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Epidemiology and Biostatistics Review, Part Ii: Danielle Tsingine Chang MSII

- This document provides an overview of key epidemiological and biostatistical concepts including incidence vs prevalence, sensitivity and specificity, predictive values, quantifying risk, mortality rates vs case fatality rates, and statistical tests such as t-tests, ANOVA, and chi-squared tests. - It defines key terms and concepts and provides examples to illustrate how to calculate and apply measures such as relative risk, attributable risk, predictive values, and odds ratios. - The document compares different statistical tests and explains that t-tests are used to compare means between two groups, ANOVA between three or more groups, and chi-squared to compare categorical variables and frequencies rather than means.

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108 views

Epidemiology and Biostatistics Review, Part Ii: Danielle Tsingine Chang MSII

- This document provides an overview of key epidemiological and biostatistical concepts including incidence vs prevalence, sensitivity and specificity, predictive values, quantifying risk, mortality rates vs case fatality rates, and statistical tests such as t-tests, ANOVA, and chi-squared tests. - It defines key terms and concepts and provides examples to illustrate how to calculate and apply measures such as relative risk, attributable risk, predictive values, and odds ratios. - The document compares different statistical tests and explains that t-tests are used to compare means between two groups, ANOVA between three or more groups, and chi-squared to compare categorical variables and frequencies rather than means.

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© © All Rights Reserved
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You are on page 1/ 32

EPIDEMIOLOGY AND

BIOSTATISTICS
REVIEW, PART II
Danielle Tsingine Chang MSII

Topics to be covered today:


Incidence vs. prevalence
Sensitivity
Specificity
Negative and Positive Predictive Value
Case fatality
Quantifying risk
T-test
ANOVA
Chi-square

Incidence vs. Prevalence


Incidence

Prevalence

The number of new cases that

The number of affected persons

Incidence is a rate because it

Useful measure of burden of

occur during a specified period


of time in a population at risk
for developing the disease

includes time

= # of new cases of a disease

in a specified time period /


Population at risk of developing
disease during same time
period

present in the population at a


specific time divided by the
number of persons in the
population at that time
disease in a community

= # of existing cases / Population

at risk

Prevalence Incidence x

disease duration

Incidence and Prevalence


How can we increase prevalence?
Add new cases i.e. increase the incidence
of a disease

How can we decrease prevalence?


Death or cure = reduce the number of
diseased persons in the population

Disease X has an incidence of 5 per 1,000 per year and 80% of the
people with the disease will die from it. Before 1985, lab test A was
used to detect the disease. In 1985, a screening test B was developed
that could detect disease X two years earlier than test A. However,
early detection of the disease did not improve prognosis for disease X.
Assume after 1985, all people were screened for disease X using test
B and that test B has a higher sensitivity and specificity than test A.
Compare the incidence and prevalence of disease X in 1984 to 1985,
the year test B was first used.
In 1985, it is true that:
a. Incidence is higher and prevalence is higher than in 1984
b. Incidence is higher in 1984 and prevalence remains the same
c. Incidence is the same and prevalence is higher than in 1984
d. Both incidence and prevalence are the same as in 1984
e. Incidence is the same as in 1984 and prevalence is lower than in
1984

Answer
A. Incidence is higher and prevalence is higher than in

1984
Test B catches disease X two years earlier than test A, thus
the duration of the disease is increased. It is also more
sensitive and specific, so you are catching more new cases
i.e. increasing the incidence
Prevalence = incidence x duration of disease

The incidence of a chronic disease in a population may be


decreased by:
a. Prolonging the lives of persons with the disease
b. Decreasing the case-fatality rate for the disease
c. Improving the treatment of the disease once it has been

diagnosed
d. Primary prevention
e. Secondary prevention

Answer
d. Primary prevention
Primary prevention = prevent disease occurrence (i.e.
vaccine), thus prevent the numbers of new cases
Secondary prevention = early detection of a disease (i.e.
screening)
Tertiary prevention = reduce disability from disease (i.e.

Sensitivity and Specificity


Used more often in a public health setting
In effect, we are asking, If we screen a population, what

proportion of people who have the disease will be


correctly identified?

Sensitivity
How good is the test in correctly identifying those who

had the disease?

Definition: Proportion of diseased people who were

correctly identified as positive by the test

Sensitivity = True Positives/(True Positives + False

Negatives) OR = 1 false-negative rate

Value close to 100% is desirable for ruling out disease


Used for screening in diseases with low prevalence

Specificity
How good is the test in correctly identifying those who did

not have the disease?

Definition: proportion of non-diseased people who are

correctly identified as negative by the test

Specificity = True Negatives / True Negatives + False

Positives OR = 1 false-positive rate

Value close to 100% is desirable for ruling in disease


Used as a confirmatory test after a positive screening test

Positive and Negative Predictive value


Used more often in a clinical setting
We are asking, If the test result is positive in this patient,

what is the probability that this patient truly has the


disease?

Positive Predictive Vale


What proportion of patients who test positive actually have the

disease in question?
Definition: proportion of positive test results that are true positive
PPV = True positives / Total number who tested positive (TP + FP)
PPV varies directly with prevalence high prevalence = high PPV

Negative Predictive Value


If the test is negative, what is the probability that this patient does not

have the disease?


Definition: Proportion of negative test results that are true negative
NPV = True Negatives / All people who tested negative (TN + FN)
NPV varies inversely with prevalence high prevalence = low NPV

Pulling it all together


A physician examined a population of 1,000 patients in an
attempt to detect heart disease. The prevalence of heart
disease in this population is known to be 15%. The
sensitivity of the physicians exam is 60% and the
specificity is 80%. Patients who test positive by the
physician are sent for examination by a cardiologist.
1. What is the total number of people who test positive for
a.
b.
c.
d.
e.

heart disease based on the physicians exam?


90
260
60
680
740

Answer
b. 260
Step 1: Prevalence is 15%. If the population is 1,000, then 150 total have heart
disease (1,000 X 0.15 = 150)
Step 2: Set up 2x2 table using the given values for sensitivity (60%) and
specificity (80%)
1.

A physician examined a population of 1,000 patients in an


attempt to detect heart disease. The prevalence of heart
disease in this population is known to be 15%. The sensitivity
of the physicians exam is 60% and the specificity is 80%.
Patients who test positive by the physician are sent for
examination by a cardiologist.
2. What is the positive predictive value of the physicians
a.
b.
c.
d.

exam?
34.6%
78.8%
85.0%
91.9%

Answer
2. a. 34.6%

Quantifying risk
How do we determine whether a certain disease is

associated with a certain exposure?


To determine whether an association exists, we can use

data from case-control and cohort studies

Odds Ratio
Most often used in case-control studies
Defined as the ratio of the odds that the cases were exposed to the

risk factor to the odds that the controls were exposed

Relative Risk
Used most often in cohort studies
Defined as the risk (i.e. incidence) of developing disease

in the exposed group divided by the risk in the unexposed


group

Attributable risk
Defined as the difference in risk between exposed and

unexposed groups, or the proportion of disease


occurrences that are attributable to the exposure

Absolute risk reduction (ARR) and


Number needed to treat and harm
ARR is defined as the absolute reduction in risk associated with a

treatment as compared to a control


Number needed to treat is defined as the number of patients who

need to be treated for 1 patient to benefit

Number needed to harm is defined as the number of patients who

need to be exposed to a risk factor for 1 patient to be harmed

A study was performed to determine if an association exists between


smoking and lung cancer. In this study, 100 people with a history of
smoking tobacco for 10 years and 100 people with no smoking history
were followed for 20 years, and the incidence rates for lung cancer
were compared in the two groups. The results are below.
Developed lung
cancer

Did not develop


lung cancer

(+) Smoking

40

60

( - ) Smoking

10

90

What is the relative risk for lung cancer in the exposed group?
a. 5
b. 10
c. 4
d. 3
1.

Answer
1. c. 4

RR = Incidence rates in the exposed / incidence rates in


the unexposed
RR = (40/40+60) / (10/10+90) = 0.4/0.1 = 4

A study was performed to determine if an association exists between


smoking and lung cancer. In this study, 100 people with a history of
smoking tobacco for 10 years and 100 people with no smoking history
were followed for 20 years, and the incidence rates for lung cancer
were compared in the two groups. The results are below.

Calculate the attributable risk and the absolute risk reduction

Or the incidence in the exposed the incidence


in the unexposed
AR = 0.4 0.1 = 0.3 means that 0.3 (or 30%) of people who smoke
develop lung cancer as a result of smoking (i.e. the exposer)
Absolute risk reduction percent = (40% of those who smoke develop lung
cancer) (10% of those who do not smoke develop lung cancer) = 30%
Describes the difference in risk of developing lung cancer between smokers
and nonsmokers.

Mortality rate vs. case-fatality rate


Mortality rate = a rate calculated

by dividing the # of deaths


occurring in the population during
a stated time period / # of persons
at risk of dying during the period

Can limit the population by age,

gender, and disease i.e.

annual mortality rate from all causes for

children younger than 10 years


annual mortality rate from lung cancer in
one year

Key: the denominator represents

the entire population at risk of


dying from the disease, including
those who have the disease and
those who do not (but are at risk
of developing disease)

Case-fatality rate = # of

individuals dying during a


specified period of time after
disease onset or diagnosis / # of
individuals with the specified
disease

Key: denominator is limited to

those who already have the


disease

Measure of the severity of the

disease

t-test vs. ANOVA vs. Chi-squared


t-test = checks the difference between the means of 2

groups
ANOVA = checks the difference between the means of 3

or more groups
Chi-square = checks the difference between 2 or more

percentages or proportions of categorical outcomes (NOT


mean values); used for frequency data rather than for
comparison of means

A physician is studying the effects of drug A and drug B on


cognitive performance in Alzheimer patients. She
administers a memory test to two groups of subjects (those
taking drug A and those taking drug B) and compares their
mean scores. Which of the following statistical tests would
be most appropriate for this purpose?
a) ANOVA
b) Chi-square test
c) Linear regression analysis
d) t-test
e) Multiple linear regression

Answer
d. t-test

t-test is used to compare two means derived from two


samples

Resources
Gordis, Leon. Epidemiology. Philadelphia: Saunders
Elsevier, 2009.
Le, T. and V. Bhushan. 2013. First aid for the USMLE step
1 2013. New York: McGraw-Hill Medical.
USMLE Step 1 Qbook, Fifth edition

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