Good Morning…

07/23/2021 1
BIOSTATISTICS

PR ES EN T ED BY :
D R . PA L LA B I S A R K A R
M D S BATC H 2 0 2 0
07/23/2021 D EP T. O F C O N SE RVATI V E D E N TI ST RY 2 A N D
 Under the guidance of :
Dr ANIL DHINGRA Dr TARUN SHARMA
HOD & PROF. PROF.
DEPARTMENT OF CONSERVATIVE DEPARTMENT OF DENTOFACIAL
DENTISTRY AND ENDODONTICS. ORTHOPEDICS
SDCH SDCH

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 1. Introduction
2. Research methodology
 Problem formulation
 Hypothesis formulation

Contents:
 P value
 Sampling
 Data
 Presentation of data
3. Analysis and interpretation:
 Measures of central tendency
 Measures of dispersion
 Tests of significance
4. Health information system
5. Conclusion
07/23/2021
6. References 5
 STATIST
ICS:
Statistics is the science of compiling, classifying
and tabulating and analyzing data and
expressing the results in a mathematical or
graphical form and draw conclusions from data.

The word ‘Statistics’ coined by political scientist

Gottfried Aschenwall (1719-72).
Essentials of public health dentistry 6th edition-
Soben Peter.

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 General overview:
Collecting
Organizing
Descriptive statistics
Summarizing
Presenting data

Statistics
Estimation
Hypothesis testing
Inferential statistics Relationship
Making inference
Making predictions
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 Biostatistics:
“A single death is a tragedy; a million deaths is
a statistic.”
Joseph Stalin

Statistical processes and

It is a method of collecting ,
methods applied to the
organizing ,analyzing,
analysis of biological
tabulating and interpreting
phenomena - Merriam-
the data related to living
Webster's Medical
organism and human being
Dictionary

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Uses of biostatistics:
To test whether the difference between two populations is real or chance
occurrence.
To study the correlation between attributes in the same population.
To evaluate the efficacy of vaccines, sera, etc.
To measure mortality and morbidity.
To evaluate the achievements of public health programs.
To fix priorities in public health programs.
To help promote health legislation and create administrative standards for oral
health.

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 Research methodology

RESEARCH- Together they form a careful and systemic

study or investigation in some field of knowledge
undertaken to establish facts or principles

RESEARCH METHODOLOGY- Is a way to systematically

solve the research problem. It may be understood as
a science of studying how research is done
scientifically
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 TYPES OF RESEARCH
Observational study -1) Descriptive and analytical
2) Cross sectional and longitudinal

Experimental study - Randomized control trial

1)Cross over study
2)Concurrent parallel study.
Ecological study

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Steps involved in research method:

Problem formulation
Objective
Study Design
Sample size calculation
Hypothesis formulation
Collection of data BIOSTATISTICS
Summarization & Analysis of data
Presentation of data
Interpretation of results
Writing the report.

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 Research question?
Problem formulation:
A researchable
problem is a
statement or question
that poses an
unknown relationship
between variables and
serves to focus the
entire investigation.
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Hypothesis formulation:
Hypothesis are carefully constructed
statements about a phenomenon in
the population.
Null
It can be defined as tentative hypothesis.
prediction or explanation of the Hypothesis
relationship between two or more : Alternative
variables. hypothesis.

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 For example, a study designed to look at
the relationship between sleep deprivation
and test performance might have
a hypothesis that states, "This study is
designed to assess the hypothesis that
sleep-deprived people will perform worse
on a test than individuals who are not
sleep-deprived."

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 Null Hypothesis:
It is the statement that there is no difference
between the variables we are testing.
Statistical tests allow us to either “reject” or
“fail to reject” the null hypothesis.

H0: μ1 – μ2 = 0
H0 : the average number of subjects getting
better in the test group is no different from the
average number of subjects in the placebo
group. Essentials of public health dentistry 6 edition- Soben Peter.
th
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 P value:

Probability
It is defined as the probability under the assumption of
null hypothesis, of obtaining a result equal to or more
extreme than what was actually observed. P value

It is calculated from a statistical test. It tells us whether

we should reject the null hypothesis.

The probability that a difference of at least as extreme

as those found in the observed data would have
occurred by chance when null hypothesis is true.
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Whether or not to reject the null hypothesis
is determined by whether the p value is
below a certain cut-off, which we call the
level of significance.

Probability
Traditionally we tend to set alpha at either
0.05 or 0.01.
P- Value

High P value of 0.8, 0.6, or 0.1 indicates high α- Value

probability to get the observed result due to

chance. It favours null hypothesis.
Low P value 0.001, 0.01 or 0.05 indicates low
probability to get the observed result due to
chance.
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For example:
If we are testing whether the average height of two groups of
children are different, and perform a t-test to produce a p-value
of 0.02, setting α = 0.05, we can conclude that null hypothesis is
rejected and that two groups do indeed have different average
heights.
Probability

α
p- value

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Accurately, the p-value is the probability of your test incorrectly
rejecting the null, when indeed the null hypothesis is true.

A useful memory aid:

If the p is less than the level of

significance, the null hypothesis is
rejected.
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 Basis for statistical analysis

Population Variables (characteristics) Probability distribution

(U) (V) (P)

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 Sampling from population:

• When a large proportions of individuals or

units have to be studied, we take a sample.
Easier and economical.
• Important to ensure that group of people or
items included in sample are representative
of whole population to be studied.

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 Errors in Sampling:
• Faulty sample
Sampling
error:
design or small
size of sample.

• Coverage error
Non • Observational
sampling
errors: error
• Processing error. 29
Essentials07/23/2021
of public health dentistry 6th edition- Soben Peter.
Variables:
A logical or numerical set of attributes (gender, age, etc. )
In math we write the relationship between 2 variables as a function
e.g. F(x) = 210 – x
Maybe this is the relationship between age and maximum attainable
heart rate.
F(x) = max Heart rate = HR
x = age

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 In mathematics:
Dependent variable Independent variable

HR = 210- x

Outcome Exposure
In epidemiology:

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Types of variables :

Continuous Categorical (Discrete)

Age, Height, Age group, Gender,
Distance, number of siblings,
Temperature. citizenship, race,..
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 DATA:
Demographic data comprise details of
population size, geographic distribution, ethnic
groups, socio-economic factors and their
trends over time.
Such data are obtained from: census, surveys,
experiments, hospital records, disease register
and other public service reports.

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 Data

Quantitative Qualitative

Discrete Nominal

Continuous Ordinal

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 Quantitative Data
Observations follow a direction and are quantifies on scale of
measurement and can be expressed in numeric value.

AGE:

WEIGHT:

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 Discrete data
This is a quantitative data, where the
variables assume whole numbers but not
fractions.

Size of a family

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 Continuous data
It can take a range of the value on a continuum, i.e. its range is
uncountable infinite.
It can take any fraction of a value, as small as the measuring
instrument permits.

Essentials
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 Qualitative data
Characteristics of people or a object which can not be naturally
expressed in a numeric value.

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Nominal data
◦ Categories are mutually exclusive and unordered.
◦ They are “naming” or categorical variable that have no measurement scale

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 Ordinal (ranked) data
◦ Categories are mutually exclusive but ordered.

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 Dichotomous variable
Most common type of categorical variable.
It has two levels or two possible values.

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 Bias:
Bias is any systematic
error in the design, Investigator

conduct or analysis of a
Extraneous
study that results in variables.
Participant

distortion of truth.
Sources of bias

Instruments Statistician

Literature

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 SURVEYS
Carried out for RECORDS
EXPERIMENTS Epidemiological studies in Records are maintained
Performed to collect the field by trained teams to as a routine in
data for investigations find incidence or prevalence registers and books
and research by one or of health or disease in a over a long period of
more workers. community. time provide
readymade data.

Sources of
statistical
data
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Depending on source data can be:
• First hand information from site visits.
Primary • The accuracy of information can be
controlled by the recorder.
data
• second hand information (from pre-
Secondary existing records)
• The accuracy of information can not be
data controlled by the recorder.

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Primary data can be collected by:

Direct personal
interviews Oral health Questionnaire
examination method
(site visits)

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 PRESENTATION OF DATA
Objective of presentation of data :
Make the data simple, concise, meaningful
and interesting.
Helpful in further analysis.

Tables
Diagrams
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 Methods of Presentation of data

TABULATION: CHARTS & DIAGRAMS

Quantitavtive data:
Qualitative data: Histogram
Bar chart Frequency polygon
Simple table
Pictogram Frequency curve
Master table
Pie chart Line chart
Frequency
distribution table Map diagram Scatter diagram

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Essentials of public health dentistry 6th edition- Soben Peter.
 Tables:
Tables are the devices, that are used to present the data in a simple form.
It is the first step before the data is used for analysis or interpretation.

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 Simple Table:
Measurements of single set are presented.

Name of country Infant mortality rate

Pakistan 90
Bangladesh 60
Sri Lanka 26
India 60
Table. Infant mortality rate of selected countries in 2004

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 Master Table:
They are tables which contain all the Data obtained from a
survey or study.

BIOSTATISTICS

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 Frequency distribution
table:
In the frequency distribution table, the data is first split up into
convenient groups (class interval) and the number of items (frequency)

Age distribution of polio patients

Age Number of patients

O-4 35
5-9 18
10-14 11
BIOSTATISTICS

15-19 8
20-24 6
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 Charts & Diagrams:
Extremely useful & Self explanatory.

Give a bird's eye view of the entire

data.

Facilitate comparison of data relating

to different time periods and regions.

Values of the variables - on horizontal

or X-axis and the frequency - vertical
line or Y-axis.
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 Bar Diagram:
Represent qualitative data.

Only one variable.

Width of the bar remains the same, the

length varies according to the
frequency in each category.

Bars : vertical or horizontal.

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SIMPLE BAR CHART
Represents only one variable.

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 MULTIPLE OR COMPOUND BAR DIAGRAM
Similar to bar diagram except that for each category of the variable there are a
set of bars of the same width corresponding to the different sections without
any gap in between.

56
COMPONENT BAR
DIAGRAM
Individual bars are divided into two or more parts.
Used to compare subgroups between different major groups of
observations.
Component bar diagram representing number of cases in OPD

57
 PIE DIAGRAM
This is graphical depiction of data as slices of a pie. The total
represents the complete pie. The central angle of each slice is
proportional to the size of that part to the whole data.

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PICTOGRAM
• The pictures representing the value of items are called
pictograms.
• It is most useful way of representing data to those
people who cannot understand or read
Figure 5: Pictogram representing distribution of literacy.

GRADUATES

PRIMARY
EDUCATION

ILLETERATES
Essentials of public health dentistry 6th edition- Soben Peter. 59
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 Map diagram:

Estimated infant mortality rate- 1989

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CARTOGRAMS OR
SPOT MAP
Show geographical distribution of
frequencies of a characteristic.
Cartogram showing
COVID-19 DENSITY IN INDIA.

61
 HISTOGRAM
A graph for interval or ratio data
collapsed into class intervals
which displays the data by using
vertical bars of various heights
to represent frequencies in each
class

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FREQUENCY POLYGON
Diagram of Frequency distribution of
quantitative data developed over a
histogram

Compare two or more frequency

distributions.

A point is marked over the mid-point

of the class interval, corresponding to
the frequency.

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FREQUENCY CURVE
As the number of observations become very large and class intervals very much
reduced, the frequency polygon loses its angulations and gives rise to a smooth curve
known as frequency curve
Figure Represents height of different people in a population

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LINE DIAGRAM
Fig - Presents a line graph that represents the
Line diagram is used to show the data on the number of lifetime births per
trend of events with the passage of Japanese woman for each decade between
time. 1930 and 2000.
It is frequency polygon presenting
variation by lines.
Each point on the graph represents a
pair of values, one on the X-axis and
the other on the Y -axis.

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SCATTER DIAGRAM
It is used to show the association between two
quantitative variables.

Hence, also called as correlation diagram.

The imaginary line drawn through the center of

the scatter shows the association.

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 Every scientific presentation needs
a statistical execution…

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 Analysis
&
Interpretation:

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07/23/2021
Mean : 71
Median:

• is a better indicator of central

tendency when more of the
lowest or the highest
07/23/2021
observations are wide apart . 72
 Mode:
Mode is rarely used
as series can have
no modes, 1 mode
or multiple modes.

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Measures of dispersion:

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Range: difference between highest
and lowest figures
Demerit: not of much practical importance. Indicates
nothing about the dispersion of values.

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 STANDARD DEVIATION
• MEASURE OF DISPERSION (OR SCATTER) OF
THE VALUES ABOUT THE MEAN

 IF THE NUMBERS ARE NEAR THE MEAN,

VARIANCE IS SMALL

 IF NUMBERS ARE FAR FROM THE MEAN,

THE VARIANCE IS LARGE

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 NORMAL CURVE
[GAUSSIAN CURVE]

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PROPERTIES OF NORMAL CURVE

BELL SHAPED AND SYMMETRICAL ABOUT THE MID POINT

MEAN, MEDIAN AND MODE COINCIDE

MAXIMUM NUMBER OF OBSERVATIONS ARE AT VALUE

CORRESPONDING TO THE MEAN AND OBSERVATIONS
07/23/2021 GRADUALLY DECREASE ON EITHER SIDES. 78
 MEAN ± 1 SD COVERS
68.3% OF
OBSERVATIONS

MEAN ± 2 SD COVERS
95.4% OF OBSERVATIONS

MEAN ± 3 SD COVERS
99.7% OF OBSERVATIONS

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 NORMAL CURVE TELLS THE PROBABILITY OF
OCCURRENCE BY CHANCE

OR

HOW OFTEN AN OBSERVATION CAN OCCUR

NORMALLY IN A POPULATION.

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STANDARD
NORMAL CURVE
TOTAL AREA IS 1

MEAN IS 0, STANDARD DEVIATION IS 1

MEAN,MEDIAN AND MODE COINCIDE

CURVE HAS NO BOUNDARIES IN EITHER

DIRECTION & NEVER TOUCHES THE
BASELINE
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 CONFIDENCE LEVEL
CONFIDENCE INTERVAL
AND
CONFIDENCE LIMIT

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 Confidence interval is the range of values
surrounding the estimated mean which have a
specified probability of including the true
population values.

Confidence limits are the lower and

upper boundaries / values of a confidence
interval, that is, the values which define
the range of a confidence interval.
2 SD 2 SD
Lower limit = mean - Upper limit = mean +
√ n √n

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 CONFIDENCE LEVELS ARE
68.3% , 95.5% AND 99.73%

WHEN WE TAKE A CONFIDENCE LEVEL OF 95%, WE MEAN THAT

THERE ARE 95% CHANCES IN 100 THAT THE SAMPLE RESULTS
REPERESNT THE TRUE CONDITION OF THE POPULATION.

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 TESTS OF
SIGNIFICANCE
• Standard error indicates how reliable an estimate of the mean is
likely to be.
• Standard error is applied with appropriate formulae to all
statistics, i.e, mean, standard deviation.etc..

i. Standard error of Mean

ii. Standard error of Proportion
iii. Standard error of difference between means
iv. Standard error of difference between proportions

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STANDARD ERROR OF MEAN
• we take only one sample from universe, calculate Mean and standard
deviation.
• But, how accurate is mean of our sample?
• What can be said about true mean of universe.
• In order to answer these questions,
we calculate standard error of Mean and set up confidence
limits
within which the mean(μ), of the population (of which we have only
one sample) is likely to lie.

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 Non parametric
Parametric test:
test:
• Z test • Chi- square
• t test test
• F test • Sign test

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 Parametric Tests
Information about population is completely known.

Specific assumptions are made regarding the

population.

Null hypothesis is made on parameters of the

population distribution.
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 Non Parametric Test

No Information about population is available.

No assumptions are made regarding the population.

Null hypothesis is free from the parameters.

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 Comparisons Hypothesis Tested Parametric test

Single Group Sample mean not different One sample t Test ( <30)
from population mean Z test (>30)

Two independent samples The two population means Unpaired t test/

are equal Independent sample t test

Two related samples or Mean difference is Zero Paired t test

paired sample

Three or more independent All the population means are ANOVA

samples equal

Three or more dependent Difference between means Repeated measures ANOVA

samples of each population group is
equal

Relation between two For normal data Pearsons Correlation

continuous variables coefficient
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Common statistical methods for clinical research 3rd edition, Glen walker.
 Comparisons Hypothesis tested Non Parametric tests

Single Group Sample median not Sign test

different from the
population median
Two independent samples The two population Mann Whitney test
medians are equal

Two related samples or Median difference is Zero Wilcoxons signed rank test
paired sample

Three or more All the population medians Kruskal Walls test

independent samples are equal

Three or more dependent Difference between Mann Whitney test for

samples medians of each each group
population group is equal
Relation between two For non normal data or Spearman's corelation
continuous variables ordinal data coefficient

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Common statistical methods for clinical research 3 edition, Glen walker.
rd
 Types of problems

Comparison of sample mean with population mean

Comparison of two sample means

Comparison of sample proportion with the population

proportion

Comparison of two sample proportions

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 Steps

• Finding out the type of problem and the question to be

answered.
• Stating the Null Hypothesis (Ho)
• Calculating the standard error
• Calculating the critical ratio
difference between statistics / standard error
• Comparing the value observed in the experiment with that
at the predetermined significant level given by the table
• Making inferences. P<0.05 significant reject the Ho
P =0.05 and P>0.05
accept the Ho

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 Z Test

Prerequisites to apply Z-test

• The sample or the samples must be randomly selected.
• The data must be quantitative.
• The variable is assumed to follow normal distribution in
the population.
• The sample size must be larger than 30

Two types:

One tailed Two tailed

z test z test.

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 • The z- test has 2 applications:
i. To test the significance of difference between a sample mean
and a known value of population mean.

Z = Mean – Population mean

S.E. of sample mean
ii. To test the significance of difference between 2 sample
means or between experiment sample mean and a control
sample mean.
Z = Observed difference between 2 sample means
SE of difference between 2 sample means

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 t - Test
Criteria for applying t-test
• Random samples
• Quantitative data
• Variable normally distributed
• Sample size less than 30

• Unpaired t-test: applied on unpaired data of

independent observations made on individuals of two
different or separate groups or samples drawn from
two populations

• Paired t-test: applied to paired data of independent

observations from one sample only

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 F-test (Analysis of variance test)

• Used for comparing more than two samples

mean drawn from corresponding normal
populations.
Ex: to find out whether occupation plays any part in
causation of BP. systolic BP values of 4 occupations
are given. Determine if there is significant difference
in mean BP of 4 groups in order to assess the role of
occupation in causation of BP.
F = Mean square between samples / Mean square
within the samples
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 Chi-square Test
Application :
1. Proportion:
a)compare the values of two binomial samples even if <30.Ex:
Incidence of diabetes in 20 obese and 20 non obese.
b)compare the frequencies of two multinomial samples ex: no of
diabetics and non diabetics in groups weighing 40-50, 50-60 and
>60 kg
2.Association: It measures the probability of association between
two discrete attributes. It has an added advantage that it can be
applied to find association or relationship between two discrete
attributes when there are more than two classes or groups.

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 Correlation and Regression

• To find whether there is significant association or not

between two variables, we calculate co- efficient of
correlation, which is represented by symbol “r”.

• The correlation coefficient r tends to lie between – 1.0 and

+1.0.

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 Repeated measures analysis:
Repeated measures refer to multiple measurements taken from the same
experimental unit, such as serial evaluations over time on the same patient.
These repeated response measurements can be used to characterize a
response profile over time. One of the main questions the researcher asks is
whether the mean response profile for one treatment group is the same as
for another treatment group or a placebo group.

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 Regression analysis:
Regression analysis is used to analyze the relationship between a
response, y, and a quantitative factor, x. Knowledge of this
relationship can be important for predicting unmeasured responses
from a known x-value.
Examples where regression analysis might be useful in clinical data
analysis include the modeling of blood pressure response (y) on the
dose of a new antihypertensive drug (x), cholesterol level (y) on
patient's age (x),

Common statistical methods for clinical research 3rd edition,

Glen walker.
07/23/2021 101
A moronic myth was born: India loses whenever Sachin Tendulkar
scores a hundred.

There are two parameters here – Tendulkar’s “Against logic there is

score and the result of the match. We are no armour like
interested in knowing how the first affects the
ignorance”
second.

At 100, the graph shows a healthy

68%, which tells us that according to
the historical data encompassing 442
innings, if Tendulkar scores a century,
there is 68% probability of India going
on to win the match.
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 Analysis of covariance:
ANCOVA provides a method for comparing response means among two or
more groups adjusted for a quantitative concomitant variable, or ‘covariate’,
thought to influence the response. The attention here is confined to cases in
which the response, y, might be linearly related to the covariate, x. ANCOVA
combines regression and ANOVA methods by fitting simple linear regression
models within each group and comparing regressions among groups.
Examples where ANCOVA might be applied include:
comparing cholesterol levels (y) between a treated group
and a reference group adjusted for age (x, in years)

Common statistical methods for clinical research 3rd edition,

07/23/2021 Glen walker. 103
 Fisher's exact test
Fisher's exact test is an alternative to the chi-square test for
comparing two independent binomial proportions, p1 and p2. This
method is based on computing exact probabilities of observing a
given result or a more extreme result, when the hypothesis of equal
proportions is true.

Common statistical methods for clinical research 3rd edition,

Glen walker.
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 Logistic regression analysis:
Logistic regression analysis is a statistical modeling method for
analyzing categorical response data while accommodating
adjustments for one or more explanatory variables or ‘covariates’.
This method is analogous to linear regression analysis for
continuous normally distributed responses or to ANCOVA

comparing survival rates in cancer patients

among various treatment groups adjusted for age
and duration of disease.

Common statistical methods for clinical research 3rd edition,

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Glen walker. 105
 Health information system:
Mechanism for the collection, processing, analysis
and transmission of information required for
organizing and operating health services and also
for research and training.

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PARKS Preventive social medicine 23rd edition. 106
 REQUIREMENTS TO BE
SATISFIED BY HEALTH
INFORMATION SYSTEMS: (WHO)
The system should
employ functional
and operational The system
The system terms (e.g. episodes should make
should be of illness, treatment provision for
population regimens, the feedback
based. laboratory test.) of data.

The system The system

should avoid the should express
unnecessary information
agglomeration briefly and
of data. imaginatively (e.g.
tables, charts,
07/23/2021 PARKS Preventive social medicine 23rd edition. percentages) WHO 1971, Techn. Rep.107
ser. No. 472
 APPLICATION OF STATISTICS TO
HEALTH PROBLEMS.

Health statistics – public health.

Medical statistics – medicine.

Vital statistics – demography.

Dental statistics – dentistry.

07/23/2021
PARKS Preventive social medicine 23rd edition. 108
 CONCLUSION

Statistics is central to most medical research .

Basic principles of statistical methods or techniques equip medical and

dental students to the extent that they may be able to appreciate the
utility and usefulness of statistics in medical and other biosciences.

Certain essential bits of methods in biostatistics, must be learnt to

understand their application in diagnosis, prognosis, prescription and
management of diseases in individuals and community.
07/23/2021
 REFERENCES:
Essentials of public health dentistry 6th edition- Soben
Peter.

PARKS Preventive social medicine 23rd edition.

Common statistical methods for clinical research 3rd

edition, Glen walker.

07/23/2021 110
 ACKNOWLEDGEMENT

Dr. HIMANSHU AERAN

DIRECTOR PRINCIPAL
PROFESSOR AND HEAD
DEPARTMENT OF PROSTHODONTICS
AND CROWN &BRIDGE

07/23/2021 111
 Dr ANIL DHINGRA Dr TARUN SHARMA
HOD & PROF. PROF.
DEPARTMENT OF CONSERVATIVE DEPARTMENT OF DENTOFACIAL
DENTISTRY AND ENDODONTICS. ORTHOPEDICS
SDCH SDCH

07/23/2021 112
 Dr. AMRINDER TULI
PROFESSOR AND HEAD
DEPARTMENT OF PERIODONTICS

Dr. VARUN KUMAR

PROFESSOR
DEPARTMENT OF PROSTHODONTICS
AND CROWN & BRIDGE

07/23/2021 113
 Dr. S. KARPAGAVALLI
PROFESSOR AND HEAD
DEPARTMENT OF ORAL MEDICINE
AND RADIOLOGY

DR. TARUN KUMAR

PROFESSOR
DEPARTMENT OF ORTHODONTICS
07/23/2021 114
 Dr. AVANTIKA TULI
PROFESSOR AND HEAD
DEPARTMENT OF PEDIATRIC
AND PREVENTIVE DENTISTRY

Dr. KULWANT RAI

READER
DEPARTMENT OF CONSERVATIVE DENTISTRY
AND ENDODONTICS
07/23/2021 115
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