextensiv
el y
.
"
Iti
stheint
erpretat
ionofdat
aint
hepr
esenceofsuchv
ari
abi
l
ityt
hatl
aysat
t
heheartofstati
sti
cs."
Li
mit
ati
onsofst
ati
sti
cs:
I
tdealswithonl
ythosesubj
ectsofi
nquir
ythatarecapabl
eofbei
ng
quant
itat
ivel
ymeasuredandnumeri
cal
lyexpressed.
1.Itdeal
sonaggregat
esoffactsandnoimportanceisat
tachedto
i
ndivi
duali
tems–sui
tedonl
yifthei
rgroupchar
acteri
sti
csaredesi
redt
obe
st
udied.
2.St
ati
sti
cal
dat
aar
eonl
yappr
oxi
mat
elyandnotmat
hemat
ical
l
ycor
rect
.
3.Ifsuff
ici
entcar
eisnotexer
cisedi
ncol
lect
ing,
anal
yzi
ngandi
nter
pret
ing
thedata,st
ati
sti
calr
esul
tsmightbemisl
eadi
ng.
4.Onlyapersonwhohasanexper
tknowl
edgeofst
ati
sti
cscanhandl
e
stat
ist
ical
dataef
fi
cient
ly.
Scal
esofmeasur
ement
Anyaspectofani ndiv
idual t
hatismeasur edandtakeanyv al
uef or
di
ff
erenti
ndi vi
dual sorcases, l
ikebl
oodpr essure,
orrecords,l
ikeage,sex
i
scall
edav ari
able.Iti
shel pfultodi
videvari
ablesint
odiffer
enttypes,as
di
ff
erentstati
stical methodsar eappli
cabletoeach.Themai ndi vi
sionis
i
ntoquali
tativ
e( orcategorical)orquanti
tati
ve(ornumericalvari
ables)
.
Quali
tat
ivevariabl
e:avariabl
eorcharact
erist
icwhichcannotbemeasur ed
i
nquantit
ativeform butcanonlybeidenti
fi
edbynameorcat egori
es,for
i
nstanceplaceofbirth,et
hnicgr
oup,typeofdrug,stagesofbreastcancer
(
I,I
I,I
II
,orIV),degr
eeofpai n(mini
mal,moderate,
sev er
eorunbear abl
e).
Quantitati
vev ari
able:Aquanti
tati
vevar
iableisonet hatcanbemeasur ed
andexpr essednumer i
call
yandtheycanbeoft wot ypes(discreteor
conti
nuous) .Thev al
uesofadiscret
evariabl
ear eusuall
ywhol enumber s,
suchast henumberofepi sodesofdiar
rhoeaint hefir
stfi
vey earsofl
ife.A
conti
nuousv ari
ableisameasur ementonacont inuousscale.Exampl es
i
ncludewei ght,height,bl
oodpressur
e,age,etc.Alt
hought hetypesof
vari
ablescoul dbebr oadl
ydivi
dedintocategori
cal(quali
tati
ve)and
quanti
tative,i
thasbeenacommonpr acti
cet oseef ourbasictypesofdata
(scal
esofmeasur ement ).
Nomi naldata:-Datathatr epresentcategori
esornames.Ther eisno
i
mpl i
edor dertothecat egor i
esofnomi nal
dat a.Intheset ypesofdata,
i
ndividualsaresimplypl acedi nthepropercat egoryorgr oup,andthe
numberi neachcat egoryi scount ed.Eachitem mustf i
tint
oexact l
yone
category.Thesimplestdat aconsistofunorder ed,dichotomous, or"
either-
or"typesofobser v
ations, i
.e.,ei
therthepatientli
vesort hepat i
entdies,
ei
therhehassomepar ticularattri
buteorhedoesnot .
e.
g.Nomi
nal
scal
edat
a:sur
viv
alst
atusofpr
opr
anol
ol-t
reat
edandcont
rol
pati
entswi t
hmy ocar dialinfarcti
onSt atus28day saf t
erhospi tal admission
Propranolol-tr
eat edpat i
entCont rolPat ientsDead 7 17Al i
v e 38 29
TotalSurv i
val rate 45 84% 46 63%Sour ce: snow, effectof
propranololi
nMI; TheLancet ,1965.Theabov et ablepr esent sdat afrom
aclini
caltri
al oft hedr ugpr opr anololint het r
eatmentofmy ocar dial
i
nfarcti
on.Ther ewer etwogr oupofmy ocardi
al i
nf arction.Ther ewer etwo
groupofpat ient swi thMI .Onegr oupr eceivedpr opranol ol;theot herdidnot
andwast hecont rol.Foreachpat i
entt her esponsewasdi chot omous;
ei
therhesur v i
v edt hef i
rst28day safterhospi taladmi ssionorhe
succumbed( died)somet imewi thinthist imeper iod.Wi thnomi nal scale
datatheobv iousandi ntuiti
vedescr i
pt ivesummar ymeasur ei st he
proporti
onorper centageofsubj ectswhoexhi bitt heat tri
but e.Thus, we
canseef rom t heabov et ablet hat84per centoft hepat ientst reat edwith
propranololsur vi
v ed,incont rastwi thonl y63%oft hecont rol group.
Someotherexampl
esofnominaldata:Eyecol
or- br
own,black,et
c.
Rel
igi
on-Chri
sti
ani
ty,
Isl
am,Hindui
sm, et
c Sex - male,female

Ordi
nalData:-haveorderamongt
heresponseclassi
fi
cat
ions(categor
ies).
Thespacesori nt
erv
alsbetweent
hecategor
iesarenotnecessari
l
yequal .
Example:
1.St
rongl
yagr
ee
2.Agr
ee
3. Noopi
nion
4. Di
sagr
ee
5. St
rongl
ydi
sagr
ee
I
ntheabov
esi
tuat
ion,
weonl
yknowt
hatt
hedat
aar
eor
der
ed.
Int
ervalData:-I
ni nt
erv
al datatheint
ervalsbetweenv al
uesarethesame.
Forexampl e,i
ntheFahr enheittemperatur
escale,thedif
fer
encebetween
70degr eesand71degr eesi sthesameast hedif
ferencebetween32and
33degr ees.ButthescaleisnotaRATI OScale.40degreesFahrenhei
tis
nottwiceasmuchas20degr eesFahrenheit.
Rati
oData:-Thedat
av al
uesinrat
iodat
adohavemeaningf
ulr
ati
os,
for
exampl
e,ageisarati
odata,someonewhois40ist
wiceasoldas
someonewhoi s20.
Bothint
erval andrat
iodat ainvol
vemeasur ement.Mostdataanalysi
s
techni
quest hatapplytor at
iodataalsoapplytointerv
aldat
a.Theref
ore,
in
mostpracticalaspects,thesetypesofdata(inter
valandrat
io)ar
egrouped
undermetricdata.Insomeot herinst
ances,thesetypeofdataar
ealso
knownasnumer i
caldiscret
eandnumer icalconti
nuous.
Numer icaldiscrete:Numer icaldiscretedat aoccurwhent heobservat
ions
areint
eger sthatcor r
espondwi thacountofsomesor t
.Somecommon
examplesar e:thenumberofbact eriacol oniesonaplate,thenumberof
cell
swit hi
napr escr i
bedar eauponmi cr
oscopi cexaminati
on,t
henumber
ofheartbeatswi t
hinaspeci fiedtimei nterval,
amot her’
shist
oryofnumber
ofbirt
hs(par i
ty)andpr egnancies( gravi
di t
y),thenumberofepisodesof
i
ll
nessapat i
entexper iencesdur i
ngsomet imeper i
od,etc.
Numer i
calcont i
nuous:Thescalewi t
ht hegreatestdegr eeofquantif
icati
on
i
sanumer i
cal cont
inuousscale.Eachobser vationtheor eti
cal
lyfall
s
somewher ealongacont i
nuum.Onei snotr est
ricted,inpr i
nci
ple,t
o
part
icul
arvaluessuchast heintegersoft hediscretescal e.Therestri
cti
ng
fact
oristhedegr eeofaccuracyofthemeasur inginst r
umentmostcl ini
cal
measurement s,suchasbloodpr essure,serum chol esteroll
evel,
height,
weight,
ageet c.areonanumer i
calcont i
nuousscal e.

Exer
cises
I
dent
if
ythet
ypeofdat
a(nomi
nal
,or
dinal
,i
nter
val
andr
ati
o)r
epr
esent
edby
eachoft
hef
oll
owi
ng.Conf
ir
myouranswer
sbygi
vi
ngy
ourownexampl
es.
1.Bl
oodgr
oup
2.Temper
atur
e(Cel
sius)
3.Et
hni
cgr
oup
4.Jobsat
isf
act
ioni
ndex(
1-5)
5.Numberofhear
tat
tacks
6.Cal
endary
ear
7.Ser
um ur
icaci
d(mg/
100ml
)
8.Numberofacci
dent
sin3-y
earper
iod
9.Numberofcasesofeachr
epor
tabl
edi
seaser
epor
tedbyaheal
thwor
ker
10.Theav
erageweightgai
nof61-yearol
ddogs(
wit
haspeci
aldi
et
suppl
ement)was950gramslastmonth.