Biostatistics

Lecture 2
TESTS – SENSITIVITY, SPECIFICITY

Saba Oniani, MD
2023
• Suppose 1,000 new cases diabetes per year
• This is the incidence of diabetes
• Suppose 100,000 cases of diabetes at one point in time
• This is the prevalence of diabetes for population
• Incidence rate = new cases / population at risk
• Determined for a period of time (e.g. one year)
• Population at risk = total pop – people with disease
• 40,000 people
• 10,000 with disease
• 1,000 new cases per year
• Incidence rate = 1,000 / (40k-10k) = 1,000 cases/30,000
• Prevalence rate = number of cases / population at risk
• Entire population at risk
• For chronic diseases
• Prevalence >> incidence
• For rapidly fatal diseases
• Incidence ~ prevalence
• New primary prevention programs
• Both incidence and prevalence fall
• New drugs that improve survival
• Incidence unchanged
• Prevalence increases
 Blood Glucose Levels

Normal Subjects Diabetics

90 115 90 140 115 140
87 112 87 132 112 132
101 101 101 110 101 110
110 92 110 105 176 105
105 85 105 127 180 127
93 79 93 170 199 170
92 100 92 140 100 140
95 99 95 160 143 160
88 86 88 112 168 112
112 102 112 160 102 160
 Normal Subjects Diabetics

No.
Subjects

Blood Glucose Level

 Normal Subjects Diabetics

No.
Subjects

Blood Glucose Level

 Disease
+ -
+ TP FP
- FN TN
 Disease
+ -
+ TP FP
- FN TN

Sensitivity = TP
TP + FN
 Sensitivity =
Normal Subjects Diabetics TP
TP + FN
No.
Subjects

Very sensitive

Blood Glucose Level

 Sensitivity =
Normal Subjects Diabetics TP
TP + FN
No.
Subjects

Not very sensitive

Blood Glucose Level

 Disease
+ -
+ TP FP
- FN TN

Specificity = TN
TN + FP
 Specificity =
Normal Subjects Diabetics
TN
TN + FP
No.
Subjects

Very specific

Blood Glucose Level

 Specificity =
Normal Subjects Diabetics
TN
TN + FP
No.
Subjects

Not very specific

Blood Glucose Level

• The results below are obtained from a study of test X
on patients with and without disease A. What is the
sensitivity of test X?

+
25 10
Test X

Disease A
75 - 10

+
-
• Midpoint cutoff maximizes sensitivity/specificity

Normal Diabetics

Blood Glucose Level

• Degree of overlap limits max combined sens/spec

Normal Diabetics Normal Diabetics

Blood Glucose Level Blood Glucose Level

• High sensitivity = good at ruling OUT disease
• High specificity = good at ruling IN disease
• Sensitivity/Specificity are characteristics of the test
• Remain constant for any prevalence of disease
 Test X
Sensitivity 80%
Specificity 50%

Group 1 Group 2
Prevalence = 80% Prevalence = 20%
Disease Disease
+ -
+ -
+ 64 10 + 16 40
Test

Test

- 16 10 - 4 40

80 20 20 80
 Group 1 Group 2
Prevalence = 80% Prevalence = 20%
Disease Disease
+ -
+ -
+ 64 10 + 16 40
Test

Test
- 16 10 - 4 40

Sens = 64/80 = 80% Sens = 16/20 = 80%

Spec = 10/20 = 50% Spec = 40/80 = 50%
• “A test is negative in 80% of people who do not
have the disease.” (true negatives; specificity)
• “A test is positive in 50% of the people who do
have the disease.” (true positives; sensitivity)

Disease
+ -
+ TP FP
- FN TN
• Use sensitive tests when you don’t want to miss cases
• Captures many true positives (at cost of false positives)
• Screening of large populations
• Severe diseases
• Use specific tests after sensitive tests
• Confirmatory tests
• Specific tests often more costly/cumbersome
• Performed only if screening (sensitive) test positive
Thanks for listening!