Statistical Correlation Tests, Bias, Risk & More

Statistical Correlation Tests

Statistical correlation tests are performed with the aim of finding out whether a relationship exists between variables, and then determining the magnitude and action of that relationship. In other words, correlation is a statistical measure that expresses the extent to which two variables are linearly related. It’s commonly used for describing simple relationships without making a statement about cause and effect.

If two variables tend to move up or down together, they are considered to be positively correlated. However, if they tend to move in opposite directions, they are considered to be negatively correlated.

Parametric tests are based on an assumption that the data being analyzed follows a normal distribution. The more data points a distribution has, the more it can approach a normal distribution. Lack of data points would require the use of non-parametric tests.

Non-parametric tests a.k.a. distribution-free tests are methods of statistical analysis that do not require a distribution to meet the required assumptions to be analyzed, especially if the data is not normally distributed.

Student T-Test

statistical correlation tests
Retrieved from https://researchbasics.education.uconn.edu/t-test/ on 11th March 2023

UNPAIRED T-TEST testing two means

The unpaired t-test a.k.a. independent t-test is a statistical test which aims to determine whether there is a difference between two unrelated groups. The unpaired t-test is used to make a statement about the population based on two independent samples. To make this statement, the mean value of the two samples is compared.

ANOVA testing more than two means

ANOVA a.k.a. Analysis of Variance, is a statistical test used to investigate the difference between the means of more than two groups. A one-way ANOVA uses one independent variable, whereas a two-way ANOVA uses two independent variables.

CHI-SQUARED TESTtesting the association between two categorical variables

A chi-squared test is a statistical test that is used to compare observed and expected results. The main aim of the chi-squared test is to identify whether a disparity between actual and predicted data is due to chance or to a link between the variables under consideration.

Choosing the Right Test

statistical correlation tests
Retrieved from https://www.scribbr.com/statistics/statistical-tests/ on 11th March 2023
statistical correlation tests
Retrieved from https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1b-statistical-methods/parametric-nonparametric-tests on 11th March 2023

Bias Potential Sources

Bias is the systematic deviation from the truth. Different sources of bias may include:

  • selection or sampling bias – inadequate selection of study participants usually due to high non-response rate, inadequate follow-up, inadequate sampling method use, or inadequate controls or comparisons groups
  • confounding bias – existing differences between comparison groups in one or more parameters which may be directly associated with the outcome and the candidate risk factor in question
  • instrumental bias – faulty measurement instrumentation due to lack of calibration, inaccurate diagnostic tests, etc
  • information bias – systematically incorrect measurements or responses, or from differential misclassification of disease or exposure status of participants eg. due to questionnaire ambiguity or insensitivity
  • systematic bias – one observer may underestimate readings, leading to his respondents having lower readings than those observed by someone else
  • respondent bias – misunderstandings, lack of interest, or recall issues in the unaffected group
  • random bias – observer may underestimate or overestimate measurements, which mistakes tend to even out on averaging

Calculating Statistical Risk

In statistics, the risk for a particular group to develop a disease refers to the rate of disease in the group concerned.

RISK DIFFERENCE / ABSOLUTE RISK – the excess risk that exposed individuals have.

RISK RATIO – the measurement of the risk in the exposed group as a multiple of the risk in the unexposed group.

ODDS RATIO – odds refer to the chance of developing the disease rather than not developing the disease. Odds Ratio refers to the chances of developing the condition for an exposed individual relative to an unexposed individual.

statistical correlation tests
Retrieved from https://www.researchgate.net/publication/249313828_Houwing_etal_AAP2013/figures?lo=1 on 12th March 2023

The Relevance of Testing the Sensitivity & Specificity of a Screening Diagnostic Test

Screening programs need to provide diagnostic tests with the least disturbance possible for the individual, yet with enough sensitivity and specificity to detect the disease in question. Assessing the sensitivity and specificity of a test requires its outcome to be compared against a gold standard eg. comparing the Faecal Occult Blood Test sensitivity and specificity to a colonoscopy, in this case considered to be the gold standard.

statistical correlation tests
Retrieved from https://www.researchgate.net/publication/49650721_Sensitivity_specificity_predictive_values_and_likelihood_ratios/figures?lo=1 on 15th March 2023

Multi-Variate Analysis

Linear regression analysis is used to predict the value of a variable based on the value of another variable. The variable you want to predict is called the dependent variable, while the variable you are using to predict the other variable’s value is called the independent variable.

statistical correlation tests
Example of Linear Regression – Retrieved from https://sphweb.bumc.bu.edu/otlt/MPH-Modules/BS/BS704-EP713_MultivariableMethods/ on 15th March 2023

Logistic regression is a statistical analysis method to predict a binary outcome eg. yes or no, based on prior observations of a data set. A logistic regression model predicts a dependent data variable by analyzing the relationship between one or more existing independent variables. This technique results in an odds ratio rather than a rate of change per unit change in the independent variable.

statistical correlation tests
Linear Regression vs Logistic Regression – Retrieved from https://www.datacamp.com/tutorial/understanding-logistic-regression-python on 15th March 2023

Poisson Regression models are best used for modeling events where the outcomes are counts. Or, more specifically, count data: discrete data with non-negative integer values that count something, like the number of times an event occurs during a given time-frame or the number of people in line at the grocery store. This technique results in a risk ratio instead of a rate of change per unit change in the independent variable.

Example of Poisson Regression – Retrieved from https://sherrytowers.com/2018/03/06/poisson-regression/ on 15th March 2023

Survival Analysis is concerned with studying the time between entry to a study and a subsequent event. Originally the analysis was concerned with time from treatment until death, hence the name, but survival analysis is applicable to many areas as well as mortality.

Example of Survival Analysis – Retrieved from https://www.graphpad.com/guides/survival-analysis on 15th March 2023

Relative Survival is defined as the ratio of the proportion of observed survivors in a cohort of cancer patients to the proportion of expected survivors in a comparable set of cancer free individuals. The formulation is based on the assumption of independent competing causes of death.

Example of Relative Survival Analysis – Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202044 on 15th March 2023

Meta-analysis is a research process used to systematically synthesise or merge the findings of single, independent studies, using statistical methods to calculate an overall or ‘absolute’ effect. Meta-analysis does not simply pool data from smaller studies to achieve a larger sample size.

Example of Meta-Analysis – Retrieved from https://www.mdpi.com/2624-8611/4/4/49 on 15th March 2023

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Systematic Reviews and Meta Analysis Critical Appraisal

A systematic review is a summary of clinical literature which, through explicit reproducible methods, performs a comprehensive and systematic literature search and critical appraisal of individual studies. Systematic reviews may incorporate statistical techniques with which they combine valid and similarly designed studies together to produce an average estimate of effect based on all reviewed studies – this is what we refer to as a meta-analysis.

Hierarchy of Evidence

Retrieved from https://www.sketchbubble.com/en/presentation-hierarchy-of-evidence.html on 18th February 2023

How To Perform Systematic Reviews & Meta Analysis

  • Step 1 – develop a question
  • Step 2 – define the criteria for inclusion of studies
  • Step 3 – perform a systematic search through available literature to find eligible studies (fitting all PICO elements)
  • Step 4 – review methods and results of the selected studies
  • Step 5 – assess heterogeneity (variation) between studies
  • Step 6 – apply statistical methods to produce a summary result

Critically Appraising a Review

  1. check whether the author/s specified their clinical query
  2. check whether each key element of the question (PICO) is clear and specific
  3. scrutinise the search strategy that was used – were boolean operators used? Was the author/s’ search extensive and comprehensive enough? If not, the study should be revised and retested. The search should include a good keyword combination, good databases, grey literature (so as to prevent publication bias), limiters, and more than one person in the search (prevents bias – sometimes it’s difficult to assess whether or not a study should be used or not, hence 2 or more should be included in this process (if consensus is not met)
  4. check whether the author/s applied any quality criteria in study selection

Publication Bias

In order to avoid publication bias, authors of reviews should look into books, grey literature, and unpublished material eg. conference proceedings, dissertations etc. This is because one should keep in mind that positive and statistically significant results are more likely to be published and be included in scientific journals easily found in electronic databases.

Critically Appraising a Meta Analysis

Heterogeneity testing

  • test for clinical and statistical heterogeneity
  • use various tests such as chi square test, and give p value. If p value is large, difference between results is not significant

statistical calculations

  • use fixed or random effect models
  • random effect models are used to make up for heterogeneity, usually needing a large sample but providing conservative results
  • NEED to qualitatively examine the potential cause of heterogeneity prior to deciding to pool results

sensitivity analysis

  • check on the impact of low quality papers on the overall result
  • 1st analysis requires the exclusion of dubious studies
  • 2nd analysis requires the re-inclusion of dubious studies to see if they affect the overall result

PRISMA Diagram

When researchers choose to perform a systematic review, they are required to present the whole search process within a PRISMA diagram. Any grey literature or manually retrieved literature should also be included in the PRISMA diagram (sample PRISMA flow diagram can be found below…)

PRISMA Flow Diagram – Retrieved from https://esraeurope.org/prospect/procedures/oncological-breast-surgery-2019/evidence-review-process-9/prisma-flow-diagram/ on 22nd February 2023

PRISMA, a.k.a. Preferred Reporting Items for Systematic Reviews and Meta-Analyses, is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses (sample PRISMA checklist can be found below…)

systematic reviews
systematic reviews

CASP Tool for Systematic Reviews

CASP tool for systematic reviews can be found here.

To view blogpost featuring Cochrane videos on all types of studies please click here.


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