Biostatistic and Epidemiology Lecture Note
Biostatistic and Epidemiology Lecture Note
Biostatistic and Epidemiology Lecture Note
JIMMA. ETHIOPIOA
Online Teaching Course Material
for
BSc -STATISTICS
3rd Year Students -2020
Subject Course : BIOSTATISTICS AND EPIDEMIOLOGY
STAT 3101
Instructor : Dr. Adiveppa . S. Kadi,
Professor
Department of Statistics
Jimma University
JIMMA, ETHIOPIA
Chapter 1
BIOSTATISTCS
* Science is built up with facts, as a house is with stones. But a collection of facts
1. We have our senses, through which we experience the world and make
observations.
2. We have the ability to reason, which enables us to make logical inferences.
All the logic in the world is not going to create an observation, and
All the individual observations in the world won't in themselves create a
theory.
There are two kinds of relation-ships between the scientific mind and the
world, and We impose two kinds of logic :
(a) Deductive and (b) inductive
From this theory we predict that math’s and statistics students who are
praised for their right answers during the year
They will do better on their final exam than those who are punished for
their wrong answers.
We go from the general—the theory—to the specific—the observations.
This is known a the hypothetical-deductive method.
Inductive Inference
For example:
It was observed in the Vienna General Hospital in the 1840s that women giving
birth were dying at a high rate of puerperal fever.
It was a young doctor named Ignaz Phillip Semmelweis who connected the
observation that medical students performing vaginal examinations did so
directly after coming from the dissecting room, rarely washing their hands
in between.
The explanation that the cause of death was the introduction of cadaverous
(Cadaverous means looking corpse-like, from being sick or too skinny, like
an aging rock star or a Halloween ghoul or looking very thin and pale )
material into a wound. L
The practical consequence of that creative leap of the imagination was the
elimination of puerperal fever as a scourge of childbirth by requiring that
physicians wash their hands before doing a delivery.
The ability to make such creative leaps from generalizations is the product of
creative scientific minds.
For example :
Several decades ago it was noted that women seemed to get heart attacks
about 10 years later than men did.
A creative leap of the imagination led to the inference that it was women’s
hormones that protected them until menopause. EUREKA!
They deduced that if estrogen was good for women, it must be good for
men and predicted that the observations would corroborate that
deduction.
A clinical trial was undertaken which gave men at high risk of heart attack
estrogen in rather large doses, 2.5 mg per day or about four times the
dosage currently used in post-menopausal women. Unsurprisingly , the
men did not appreciate the side effects, but surprisingly to the
investigators, the men in the estrogen group had higher coronary heart
disease rates and mortality .
What was good for the goose might not be so good for the gander.
The trial was discontinued and estrogen as a preventive measure was
abandoned for several decades.
“What was good for the goose might not be so good for the gander”.
When many studies provide affirmative evidence in favor of a theory, does that
increase our belief in it?
Affirmative evidence means more examples that are consistent with the
theory. But to what degree does supportive evidence strengthen an
assertion?
Those who believe induction is the appropriate logic of science hold the
view that affirmative evidence is what strengthens a theory.
Another approach is that of Karl Popper, perhaps one of the fore most
theoreticians of science. Popper claims that induction arising from
accumulation of affirmative evidence doesn't strengthen a theory.
Induction
After all, is based on our belief that the things unobserved will be like those
observed or that the future will be like the past.
For example, “we see a lot of white swans and we make the assertion that all
On the other hand, this assertion can be knocked down by the sighting of
a single black swan.
Now we would have to change our assertion to say that most swans are
white and that there are some black swans.
This assertion presumably is closer to the truth.
In other words, we can refute the assertion with on e example, but we can't prove
it with many.
The assertion that all swans are white is a descriptive generalization rather than a
theory.
Asking which comes first, theory or observation, is like asking which comes
first, the chicken or the egg.
CH-3 PROBABILITY
The theory of probability is at bottom nothing but
common sense reduced to calculus.
3.1 What Is Probability?
* The probability of the occurrence of an event is indicated by a
number ranging from 0 to 1.
+* An event whose probability of occurrence is 0 is certain not
to occur,
Where as an event whose probability is 1 is certain to
occur.
The classical definition of probability is as follows:
“if an event can occur in N mutually exclusive, equally likely
ways and if n of these outcomes have attribute A, then the
probability of A, written as P(A),equals n/N. “
This is an a priori definition of probability, that is, one
determines the probability of an event before it has happened.
Example: Assume one were to toss a die and wanted to
know the probability of obtaining a number divisible by
three on the toss of a die.
Here there are six possible ways that the die can land.
Of these, there are two ways in which the number on the
face of the die is divisible by three, are 3 and 6.
Thus,the probability of obtaining a number divisible by
three on the toss of a die is 2/6 or 1/3.
In many cases, however, we are not able to enumerate all
the possible ways in which an event can occur, and,
therefore, we use relative frequency definition of
probability.
This is defined as the number of times that the event of
interest has occurred divided by the total number of trials
(or opportunities for the event to occur).
Since it is based on previous data, “it is called the a
posteriori definition of probability”.
For instance, if you select at random a whit American
female, the probability of her dying of heart disease is .
00287.
Particular day,
let A be the event that the first man dies and let B be the
event that the second man dies.
The probability that both will die is
P(A and B)= P(A) P(B) = 15/100x 15/100 =0.15x0.15= 0225
BASIC EPIDEMIOLOGY
1 Introduction
Before the turn of the 19th century the world has witnessed
severe pains and agony due to sequence of epidemics.
Now we are facing CARONA Pandemic throughout the world
Several thousands of death tools of human lives occurred
because of dreadful infectious diseases.
The ravages of the Black Death, a plague in the 14th century are
well known.
In Europe alone, about 25 million deaths occurred in a
population of around 100 million.
Similarly reports came from China,UK, France , Spain ect., now
in USA and other parts of the world where millions of many
local populations were said to have died in widely scattered
areas due to Corona Virus .
Since the first case of AIDS was reported among homosexual men in
the USA in 1981.
Similary the first case of Corona found in Wuhan city of Chaina , now
it has reached pandemic proportions, as no country in the world is
free from HIV/AIDS and Corona
AIDS and its related syndromes have changed virtually every aspect of
medicine and society at large. whereas no medicine is not yet found
for Corona
Objectives:
After reading this chapter you should understand:
Definition of epidemiology:
The identity of the person who coined the term
epidemiology is unknown but it is derived from the
Greek words meaning study upon populations (epi
=upon, demos = people, ology =study).
This derivation does not convey what is studied or
the nature of that study.
“Epidemiology is concerned primarily with disease,
and how disease detracts from health.
A more descriptive word would be
epidemiopathology (pathos is the Greek word for
suffering and disease) but it is too clumsy to
recommend.
The word epidemic was used by Hippocrates, but
his writings were mainly compilations of the case
histories of affected people and not a study of the
causes or descriptions of the pattern of the
epidemic in the population.
.
*
Subclinical disease: An illness that is staying below the surface of clinical detection. A subclinical disease
has no recognizable clinical findings. It is distinct from clinical disease, which has signs and symptoms
that can be recognized.
* If we have sufficient knowledge about the causes of the disease and if these
causes are avoidable, then we may be able to propose effective preventive
programs.
CH-7
Measures of Disease Occurrence
* Public health priorities should be set by the combination of two aspects
1. How serious diseases are (i.e. it is a product of the number of persons suffering
from a disease and its impact on those affected and society).
* Public health bodies may focus on the big picture by taking the frequency of
disease and considers:
2. How to Prevent ill health and social impairments within available resources?, a
Measures of Diseases:
* We may use number of measures to describe the frequency of a disease.
1. we must count the number of people with the disease in the population
(i.e. called the prevalence of the disease).
2. Also must know how many new cases may appear over a given time
period?
the world and they are often considered strong indicators of general health. But
similar effort was not made so far to compute other epidemiological measures.
*Over a lifetime each of us will get a given disease or we will not get
the disease in question,
* If you die at the age of 30, you are less likely to suffer from a heart
stroke in your lifetime.
* On the other hand if you die at the age of 90 you are more likely to
die because of heart stroke.
Example:
1. Suppose, the person has a 25% risk of getting the disease within
the next 10 years it does not mean that he/she will be 25%
diseased.
It means that among, say, 1,000 people with his/her
characteristics will expect about 250 persons may develop the
disease.
Incidence Rates:
* Incidence rates are the most common measure of disease of
measure of disease in a population.
1. Point prevalence
2. Period prevalence
*The amount of disease present in a population is constantly changing
over time.
1. Example
Solution:
Denote x= No. persons used condom over the period of last 2 Months
Thus, the prevalence of condom use in the 2 months before the study
was 60% in this Population of patient.
2.Example :Two surveys were done of the same community 12
months apart. Of 5,000 people surveyed the first time, 25 had
antibodies to histoplasmosis. Twelve months later, 35 had
antibodies, including the original 25.Calculate the prevalence at
the second survey, and compare the with the 1-year incidence.
Solution:
y= population = 5,000
Risk Ratio :
*A risk ratio, or relative risk, compares the risk of some health-related event such
as disease or death in two groups.
*The two groups are typically differentiated by demographic factors such as sex
(e.g., males versus females) or by exposure to a suspected risk factor (e.g.,
consumption of potato salad or not).
*Among the two groups, the group of primary interest labeled the “exposed”
*Taking the group that we are primarily interested in the numerator; and the
other group will be placed in the denominator, thus,
* A risk ratio greater than 1.0 indicates an increased risk for the numerator group,
* While a risk ratio less than 1.0 indicates a decreased risk for the numerator
group
Example:
calculate the risk ratio of pellagra for females versus males. Pellagra is a disease
caused by dietary deficiency of niacin and characterized by dermatitis, diarrhea,
and dementia. The totals for females and males are also shown in below Table.
To calculate the risk ratio of pellagra for females versus males, we must first
calculate the risk of illness among females and among males.
Conside the below table
The odds ratio is sometimes called the cross-product ratio, because the
numerator is the product of cell and cell d, while the denominator is the
product of cell band a and cell d. A line from cell to cell d(for the numerator) and
another from cell b to cell c(for the denominator) creates an xor cross on the
two-by-two table.
To quantify the relationship between pellagra and sex, the odds ratio is calculated
as:
Problems
HOME ASSIGNMENT
Q.NO.1 Discuss Deductive and Inductive Inference in the context of Biostatistics
Q.NO.2. Discuss Karl Popper claims that “ induction arising from accumulation of
affirmative evidence doesn't strengthen a theory”
q.No.3. Define Probability and state the additive and multiplicative theorems
Q.No.4. Define Conditional and Bayesian probability. also use of Bayesian
probability
Q.No.5.Define Chi-Square Statistics and use of Contingency Tables
Q.NO.6. Define Epidemiology and explain its use and scope
Q.No.7. Define Incident Rate and Prevalence Proportion. Also define
interrelationship between them
Q.No.8. Define attack rate, secondary attack rate, risk ratio and odd ratio
Q.No.9 Two surveys were done of the same community in 2 years apart. Of 8,000
people surveyed the first time, 45 had Malaria. After one year, 65 had same
disease including the original .Calculate the prevalence at the first survey, and
Incidence rate.
Q.No.10.In a city survey conducted in a year out of 1000, about 180 people
suffering from a certain disease. Find Prevalence Proportion and what the
Incidence ratio after two years using prevalence proportion
Q.No.11. In a sample of size n denoted by Xi , where i= 1234…….n, each
Xi = 1 if disease is present
Xi = 0 if disease is not present
Estimate E (Xi) , Var( Xi ), sample proportion p, Var(p) and also 95%
confidence interval for p