Biostatistics and Epidemiology (Lecture)

Trans#1 – Introduction to Biostatistics

Prof. Bladimir C. Ocampo
21 September 2021

MODULE 1 INTRODUCTION TO BIOSTATISTICS 9. In systems biology

10. In agriculture
This module will introduce the students to the theory and 11. In genetics
application of Biostatistics, focusing on its application to 12. In physiology and anatomy
healthcare and medical laboratory science. It will cover
the process of data selection, data collection, data
presentation and data analysis.
M1 LESSON 2 TYPES OF EPIDEMIOLOGICAL STUDY
MODULE 1 | LESSON 1 - WHAT IS STATISTICS?
The two main types are Non-Experimental
What is Statistics? study and Experimental study. The other types of
studies branch out from these two main branches.
Statistics is the study and use of theory and methods for
the analysis of data arising from random processes or
phenomena.

What is Biostatistics?

Biostatistics is the branch of applied statistics directed

toward applications in the health sciences and biology.

PROCESS OF APPLYING STATISTICS

1. Making hypotheses Design

experiments and observational studies
2. Gathering data Summary of data
3. Drawing Interferences Testing of
M1 LESSON 2.1 POPULATION BASED STUDIES
hypotheses
Lesson 2.1 - Non-Experimental Studies - Population
Based Studies
This is also called Observational Study
This can be further divided into Population Based
Studies and Individual Based Studies

2 Types of Non-Experimental Studies

1. Population based studies

2. Individual based studies

APPLICATION OF BIOSTATISTICS
I. Population Based Studies
1. In community medicine and public health
2. In cancer research
3. In advanced biomedical technologies
4. In pharmacology
5. In ecology A. Descriptive study
6. In demography B. Analytic study
7. In population genetics and statistical
genetics
8. In bioinformatics

1
 Vocabulary Check! The word novel means new and
A. DESCRIPTIVE STUDY not resembling something formerly known or used.

This study aims to generate a hypothesis by B. Analytic Study

answering the following questions,
1. What?
2. Who? Examples - Cross-sectional study, Case-control study,
3. Where? and Cohort study
4. When?
1. Cross-Sectional Study
Person: characteristics (age, sex, occupation) of t To learn about the characteristics of a population
he individuals affected by the outcome at one point in time
Place: geography (residence, work, hospital) of the Does not use a comparison group
affected individuals
2. Case-Control Study
Time: when events (diagnosis, reporting; testing)
To study rare diseases
occurred
To study multiple exposures that may be related to a
Example: single outcome

Incidence Study 3. Cohort Study/ Longitudinal Study/ Follow-up

Newly reported or registered disease cases compared Study
over time, place, or person Can be used to find multiple outcomes from a single
Population estimates or other population group totals exposure
used as denominators A cohort is a well-
defined group of individuals who share a common
characteristic or experience

B. ANALYTIC STUDY

M1 LESSON 2.3 - EXPERIMENTAL STUDIES

This study aims to generate a hypothesis by
answering the the "why?" and "how?" questions.
The goal of this study is to measure the association
between exposure and outcome. This is divided into two branches - Randomized study
This type of study uses a comparison group. and Non-randomized study

Example:
I. RANDOMIZED STUDY
Ecological Study Under this branch is Clinical trial and Control trial
Rates are linked to the level of exposure to some
agent for the group as a whole
Randomized Controlled Trial (RCT) is a study in
which people are allocated at random (by chance
LESSON 2.2 - II. INDIVIDUAL BASED STUDIES alone) to receive one of several clinical interventions.

One of these interventions is the standard of

comparison or control.
A. Descriptive Study The control may be a standard practice, a placebo
("sugar pill"), or no intervention at all. Someone who
Example - Case reports takes part in a randomized controlled trial (RCT) is
called a participant or subject.
Case Reports are prepared for illustrating novel,
unusual, or atypical features identified in patients in RCTs seek to measure and compare the outcomes
medical practice, and they potentially generate new after
research questions. the participants receive the interventions. Because
the outcomes are measured, RCTs are quantitative
studies.

2
 MODULE 1 | LESSON 4 - METHODS OF DATA
PRESENTATION
II. NON-RANDOMIZED STUDY Lesson 4- Methods of Data Presentation
Under this branch are Quasi-experimental study, Field
trial, and Community trial Textual - The data gathered are presented in paragr
aph form. Data are written and read. It is a
Quasi-Experimental Research combination of texts and figures.
Shares similarities with the traditional experimental Tabular - Method of presenting data using the statist
design or randomized controlled trial, but it specifically ical table.
lacks the element of random assignment to treatment
or control. Graphical - The most effective manner of presenting
data since it can be easily understood. Examples are
Field Trial Pie, Barr, Venn, Histogram, Line Diagram and Epidemic
Applies preventive interventions to healthy individuals curve
Community Trial
Applies intervention to aggregative units Parts of a Tabular Data

1. Table heading consists of table number

Aims of Experimental Studies and title
2. Stubs categories which are found at the
To provide scientific proof of etiological factors left side of the body of the table
which may permit modification or control of disease 3. Box head the top of the column
To provide a method of measuring the effectiveness 4. Body main part of the table
and efficiency of health services for the prevention, 5. Footnotes any statement or note
control and treatment of disease and improve the inserted
health of the community. 6. Source Note source of the statistics

MODULE 1 | LESSON 3 - DATA COLLECTION AND

ORGANIZATION

LESSON 3 - WHAT IS DATA?

Data are observations of random variables made on the

elements of a population or sample. Data are the
quantities / numbers or qualities/ attributes measured or
observed that are to be collected and or analyzed.

What are the Types of Data?

Observational Data- researchers simply collect data

based on what is seen and heard and infer based on the
data collected. Researchers should not interfere with the
subjects or variables in any way.
An important skill to learn is how to
Experimental Data -
properly create graphs, which you will be
researchers produced this by measurement,
using in thesis writing. Just remember that
test method, experimental design. The researcher has
a table should always be complete with all
control over some variables.
the parts. A common mistake is forgetting to indicate
the table heading - this should have the Table
Number and Title.

3
 MODULE 1 | LESSON 4.1 - TYPES OF GRAPHICAL patterns, and identify extreme or unusual values
PRESENTATION (outliers) for checking or further investigation.

LINE PLOT
Lesson 4.1 - Types of Graphical Presentation

Graphical presentations when used properly are a

powerful tool in quickly and effectively relaying
information to your audience. However, you need to take
into consideration the type of data you are going to
present, and your target demographic who will view your
graph.

"An important skill to learn is how to

effectively explain a graph. This skill is
essential for your thesis writing or research
subject. A simple tip is to be direct to the point
and explain it as simple as possible, relying on One common situation where line plots are often
information that exists on the graph. useful is where the x- axis represents some sequential
variable like time, or distance along a transect (right,
When explaining a graph, you goal is to guide the and below). In both cases there is an explicit (spatial
viewer on what they should be taking note of. You are or temporal) relationship between adjacent points
NOT supposed to draw a conclusion based on a along the x-axis, and the inclusion of the line makes
graph, you are just going to explain what is on the the pattern of this sequence much clearer.
graph."

Here are the different types of graphical presentation.

DOUBLE Y PLOT

SCATTERPLOT

The name suggests, have two different y-

axes, allowing variables with different scales to be
plotted on the same graph. Primarily used in the same
sorts of situations as line plots, where you want to
compare the pattern of change in two different types
of variable.
To examine a relationship between two (non-
sequential) variables.

It is hard for such a graph not to be informative about

the data since all the
data points are explicitly represented, hence it is
very good for examining data to get a 'feel' for the

4
BAR CHARTS PIE CHART

Probably the most widely used type of graph in

science. Bar charts are usually fairly straightforward to
produce, and generally are either used to represent Pie diagrams are familiar to everyone, much beloved
means (and appropriate error bars), as in the gra of business graphics packages
ph here (right), or counts of some sort, including and the media, but of relatively limited use for sci
proportions or percentages. This chart can be entific figures.
presented horizontally or vertically.

HISTOGRAM
AREA PLOT

A histogram is a plot that lets

Area plots combine features of line plots you discover, and show, the underlying frequency
and stacked bar charts. They distribution (shape) of a set of continuous data.
have similar disadvantages to the latter, though si FREQUENCY TABLE
nce such plots are
generally used to show trends in time or space it
is often easier to
interpret, as the patterns of expansion or contracti
on of areas on the graph have a logical meaning.

method of organizing raw data in a compact form by

displaying a series
of scores in ascending or descending order, t
ogether with their frequencies

5
VENN DIAGRAM MODULE 1 | LESSON 5 - ROLES OF QUANTITATIVE
RESEARCH IN PUBLIC HEALTH

Here are the different roles and applications of

quantitative research to public health,

1. Survey Study - is used to estimate the extent of

the disease in the population.

2. Surveillance Study - is designed to monitor or

detect specific diseases.

3. Observational Study - investigate association

between an exposure and a disease outcome.

exposed or non-exposed groups.

4. Experimental Study - also investigate the

association between an exposure, often
A diagram representing mathematical or logical sets therapeutic treatment, and disease outcome
pictorially as circles or
closed curves within an enclosing rectangle (the u treatment groups by the investigators.
niversal set), common elements of the sets being
represented by the areas of overlap among the
circles.

EPIDEMIC CURVE

A visual
display of the onset of illness among cases associ
ated with an outbreak.

6
Biostatistics and Epidemiology LECTURE 2nd Year BSMT

Conveniency

Non-biased

Eliza Mae Regino Landero

Biostatistics and Epidemiology LECTURE 2nd Year BSMT

LESSON 2

LESSON 3

Eliza Mae Regino Landero

Biostatistics and Epidemiology LECTURE 2nd Year BSMT

Lesson 4
Measures of Central Tendency for
Grouped Data

Eliza Mae Regino Landero

Biostatistics and Epidemiology
LECTURE / WEEK 2 / MODULE 3 4

Module 3 | Lesson 1.1 Ratio - Age

LEVELS OF MEASUREMENTS - Weight
exactly the same as - Height
EXAMPLES the interval scale - Sales Figures
Nominal o Gender: Male, except that the zero on - Ruler measurements
- nominal is Female, Other. the scale means: does - Income earned in a
from the o Hair Color: Brown, not exist. For week
Latin nomalis, Black, Blonde, Red, example, a weight of - Years of education
which means Other. zero doesn’t exist; an - Number of children
“pertaining to o Type of living age of zero doesn’t
names”. It’s accommodation: exist.
another name House, Apartment,
for Trailer, Other. Module 4 | Lesson 1
a category. o Genotype: Bb, bb, Lesson 1 – Tools of Demography
BB, bB.
o Religious preference: Demographic The study of components of
Buddhist, Mormon, Analysis - variation and change in
Muslim, Jewish, demographic variables and the
Christian, Other. relationships between them.

Ordinal o High school class Population The study of the relationships

ranking: 1st, 9th, Study between demographic variables
means in order. 87th… and other variables such as social
Includes “First,” o Socioeconomic and economic variables.
“second” and “ninety status: poor, middle
ninth.” class, rich Population It is a structure based on gender,
o Likert Scale: Composition race or other factors that can be
The ordinal scale strongly disagree, inserted to.
classifies according to disagree, neutral,
rank. agree, strongly agree
o Level of Agreement: Tools of Demography
yes, maybe, no
o Time of Day: dawn, 1. Count
morning, noon,
afternoon, evening, - The absolute number of a population or any
night demographic event occurring in a specified area
o Political in a specified time period.
Orientation: left,
center, right 2. Ratio

Interval - Celsius Temperature - The relation of one population subgroup to the

- Fahrenheit total population or to another subgroup; that is,
has values of equal Temperature one subgroup divided by another.
intervals that mean - IQ (intelligence
something. For scale) Rate
3. Ratio
example, a - SAT scores
thermometer might - Time on a clock with - The frequency of demographic events in
have intervals of ten hands population during a specified time period
degrees.
VERDILLO 1
Biostatistics and Epidemiology
LECTURE / WEEK 2 / MODULE 3 4

divided by the population “at risk” of the event Lesson 1.1 - Computation for Ratio
occurring during that time period.
Formula for Ratio = # of cases / # of cases
4 TYPES OF RATES Answer is expressed as "is to 1"

Incidence Rate 70 new cases of breast Example #1

rate at which a new event occurs cancer per 1,000 women
over a specified period of time
per year*
Attack Rate/Incidence 20 or 130 persons Category No. of Cases
Proportion/Risk developed diarrhea after
proportion of those who became ill attending a picnic.
after a specified exposure

Prevalence Rate 70 influenza case-patients Diabetic Men 189

in March 2019 reported
proportion of a population who have
a specific characteristic in a given in Taguig City.
time period.
Nondiabetic Men 3,151
Case-fatality Rate 2 deaths due to HIV in
proportion of deaths within a defined Pasay City.
population of interest
Diabetic Women 218

4. Proportion

- The relation of a population subgroup to the Nondiabetic Women 3,823

entire population; that is, a population subgroup
divided by the entire population.
Table 1. Comparison of Diabetes Status of Men and
5. Constant
Women
- An unchanging, arbitrary number by which
o What is the ratio of non-diabetic women to
rates, ratios, or proportions can be multiplied to
diabetic women?
express these measures in a more understandable
o Ratio = # of cases of non-diabetic women / # of
fashion.
cases of diabetic women
o Ratio = 3,823 / 218
6. Cohort Measure
o Ratio = 17.53 or 18 (We will round off the
answer to 18 since we cannot refer to humans as
- A statistic that measures events occurring to a
decimals)
COHORT (a group of people sharing a common
demographic experience) who are observed
Final Answer: There are 18 non-diabetic women
through time.
for every 1 diabetic woman (18:1)
7. Period Measure
Lesson 1.2 - Computation for Rate
- A statistic that measures events occurring to all
or part of a population during one period of time. Formula for Rate = (# of cases / # of total cases) x 100

Answer is expressed in percentage (unless needed to be

expressed per person)

Example #1
VERDILLO 2
Biostatistics and Epidemiology
LECTURE / WEEK 2 / MODULE 3 4

In 2003, 44,232 new cases of acquired

immunodeficiency syndrome (AIDS) were reported in
the United States. The estimated mid-year population of
the U.S. in 2003 was approximately 290,809,777.

Calculate the risk of AIDS in 2003 per 100,000 persons.

Rate = (44,232 / 290,809,777) x 100,000

Rate = 0.00015 x 100,000
Rate = 15.2 or 15

Final Answer: 15 per 100,000 persons were at risk of

AIDS in the United States in 2003

VERDILLO 3
 Module 6 | Lesson 1 Infectious - Spread from
SPREAD BY FECAL ORAL ROUTE mononucleosis(“kissing person to person
disease”) and by direct contact.
• According to the CDC, Fecal Oral Route is the gonorrhea - All terms
spread of microorganism from the infected stool popularly used for
of one person into the mouth of another; may the very common
occur via fecal contamination of food or water infection typically
supply, or by hand -to-mouth transmission caused by the
following inadequate hand washing after Epstein-Barr Virus
touching contaminated items. (EBV)
Hookworm - Spread by direct
contact with
Entamoeba Is transmitted contaminated soil.
histolytica(cyst) orally by ingestion
of food, water or
vegetables WHAT ARE THE DISEASES THAT CAN BE
contaminated by THROUGH DIRECT CONTACT
the feces that - Chicken pox, common cold, conjunctivitis
contain the (Pink Eye), Hepatitis A and B, herpes
infected with this simplex (cold sores), influenza, measles,
will develop mononucleosis, Fifth disease, pertussis,
Amebiasis. adeno/rhino viruses, Neisseria meningitidis
Salmonella Is spread by the and mycoplasma pneumoniae.
fecal-oral route,
which means it is
shed in the stool of Lesson 3
host and enters the VECTOR BORNE
mouth of the next Vector
host by some Borne - Diseases can also be
means. transmitted by a mechanical
or biological vector, an
Both humans and
animals are animal (typically
an arthropod) that carries
infected with
salmonella. the disease from one host to
another.
Lesson 2 - Mechanical transmission is
SPREAD THROUGH DIRECT CONTACT facilitated by a mechanical
vector, an animal that
carries a pathogen from one
host to another without
Direct - Occurs through
being infected itself.
Contact skin-to- skin
contact, kissing,
and sexual
intercourse.

- Refers to contact
with soil or
vegetation
harboring
infectious
organisms.
 Ex. a fly may land
on fecal matter and WHAT ARE DIFFERENT TYPES OF
later transmit NCD’s
bacteria from the
feces to food that it 1. Cardiovascular Disease
lands on; a human 2. Cancer
eating the food may 3. Respiratory Disease
then become 4. Type 2 Diabetes
infected by the 5. Other NCDs
bacteria, resulting
in a case of diarrhea
or dysentery.

Lesson 4
SPREAD THROUGH AIRBORNE

Airborne - greater than one meter

Transmission or 3 feet is
called airborne
transmission.

Examples:
- Tuberculosis, measles,
chickenpox,
disseminated herpes
zoster

Lesson 5
NON- COMMUNICABLE DISEASE (NCD)

Non Communicable - Noncommunicable

Disease diseases (NCD's),
also known as
chronic diseases, are
not passed from
person
to person. They are
of long duration and
generally slow
progression
Module 7 10. Research for new insights and
innovative solutions to health problems
Lesson 1 - Public Health
Lesson 2 - Levels of Disease Prevention

Diagram on the Three Levels of Disease

Prevention

Introduction
The Diagram of The 10 Essential Public A distinction is usually made between "Primary
Health Services Prevention", in which measures are applied
to prevent the occurrence of a disease,
and"Secondary Prevention", where a disease
or its complications are halted or averted at any
The 10 Essential Public Health Services point after the onset of disease.

1. Monitor health status to identify and Primary Prevention

solve community health problems Key Concept: Disease Prevention and Health
2. Diagnose and investigate health Promotion
problems and health hazards in the Examples: Immunizations or vaccinations, stop
community smoking
3. Inform, educate, and empower people This consists of the manipulation of man's
about health issues environment, his water supply, the air
4. Mobilize community partnerships to one breathes, and also the manipulation of man
identify and solve health problems himself by such measures as immunization
5. Develop policies and plans that support against infectious disease.
individual and community health efforts
6. Enforce laws and regulations that Secondary Prevention
protect health and ensure safety
7. Link people to needed personal health Key Concept: Diagnosis and Cure
services and assure the provision of Examples: Screenings such as mammograms,
health care when otherwise unavailable PAP tests, Mantoux Test
8. Assure a competent public and Involves: Lifestyle changes to prevent disease
personal health care workforce such as starting a low cholesterol diet or joining
9. Evaluate effectiveness, accessibility, a physical activity program
and quality of personal and population- This includes therapy to prevent the spread of
based health services disease to non-affected individuals,
identification of those in the early stages of a
disease process when treatment should be most Mode of Transmission – How pathogen carried
effective. from one place to another.
Portal of Entry – Where pathogen enter the
Tertiary Prevention host.
Susceptible Host – The host is the person who
Key Concept: Rehabilitation, Health cannot defend against pathogens such as the
Restoration and Palliative Care elderly or the immunocompromised patients.
Involves: Rehabilitation after a stroke, and
comfort care for the terminally ill Lesson 4 - Methods to Stop Communicable
This is the prevention or delay of the Diseases
consequences of clinically advanced disease by
both therapy and rehabilitation. This is a result What is a Communicable Disease?
of failure of primary or secondary prevention at Another term for communicable disease is
some earlier stage in the disease process. infectious disease or contagious disease. This
refers to diseases that can be passed on or
"A patient diagnosed with chronic "infected" to another human being. According to
hypertension who needs to take regular the CDC, this can happen from direct or indirect
"maintenance" or anti-hypertensive transmission of infectious agents.
medication is categorized under Tertiary
Prevention. The disease already exists and the An example of communicable disease is the
patient is aware of the existence of disease, common cold, sexually transmitted diseases and
however must maintain their health through fungal infections.
medication."
"Diabetes and obesity are NOT communicable
What is Rehabilitation? diseases because they are not passed from
Rehabilitation is the action of restoring someone human to human."
to health or normal life through training and
therapy. 10 General Methods to Control
Victims of stroke or recent bone or muscle injury Communicable Disease
can be rehabilitated back to
1. Notification - Once an infectious disease has
Lesson 3 - Chain of Infection been detected for even suspected, it should be
notified to the local health authority, whose
Medical Technologist are exposed to disease in responsibility is to put into operation control
different aspects of their work. Medical measures including the provision of medical care
Technologists can have direct contact with the to patients
Patient during Phlebotomy. Specimen containers
for blood/stool/urine and other body fluids can 2. Early Diagnosis and Prompt Treatment -
be reservoirs for viruses and bacteria. As future The infection will rapidly spread to the
Medical Technologists you should be aware of community without early diagnosis. Clinical
how to break the chain of infection to protect diagnosis with epidemiological support is
yourself from disease. sufficient enough to warrant treatment and
appropriate control measures. Treatment is
Infectious Agent – an organism having the targeted to the reservoir or source of infection.
ability to cause disease. Proper and adequate treatment should be given
Reservoir – Where pathogens can reproduce. in order to kill the infectious agents or to reduce
(Ex. Table tops, door knobs, and people). the number of infectious agents in the reservoir
Portal of Exit – Where the pathogen leaves the or source. Inadequate and improper treatment
reservoir. (ex. Sneezes, or coughs) will reveal chronic cases, carrier state and drug
resistant problems
3. Reporting - This must be started from the 8. Immunoprophylaxis - It is used to prevent
area of an epidemic outbreak to WHO within 24 disease by giving immunizing agents. Its main
hours. There is definite detail procedure for goal is to produce herd immunity to the risk
reporting with specific forms. There should be population
control measures for clinically showing patients.
Passive Immunization - Administration of
4. Isolation - It is the separation of patient from prepared antibodies.
other person for the communicable period of a Active Immunization - Administration of
particular disease. Separation should be done in antigen in the forms of vaccines and toxoids .
such places and under such conditions as will
prevent direct spread of infection from an 9. Chemoprophylaxis - To prevent from the
infected person to the healthy persons development of an infection or the progressive
of an infection to actively manifest disease,
5. Quarantine - It is the prohibition of some drugs can be administered
movement of persons who have been exposed to
communicable disease in order to prevent them 10. Health - The essential duty of every health
from coming into contact with those not so workers is to educate the community about
exposed. Any members of the family are not disease causation, clinical features, mode of
allowed to move outside of their house, the transmission, prevention, importance of
whole village, a block of town or a sea vessel. notification, immunization, personal hygiene and
environmental sanitation, etc.
2 Types of Quarantine
Inner Quarantine- imposed on the infected Lesson 5 - Epidemiology
house
Outer Quarantine- placed on the infected What is Epidemiology?
village or ward
basic science of preventive and social medicine.
6. Disinfection - Killing of infectious agents It is the scientific discipline of public health to
outside the body by means of physical or study diseases in the community to acquire
chemical disinfectants knowledge for the health care of the society.

Concurrent Disinfection - Application of

disinfective measures as soon as possible after
the discharge of infection material from the body
of an infectious person. Consists of disinfection
of urine, feces, vomit, clothes, hands, and
gloves.

Terminal Disinfection - Application of

disinfective measures after the patient has died
or has ceased to be a source of infection.

7. Disinfestation - It is used to destroy or

remove undesired small animal forms arthropods
or rodents present upon the person, the clothing,
in the environment, or domestic animals by
using Insecticides, Rodenticides, Larvicides,
Repellants and Gassing.
Figure 1. Natural History and Spectrum of
Disease
What is a Carrier?
A carrier is a person who are infectious but with
subclinical disease. An asymptomatic person is
usually a carrier.

Parts of Subclinical Diseases

A. Induction – time of disease initiation
B. Incubation – time of symptoms
C. Latency – time of detection in non
communicable and infectiousness in
Communicable.

Level of Disease Occurrence

A. Sporadic – disease that occurs infrequently
or irregularly
B. Endemic – constant presence or usual
prevalence of disease within an area
C. Hyperendemic – persistent high levels of
disease occurrence
D. Epidemic – sudden increase in number of
cases of disease in the population
E. Outbreak – same as epidemic but within
more limited area
F. Pandemic – epidemic that spread over
several countries or continents