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CHE 233 HEALTH STATISTICS

INTRODUCTION
Population changes reflect the natural facts of life: births and deaths. Births, in

turn, have long been largely governed by the mechanisms of family formation.

Vital statistics are compilations of data on marriage, divorce, birth, and death.

Births and deaths directly determine changes in the size of a population; marriages

and divorces create and dissolve, respectively, the conditions under which most

births occur. The surplus of births over deaths is called natural increase; under

unfavorable demographic conditions, deaths may exceed births, in which case a

natural decrease occurs.

Definition of Terms

Statistics is a branch of science that deals with collecting, organising, analyzing

and interpreting numerical data for understanding a phenomenon or making wise

decisions.

Vital statistics are quantitative information about a population's "vital events"

such as the number of births (natality), deaths (mortality), marriages (nuptiality)

and divorces.

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Health statistics is a branch of statistics which deals with collecting, organizing,

analyzing and interpreting numerical data for health and disease in human

population.

Population: is the entire collection, or set, of individuals or objects whose

properties are to be analyzed.

Biostatistics - When the different statistical methods are applied in biological,

medical and public health data they constitute the discipline of biostatistics.

Sources of Health Statistics

i. Surveys

ii. Administrative and medical records

iii. Health care claims data

iv. Vital records

v. Disease registries

vi. literatures

The Importance of Statistics in Healthcare

 Describe the level of community health

 Diagnose community illnesses

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 Discover solutions to health problems and find clues for administrative

action

 Determine priorities for health programmes

 Promote health legislation

 Determine the met and unmet health needs

 Disseminate information on the health situation and health programmes

 Determine success or failure of specific health programmes

 Demand public support for health work

DATA AND DATA COLLECTION METHODS

These are raw facts or unprocessed information. There are basically two types of

data:

i. Numeric or quantitative information and

ii. Non-numeric or qualitative information.

There are two classifications of numeric data:

i. Discrete numeric data: These are countable whole numbers or integers,

e.g. the number of Patients, nurses or doctors in a hospital

ii. Continuous numeric data: These are numbers within an interval or

uncountable range of numbers, e.g. a measure of a quantity will usually

be continuous, i.e. weight, mass, litres etc.

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Non-numeric data are values that cannot be quantified. For example, matriculation

number, age group, blood group, DNA, RNA, sex, tribe, country, etc. Data in this

form are either categorical or ordinal. Examples of ordinal non-numeric data are

students‟ height, age group, while DNA, RNA, sex, country, tribe are examples of

categorical non-numeric data.

Methods of Data Collection

Data collected for investigation can either be primary data or secondary data. Data

collected directly from the source or respondents are known as primary data. These

are data, which are collected by the investigator for the purpose of a specific

inquiry or study. Such data are original in character and are mostly generated by

surveys conducted by individuals or research institutions. When an investigator

uses data, which have already been collected by others or those from established

data bank are known as secondary data. Such data are primary data for the agency

that collected them, and become secondary for someone else who uses these data

for his own purposes. Secondary data are less expensive to collect both in money

and time.

How to Collect Primary Data

i. Observation: is a technique that involves systematically selecting,

watching and recoding behaviors of people or other phenomena and

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aspects of the setting in which they occur, for the purpose of getting

(gaining) specified information.

ii. Interviews: A good interviewer can stimulate and maintain the

respondent’s interest, and can create a rapport (understanding, concord)

and atmosphere conducive to the answering of questions.

iii. Experiments

iv. Self-administered Questionnaire

Sources of Secondary Data include:

i. Official publications of Central Statistical Authority

ii. Publication of Ministry of Health and Other Ministries

iii. Internet, Websites, News Papers and Journals

iv. International Publications like Publications by WHO, World Bank,

UNICEF

Data analysis and Presentation

The presentation of data in a meaningful way is done by preparing a frequency

distribution. A table listing all classes and their frequencies is called frequency

distribution.

Let us demonstrate the concept of a frequency distribution by using the following

set.
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1 5 3 4 1 3 2 5

2 4 1 3 2 0 1 2

1 2 0 2 1 4 5 3

Let x represent these data values, we can use a frequency distribution to represent

this set of data by listing the x values with their frequencies in Table.

Frequency distribution

X 0 1 2 3 4 5

F 2 6 6 4 3 3

GRAPHICAL METHODS
Graphical (pictorial) representation of the data reveals patterns of behaviour of the

variable being studied. There are several graphic (pictorial) ways to describe data.

Data can be presented graphically in many ways as, line graph, dot plot display,

bar chart, pie chart, histogram, cumulative frequency curve (Ogive) and stem-and-

leaf display.

Dot Plot Display

Dot plots display the data of a sample by representing each piece of data with a dot

positioned along a scale. This scale can be either horizontal or vertical. The

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frequency of the values is represented along the other scale. They are usually used

to represent the frequency distribution of a discrete variable. The dot plot display is

a convenient technique to use as you first begin to analyze the data. It results in a

picture of the data as well as sorts the data into numerical order.

Example

A random sample of 20 children took their weights in kilogram in a hospital are

presented below:

23 22 26 28 22 29 30 25 26 27

21 23 27 26 25 29 30 26 25 28

Construct a dot plot of these data.

Bar Chart

Bar chart/diagrams are used to represent and compare the frequency distribution of

discrete variables and attributes or categorical series. When we represent data

using bar diagram, all the bars must have equal width and the distance between

bars must be equal.

There are different types of bar diagrams, the most important ones are:

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Simple bar chart

It is a one-dimensional diagram in which the bar represents the whole of the

magnitude. The height or length of each bar indicates the size (frequency) of the

figure represented.

Series 1
4.5

3.5

2.5

1.5

0.5

0
21 22 23 25 26 27 28 29 30

Multiple bar chart

In this type of chart, the component figures are shown as separate bars adjoining

each other. The height of each bar represents the actual value of the component

figure. It depicts distributional pattern of more than one variable.

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Example

The following table shows the intake through JAMB by the Faculty of Science of a

certain University in three consecutive years.

Department 2002 2003 2004

Botany 43 40 35
Chemistry 28 35 42
Zoology 45 40 35
Computer Science 33 25 28
Physics 40 35 38
Mathematics 35 42 45
Biology 37 40 42
Total 261 257 265
Draw (i) multiple bar chart department by department for the three years.

50

45

40

35

30
2002
25
2003
20 2004

15

10

0
Botany chemistry zoology computer science physics mathematics biology

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Pie-chart

The pie chart (circle graph) is used to display relative frequencies rather than actual

frequencies for the data (qualitative or quantitative discrete data). We draw a circle

and then divide it into a series of wedges or slices to represent each class in the

relative frequency distribution. The size of each slice is proportional to the

percentage of the data that fall into the corresponding class.

Example

The population of five towns in a country X in 1986 is as follows:

Town Population Sectorial Angle

A 50,000 90
B 100,000 180
C 25,000 45
D 12500 22.5
E 12500 22.5
SOLUTION

POPULATION

A
B
C
D
E

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VITAL RATIO

A ratio is a general term given to any numerator – denominator relationship

between two numbers. Example 5/6 59/10 23/60 etc

General fertility rate

This is the number of live births per 1000 women aged 15-49 in a given year.

i.e. GFR = live births x 1000

Pf15-49

Age – specific Fertility Rate

This is the number of births per annum per 1000 women of specific age group.

Example
Age popn of females live births ASFR
(births/Pfax100)
15 – 19 1611090 463631 288
20 – 24 1558276 427298 274
25 – 29 1425242 412878 290
30 – 34 1381174 380778 276
35 – 39 1632695 308671 189
40 – 44 1581373 281161 178
45 – 49 1400555 239701 171
10590405 2514118 1666
GFR = 2514118 x 1000 = 237 per 1000 women
10590405

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Total fertility rate

This is the average number of children that would be born to a woman by the time

she ended child bearing if she were to pass through all her child bearing years

conforming to the age-specific fertility rates of a given year.

i.e. TFR = 5x∑ASFR / 1000

= 5(1666/1000) = 5x1.66 = 8 per woman

Mortality

Mortality is a relationship of death cases to the whole population. Two basic types

of mortality include;

i. General (crude) mortality rate or death rate

ii. Specific mortality rate or death rate

Crude death rate (or mortality rate) is the number of death cases in a year per

1000 of the population.

Specific Mortality Rate or Death Rate

Age and sex related mortality rates can be computed for both genders and age

groups.

Sex related mortality rate is the number of death cases of the cohort by 1000

mid-year population of the cohort.

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FREQUENCY OF DEATHS BY AGE

Perinatal mortality rate is the number of infant deaths in the first 24hours by

1000 live births in the given year.

Postnatal mortality rate is the number of infant deaths in the first 0-6 days by

1000 live births in the given year.

Neonatal mortality rate is the number of neonatal death (0-28 days) by 1000 live

births in the given year.

Infant mortality rate is the number of infant death 0 – 365 days by 1000 live

births.

CAUSE SPECIFIC DEATH RATES (CSDR)

The CSDR is the number of deaths attributed to a particular cause (c) divided by

population at risk (p), usually expressed in deaths per 100,000

i.e. CSDE = Dc x 100,000

P

Example:
Community popn at risk TB Malaria Diabetes
A 304848 278 252 188

B 211075 170 170 154

C 416418 193 180 228

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Maternal Mortality Rate

Maternal mortality is the death of a woman while pregnant or within 42 days of

termination of pregnancy, irrespective of the duration and site of the pregnancy

from any cause related or aggravated by the pregnancy or its management but not

from accidental or incidental causes.

Example:

Region live births Abortion Lack of ANC Lack of PNC labour

A 56403 67 32 10 193

B 97166 81 14 6 104

C 93415 72 18 10 107

Life expectancy rate is the estimate of the average number of additional years that

a person of a given age can expect to live. The most common measure of life

expectancy is life expectancy at birth.

SAMPLE

Sample can be defined as a finite part of a statistical population whose properties

are studied to gain information about the whole population.

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SAMPLING TECHNIQUE: Sampling technique is the act, process, or technique

of selecting a representative part of a population for the purpose of determining

parameters or characteristics of the whole population.

Types of Sampling Technique

The types of sampling are referred to as sampling procedures or methods of

sampling. They are also grouped as:

 Scientific or probability sampling

 Non-scientific or non-probability sampling

Scientific or non-probability sampling method: This is a sampling method where

every member of the population has a greater chance of being selected as a sample.

The different methods in scientific or probability sampling include:

i. Simple random sampling – every member or element of the population

has equal chance of being selected. The steps involved identifying each

member of the population, for example listing with name or number and

then selecting the sample through any of table of random numbers, ballot

method, or throw of dice.

ii. Systematic random sampling –the researcher starts randomly, that is at

any point, having listed the population, and selects the ‘nth’ member until

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the sample size is reached. A way of getting the interval is often by

dividing the total population by the sample size required.

iii. Stratified random sampling – the researcher starts by subdividing the

population into homogenous subgroups or strata (stratum for singular),

by some known unifying qualities for those groups, then draws a sample

using simple random sampling or systematic sampling methods.

iv. Cluster or area sampling -with the cluster sampling, instead of drawing

individual members of the population, groups or clusters are selected

from the population. The population is divided into clusters along

geographical boundaries, and clusters randomly selected. All the

members of selected clusters are studied.

Non-scientific/Non-probability Sampling

Non probability or non-scientific sampling method is the method of sampling

where not every member of the population is given a chance to be part of the

sample. Choice usually depends on the judgment of the researcher. The major

types of non-scientific or non-probability sampling are:

1. Convenience (accidental) sampling –the researcher primarily works with a

group that is accessible and convenient; hence this method is prone to bias.

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There is no evidence that the sample is representative of the population of

interest.

2. Purposive (judgmental) sampling – where the researcher uses his/her

discretion to determine the members of the population that may suit the

purposes and requirements of the study.

3. Quota (proportional) sampling is the nonprobability equivalent of stratified

sampling. Like stratified sampling, the researcher first identifies the stratums

and their proportions as they are represented in the population. Then

convenience or judgment sampling is used to select the required number of

subjects from each stratum. This differs from stratified sampling, where the

stratums are filled by random sampling.

VARIABLE

A variable is any entity that can take on different values. Variables are of interest

in research because they are the main reasons for the research.

Examples of variables include age, sex, weight, height, educational

attainment/qualification, experience, weather, socio-economic status, temperature,

state of health etc.

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Types of Variables

Independent variable – the independent variable is that variable in the research,

which the researcher manipulates, and could be equated to a cause or stimulus or

treatment in research that has to establish cause-effect relationship.

Dependent variable - is that variable not manipulated by the researcher, but which

the researcher expects will change once the independent variable is introduced. It

can be equated to the effect, response or the result.

MEASURES OF CENTRAL TENDENCY

A measure of central tendency is a single value that attempts to describe a set of

data by identifying the central position within that set of data. As such, measures of

central tendency are sometimes called measures of central location. They are also

classed as summary statistics. The mean (often called the average) is most likely

the measure of central tendency that you are most familiar with, but there are

others, such as the median and the mode.

The mean, median and mode are all valid measures of central tendency, but under

different conditions, some measures of central tendency become more appropriate

to use than others. In the following sections, we will look at the mean, mode and

median, and learn how to calculate them and under what conditions they are most

appropriate to be used.
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Mean (Arithmetic)

The mean (or average) is the most popular and well known measure of central

tendency. It can be used with both discrete and continuous data, although its use is

most often with continuous data. The mean is equal to the sum of all the values in

the data set divided by the number of values in the data set. So, if we have n values

in a data set and they have values x 1, x 2 …, x n, the sample mean, usually denoted by

x (pronounced "x bar"), is:

x 1+ x 2+ …+ xn
x=
n

This formula is usually written in a slightly different manner using the Greek

capitol letter, ∑, pronounced "sigma", which means "sum of...":

∑x
x=
n

Example, consider the wages of staff at a factory below:

Staff 1 2 3 4 5 6 7 8 9 10

Salar 15k 18k 16k 14k 15k 15k 12k 17k 90k 95k

The mean salary for these ten staff is $30.7k. However, inspecting the raw data

suggests that this mean value might not be the best way to accurately reflect the

typical salary of a worker, as most workers have salaries in the $12k to 18k range.

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The mean is being skewed by the two large salaries. Therefore, in this situation, we

would like to have a better measure of central tendency. As we will find out later,

taking the median would be a better measure of central tendency in this situation.

Mean for grouped data

In Tim’s office, there are 25 employees. Each travels to work every morning in

his/her own car. The distribution of the driving times (in minutes) from home to

work for he employees is shown in the table below:

Class 0 – 10 10 – 20 20 – 30 30 – 40 40 – 50

Frequency 3 10 6 4 2

Solution

Find the class mark for each class by adding the lower and upper class limits of the

class and divide by 2.

Class Interval (x) Frequency (f) Fx

0 – 10 5 3 15
10 – 20 15 10 150
20 – 30 25 6 150
30 – 40 35 4 140
40 – 50 45 2 90
∑ 25 545
∑ fx 545
x=
∑f
= 25 = 21.8

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Median

The median is the middle score for a set of data that has been arranged in order of

magnitude. In order to calculate the median, suppose we have the data below:

65 55 89 56 35 14 56 55 87 45 92

We first need to rearrange that data into order of magnitude (smallest first):

14 35 45 55 55 56 56 65 87 89 92

Our median mark is the middle mark - in this case, 56 (highlighted in bold). It is

the middle mark because there are 5 scores before it and 5 scores after it. This

works fine when you have an odd number of scores, but what happens when you

have an even number of scores? What if you had only 10 scores? Well, you simply

have to take the middle two scores and average the result. So, if we look at the

example below:

65 55 89 56 35 14 56 55 87 45

We again rearrange that data into order of magnitude (smallest first):

14 35 45 55 55 56 56 65 87 89

Only now we have to take the 5th and 6th score in our data set and average them to

get a median of 55.5.

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Mode
The mode is the most frequent score in our data set. On a histogram it represents

the highest bar in a bar chart or histogram. You can, therefore, sometimes consider

the mode as being the most popular option. An example of a mode is presented

below:

14 35 45 55 55 55 56 65 87 89
Assignment
1. Stephen has been working on programming and updating a web site for his

company for the past 15 months. The following numbers represent the past 7

months:

24, 25, 31, 50, 53, 66, 78

What is the mean (average) number of hours that Stephen worked on thei

website each month?

2. a. find the median of the following data

12, 2, 16, 8, 14, 10, 6

b. find the median of the following data:

1, 1, 3, 4, 4, 6, 7, 8, 9, 11

3. a. The ages of 12 randomly selected students are listed below:

23, 21, 29, 24, 31, 21, 27, 23, 24, 32, 33, 19

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b. find the mode of the following data:

76, 81, 79, 80, 78, 83, 77, 79, 82, 75

Bibliography

Last, J. M. (1997). Public Health and Human Ecology, 2nd edition. Stamford, CT:

Appleton and Lange.

Slee, V. N.; Slee, D. A.; and Schmidt, H. J. (2000). The Endangered Medical

Record. St. Paul, MN: Tringa Press.

Webb, E. J.; Campbell, D. T.; and Schwartz, R. D. et al. (1988). Unobtrusive

Measures: Non-interactive Research in the Social Sciences. Chicago: Rand

McNally.

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