7/1/2021 10.
3 - Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value | STAT 507
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STAT 507 Epidemiological Research Methods
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10.3 - Sensitivity, Specificity, Positive Predictive Value, and
Lesson
Negative Predictive Value
Welcome to STAT 507!
Lesson 1: Introduction to Epidemiology
Lesson 2: Measurement (1) Case
Definition and Measures In this example, two columns indicate the actual condition of the subjects, diseased or non-diseased. The rows indica
Lesson 3: Measurement (2) Exposure results of the test, positive or negative.
Frequency; Association between Exposure
and Disease; Precison and Accuracy Cell A contains true positives, subjects with the disease and positive test results. Cell D subjects do not have the dise
Lesson 4: Descriptive Studies (1) test agrees.
Surveillance, Standardization
A good test will have minimal numbers in cells B and C. Cell B identifies individuals without disease but for whom th
Lesson 5: Descriptive Studies (2) Health
indicates 'disease'. These are false positives. Cell C has the false negatives.
Surveys
Lesson 6: Ecological Studies, Case-
Control Studies
Lesson 7: Etiologic Studies (2) Outbreak
Investigation; Advanced Case-Control
Design
Lesson 9: Cohort Study Design; Sample
Size and Power Considerations for
Epidemiologic Studies
Lesson 10: Interventional Studies (1)
Diagnostic Tests, Disease Screening
Studies
10.1 - Prevention
10.2 - Early Detection and Screening
10.3 - Sensitivity, Specificity,
Positive Predictive Value, and
If these results are from a population-based study, prevalence can be calculated as follows:
Negative Predictive Value
10.4 - Examples
Prevalence of Disease=
10.5 - Risks from Screening
10.6 - Screening Biases
The population used for the study influences the prevalence calculation.
10.7 - Designs for Controlled Trials
for Screening Sensitivity is the probability that a test will indicate 'disease' among those with the disease:
10.8 - Considerations in the
Establishment of Screening Sensitivity: A/(A+C) × 100
Recommendations and Programs
Specificity is the fraction of those without disease who will have a negative test result:
10.9 - References
Specificity: D/(D+B) × 100
Lesson 11: Interventional Studies (2):
Group and Community-Based
Sensitivity and specificity are characteristics of the test. The population does not affect the results.
Epidemiology
Lesson 12: Statistical Methods (2) A clinician and a patient have a different question: what is the chance that a person with a positive test truly
Logistic Regression, Poisson Regression has the disease? If the subject is in the first row in the table above, what is the probability of being in cell A
Lesson 13: Proportional Hazards as compared to cell B? A clinician calculates across the row as follows:
Regression
Positive Predictive Value: A/(A+B) × 100
Negative Predictive Value: D/(D+C) × 100
Positive and negative predictive values are influenced by the prevalence of disease in the population that is
being tested. If we test in a high prevalence setting, it is more likely that persons who test positive truly have
disease than if the test is performed in a population with low prevalence..
Let's see how this works out with some numbers...
Hypothetical Example 1 - Screening Test A
100 people are tested for disease. 15 people have the disease; 85 people are not diseased. So, prevalence is
15%:
Prevalence of Disease:
15/100 × 100 = 15%
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7/1/2021 10.3 - Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value | STAT 507
Sensitivity is two-thirds, so the test is able to detect
two-thirds of the people with disease. The test misses
one-third of the people who have disease.
Sensitivity:
A/(A + C) × 100
10/15 × 100 = 67%
The test has 53% specificity. In other words, 45 persons
out of 85 persons with negative results are truly
negative and 40 individuals test positive for a disease
which they do not have.
Specificity:
D/(D + B) × 100
45/85 × 100 = 53%
The sensivity and specificity are characteristics of this test. For a clinician, however, the important fact is
among the people who test positive, only 20% actually have the disease.
Positive Predictive Value:
A/(A + B) × 100
10/50 × 100 = 20%
For those that test negative, 90% do not have the disease.
Negative Predictive Value:
D/(D + C) × 100
45/50 × 100 = 90%
Now, let's change the prevalence..
Hypothetical Example 2 - Increased Prevalence, Same Test
This time we use the same test, but in a different population, a disease prevalence of 30%.
Prevalence of Disease:
30/100 × 100 = 30%
We maintain the same sensitivity and specificity
because these are characteristic of this test.
Sensitivity:
A/(A + C) × 100
20/30 × 100 = 67%
Specificity:
D/(D + B) × 100
37/70 × 100 = 53%
Now let's calculate the predictive values:
Positive Predictive Value:
A/(A + B) × 100
20/53 × 100 = 38%
Negative Predictive Value:
D/(D + C) × 100
37/47 × 100 = 79%
Using the same test in a population with higher prevalence increases positive predictive value. Conversely,
increased prevalence results in decreased negative predictive value. When considering predictive values of
diagnostic or screening tests, recognize the influence of the prevalence of disease. The figure below depicts the
relationship between disease prevalence and predictive value in a test with 95% sensitivity and 95% specificity:
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7/1/2021 10.3 - Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value | STAT 507
Relationship between disease prevalence and predictive value in a test with 95% sensitivity and 85% specificity.
(From Mausner JS, Kramer S: Mausner and Bahn Epidemiology: An Introductory Text. Philadelphia, WB Saunders,
1985, p. 221.)
Try it!
Under what circumstance would you really want to minimize the false positives?
Try it!
When would you want to minimize the false negatives?
What is a good test in a population? Actually, all tests have advantages and disadvantages, such that no test is
perfect. There is no free lunch in disease screening and early detection.
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