MEDICAL STATISTICS USING

SPSS

Dr. Hussien Ahmed Hussien

FACULTY OF MEDICINE | ZAGAZIG UNIVERSITY
Medical Statistics Using SPSS Dr. Hussien Ahmed Hussien

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Part I

Starting the program and Descriptive Statistic

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Starting the program

The following steps are for starting IBM
SPSS Statistics 22 using the computers in
the ITS Training Program computer labs.
The steps for starting the program on
other computers may vary.

To start IBM SPSS Statistics 22:

1. Click the Start button, click All

Programs, click IBM SPSS Statistics, and
then click IBM SPSS Statistics 22. The IBM
SPSS Statistics 22 dialog box opens (see
Figure 1).

2. Click the Cancel button to close the dialog box.

Exploring the User Interface

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1- Defining Variables
First, assign variable names based on your research questionnaire. If variable names are not
assigned, SPSS Statistics provides default names that may not be recognizable

3. Under the Type column, click Numeric, and then click the Ellipses utton that

appears next to it. The Variable Type dialog box opens.

4. Select the String option, and then click the OK button.

5. Type Sex in row two under the Name column, and then press the Enter key.

6. Click the cell in row two under the Decimals column and change the entry to 0 using the

spin box.

7. Type What is your sex? in row two under the Label column, and then press the Enter

key.

8. Click None in row two under the Values column, and then click the Ellipses button. The

Value Labels dialog box opens (see Figure 5).

9. Type 1 in the Value box, type Female in the Label box, and then click the Add button.

10. Repeat step 9 using a value of 2 and a label of Male.

11. Click the OK button.

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15. Type What is your age?

in row four under the Label column, and then press the Enter key.
16. Click None in row four under the Values column, and then click the Ellipses button. The
Value Labels dialog box opens (see Figure 6).
17. Type 1 in the Value box, type 19 or younger in the Label box, and then click the Add button.
18. Repeat step 17 for values 2 through 5 and label them as shown in Table 3 (you may also
refer back to the sample questionnaire). See Figure 6 for the results.
19. Click the OK button

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2- Data Entry
After defining the variables, users can enter data for each case. If variables are defined with the
Numeric data type, then numeric data should be entered. SPSS Statistics will only accept
numeric digits (0-9) for a Numeric data type. If variables are defined as String data, any
keyboard character can be entered.
To enter data:
1. Click the Data View tab in the lower-left corner of the Data Editor window (see Figure 7).
2. Click in a cell and type the corresponding data. The entry also appears in the Cell Editor
(see Figure 8).

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Descriptive Statistics
1- Fequency analysis: frequancy
analysis is used to describe one variable.

1- Click the Analyze menu, point to Descriptive

Statistics, and then click Frequencies (see Figure
9). The Frequencies dialog box opens

2- Select the variable(s) you want to analyze,

and then click the transfer arrow button . The
selected variable is moved to the Variable(s) box
(see Figure 10).

3- Select the Display frequency tables check

box if necessary.

4- Click the Statistics button. The Frequencies:

Statistics dialog box opens (see Figure 11).

5. Select the Mean, Median, and Mode check

boxes in the Central Tendency section.

6. Select the Std. deviation check box in the

Dispersion section.

7- Click the Continue button to return to the

Frequencies dialog box.

8. Click the OK button. An Output Viewer

window opens and displays the statistics and

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2- Cross tabes: Crosstabs are used to examine the relationship between two
variables.

1- In Data View, click the Analyze menu, point to Descriptive Statistics, and then click
Crosstabs (see Figure 13). The Crosstabs dialog box opens.

2. Select the the first variables and move it to the Row(s) box. Then select the second
one then move it to the Column(s) box. (see Figure 14)

3- Click the OK button. An Output Viewer window opens and displays two tables: Case
Processing Summary and the Crosstabulation matrix.

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Data Manipulation
Data files are not always organized to meet specific user needs. For example, users
may wish to select a specific subject or split the data file into separate groups for
analysis.

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Splitting a File
To split a file for analysis:
1- Click the Data menu, and then click Split File (see Figure 19). The Split File dialog box
opens (see Figure 20).
2- Select the sex variable in the left box.
3- Select the Compare groups option.
4- Click the transfer arrow button to move the sex variable to the Groups Based on box.
5- Click the OK button.

NB: Do not forget to reset the split file option.

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Three methods to test whether data is normally distributed.

1- Draw a histogram of the data and get SPSS to superimpose a normal curve.
2- Checking for normality with a Q-Q plot.
3- Checking The results of the Kolmogorov-Smirnov test.

If P value <0.05 : Not Normal

If P value >0.05 : Normal

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Part II
How to choose the best Statistical Test

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How to choose the best Statistical Test?

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To run a One-Samples T Test:

1. Click the Analyze menu, point to Compare Means, and then click one-Samples T
Test.
2. select the variable and determine the test value
3. Click OK

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To run a Paired-Samples T Test:

1. Click the Analyze menu, point to Compare Means, and then click Paired-Samples T
Test. The Paired-Samples T Test dialog box opens.
2. Select the pre and post treatment variables in the box on the left, and then click the
transfer arrow button to move them to the Paired Variables box.
3. Click the OK button.

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To run the Independent-Samples T Test:

 Don’t forget to code the data

1. In Data View, click the Analyze menu, point to Compare Means, and then click
Independent-Samples T Test. The Independent-Samples T Test dialog box opens.
2. Select sleeping hours variable in the box on the left, and then click the transfer arrow
button to move it to the Test Variable(s) box.
3. Select the Drug type variable in the box on the left, and then click the transfer arrow
button to move it to the Grouping Variable box.
5. Click the Define Groups button. The Define Groups dialog box opens.
6. Type 1 in the Group 1 box, type 2 in the Group 2 box, and then click the Continue
button.
7. Click the OK button. The Output Viewer window opens with several tables, including an
Independent Samples Test table

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To run One-Way ANOVA: Levene's Test for Homogeneity

If P <0.05 No homogeneity between the two groups
if P >0.05 Homogeneity

1. In Data View, click the Analyze menu, point to Compare Means, and then click
OneWay ANOVA. The One-Way ANOVA dialog box opens.
2. Select the Hemoglobin variable in the box on the left and move it to the Dependent List
box.
3. Select the Drug variable in the box on the left and move it to the Factor box.
4. Click the Options button. The One-Way ANOVA: Options dialog box opens.
5. Select the Descriptive, Homogeneity of variance test, and Means plot check boxes.
6. Click the Continue button.

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Post Hoc analysis of One-Way ANOVA Test.

In ANOVA, if the null hypothesis is rejected, then it is concluded that there are differences
between the means (μ1, μ2,…, μa). It is useful to know specifically where these differences exist.
Post hoc testing identifies these differences.

To run post hoc tests:

1. In Data View, click the Analyze menu, point to Compare Means, and then click OneWay ANOVA. The One-
Way ANOVA dialog box opens
2. Click the Post Hoc button. The One-Way ANOVA: Post Hoc Multiple Comparisons
dialog box opens.
3. Select the Tukey check box, and then click the Continue button.
4. Click the OK button. The Output Viewer window opens.

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To run Two-Way ANOVA:

1. In Data View, click the Analyze menu, point to General Linear Model, and then click
Univariate. The Univariate dialog box opens.
2. Select the hemoglobin variable in the box on the left and move it to the Dependent Variable
box.
3. Select the Drug and Duration variables in the box on the left and move them to the Fixed Factor(s) box.
4. Click the Options button. The Univariate: Options dialog box opens.
5. Select the Descriptive statistics check box, and then click the Continue button.

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Post Hoc analysis of Two-Way ANOVA Test

As before

To run Chi-squared test

1- Data coding
2- In Data View, click the Analyze menu, point to Descriptive Statistics, and then click
Crosstabs. The Crosstabs dialog box opens.
4- Select Gender to move it to the Row(s) box.
5- Select the Smoking to move it to the Column(s)
6- Select Cells dialog box
7- Select Expected from content list then continue.
8- Select Statistics dialog box
9- Select Chi-square then continue

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Mann–Whitney test

Non-parametric statistics are used when the data are not normally distributed and so are not
appropriate for “independent t-test” tests.

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Wilcoxon test
Non-parametric statistics are used when the data are not normally for two paired group. It is
similar to paired sample t-test tests for normally distributed data.

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Part III
Regression and Correlation Analysis

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Correlation Analysis
When is it used?
Where there is a linear relationship between two variables there is said to be a correlation between them.
Examples are height and weight in children, or BMI and the dose of anesthesia.

The strength of that relationship is given by the “correlation coefficient (denoted r)”.

The most effective way to assessing the nature of any association between two variables is by
considering a scatterplot

Scatter Plot

The first step is create a scatter plot of the data. “There is

no excuse for failing

In general, scatter plots may reveal:

• positive correlation (high values of X associated with
high values of Y)
• negative correlation (high values of X associated with
low values of Y)
• no correlation (values of X are not at all predictive of
values of Y).
These patterns are demonstrated in the figure to the
right.

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Correlation coefficient is a measure of association between two variables, and it

ranges between (–1 and +1).
1- A positive correlation is ranged from 0 to +1

2- A negative correlation is ranged from 0 to -1

3- A perfect correlation is equal +1 or -1

4- If the correlation is equal zero, there is no association.

5- Strong correlation if r > +0.5 or r < -0.5.

6- Week correlation if r < +0.5 or r > -0.5.

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Pearson r correlation
It is the most widely used correlation statistic to measure the degree of the relationship between:

1- linearly related variables

2- continuous variables
3- At least one of the two variable is normally distributed.

Examples of research questions a Pearson correlation can examine:

1- Is there a statistically significant relationship between age, and height?

2- Is there a relationship between temperature, and bacterial growth?

Spearman rank-order correlation

It is used to measure the degree of the relationship between:

1- Non-linearly related variables (See Figure)

2- two continuous or ordinal variables

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Is there a relationship between academic performance and Internet access?

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Regression Analysis
Regression analysis is a statistical process for estimating the relationships among variables by creating a
prediction equation; used to estimate how the value of dependent variable (Y) can be predicted based
on the value of one independent variable (X).

(Regression analysis is a statistical tool used in prediction of value of unknown variable from known
variable)

Simple Regression
Simple regression estimates how the value of one dependent variable (Y) can be predicted based on
the value of one independent variable (X). The linear equation for simple regression is as follows:

Y = X*b + a

Y= dependent variable (needed)

X= independent variable (given)
a= constant from SPSS (value of Y when x=0)
b= slop of regression (called confession B in SPSS)

To run a simple regression analysis:

1. Switch to the Data Editor window.
2. Click the Analyze menu, point to Regression, and then click Linear (see Figure 5). The Linear
Regression dialog box opens (see Figure 6).
3. Select the (Response rate) variable in the box on the left, and then click the first transfer arrow
button to move it to the Dependent box.
4. Select the (Dose) variable in the box on the left, and then click the second transfer arrow button to
move it to the Independent(s) box.
5. Click the OK button.

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Figure 5 – Analyze Menu When Selecting Linear Figure 6 – Linear Regression Dialog Box

Model Summary

R Adjusted R Std. Error of the

Model R Square Square Estimate

1 .974a .948 .943 4.56065%

Coefficientsa

Standardized
Unstandardized Coefficients Coefficients

Model B Std. Error Beta t Sig.

1 (Constant) 36.964 2.574 14.361 .000

Dose .264 .019 .974 14.119 .000

b a

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Part IV
Diagnostic test using SPSS

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Calculating the sensitivity and specificity of a diagnostic test using spss:

To perform this analysis, we have to use the crosstabs box:

1. In Data View, click the Analyze menu, point to Descriptive Statistics, and then click
Crosstabs. The Crosstabs dialog box opens.
2. Select screening test to move it to the Row(s) box.
3. Select the diagnostic test to move it to the Column(s)
4- select Cells dialog box
5- Select column from percentage list then continue. >> Ok

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True False
negative negative

screening test * diagnostic test Crosstabulation

diagnostic test

Negative Positive Total

screening test Negative Count 8 3 11

% within diagnostic test 88.9% 9.7% 27.5%

Positive Count 1 28 29

% within diagnostic test 11.1% 90.3% 72.5%

Total Count 9 31 40

% within diagnostic test 100.0% 100.0% 100.0%

False True
positive positive

specificity NPV

screening test * diagnostic test Crosstabulation

diagnostic test

Negative Positive Total

screening test Negative Count 8 3 11

% within screening test 72.7% 27.3% 100.0%

% within diagnostic test 88.9% 9.7% 27.5%

Positive Count 1 28 29

% within screening test 3.4% 96.6% 100.0%

% within diagnostic test 11.1% 90.3% 72.5%

Total Count 9 31 40

% within screening test 22.5% 77.5% 100.0%

% within diagnostic test 100.0% 100.0% 100.0%

PPV Sensitivity

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Receiver Operating Characteristics (ROC) curve

1- Under the top menu option “Analysis”, select “ROC Curve”

2- You will have a dialog box that says ROC Curve. In this box, you should drag your screening
measure to the box that says “Test Variable”. You should drag your dichotomized outcome (+ve and –
ve) variable into the “State Variable” box.

3- In the box that asks for the “Value of the State Variable”, put “1” – (The coding of positive results
of screening test).

4- In the box labeled “Display” check the options for “ROC Curve” “with Diagonal reference line”
and “Standard Error and Confidence Interval”

5- In the upper right corner of the ROC Curve dialog box, you’ll see the word “Options” – click on it.

6- A new dialog box should open called “ROC Curve Analysis; Options”. In this box, under “Test
Direction” select the appropriate option.

7- Select “Continue” and you should be returned to the ROC Curve dialog box, select “Ok” and the
analysis will run.

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Area Under the Curve

Test Result Variable(s): CA 125 level (kU/L )

Asymptotic 95% Confidence

Interval

Area Std. Errora Asymptotic Sig.b Lower Bound Upper Bound

.931 .032 .000 .868 .994

When the serum CA-125 level=38

U/mL as a cut-off level using the ROC
curve in ovarian adenomyosis, the
sensitivities and specificities were
96% and (100-21)=79%, respectively

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Part V
Odds ratio (OR) and Relative risk (RR)

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Odds ratio (OR)

Used by epidemiologists in studies looking for risk factors, it is a way of

comparing patients who already have a certain condition (cases) with
patients who do not (controls) – a “case–control study”.

Case Control

Exposed a b
Unexposed c d

𝑛𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒 (𝑎)

Odds of exposure in case =
𝑛𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑤𝑖𝑡ℎ𝑜𝑢𝑡 𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒(𝑐)

Odds of exposure in control =,𝑛𝑛. 𝑛𝑛control 𝑛𝑛 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛 (𝑛)-, -

𝑛𝑛. 𝑛𝑛control 𝑛𝑛𝑛ℎ𝑛𝑛𝑛 𝑛𝑛𝑛𝑛𝑛𝑛𝑛𝑛(𝑛)..
Odds Ratio (OR) =,Odds of exposure in case-Odds of exposure in control.

Online calculator: www.hutchon.net/confidOR.htm

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Interpreting the odds ratio

The odds ratio indicates the increased (or decreased) odds of the disease being
associated with the exposure of interest. The odds ratio can take any value
between 0 and infinity, for example:

• If the odds ratio is 1, the odds of disease is the same in the exposed and
unexposed groups.
• If the odds ratio is 2, the exposure of interest doubles the odds of disease.
• If the odds ratio is 0.5, the exposure of interest halves the odds of disease.
• If the odds ratio is 0.25, the exposure of interest reduces the odds of disease by
75%.

NB (If the OR<1, it means that this risk factor protects against this disease).

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Risk ratio (RR)

Often referred to as relative risk

Relative risk is used in “cohort studies”, prospective studies that follow a group
(cohort) over a period of time and investigate the effect of a treatment or risk
factor.

Exposed Unexposed total

Diseased a C a+c
Not diseased b d B+c
total a+b c+d

𝑛𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑖𝑛 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝 (𝑎)

Risk in ex𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝 =
𝑡𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑒𝑥𝑝𝑜𝑠𝑒𝑑 (𝑎+𝑏)

𝑛𝑜. 𝑜𝑓𝑐𝑎𝑠𝑒𝑠 𝑖𝑛 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒 (𝑐)

R𝑖𝑠𝑘 𝑖𝑛 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝 =
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑢𝑟𝑒 (𝑐+𝑑)

Risk in ex𝑝𝑜𝑠𝑒𝑑 𝑔𝑟𝑜𝑢𝑝

Risk ratio (RR) =
R𝑖𝑠𝑘 𝑖𝑛 𝑢𝑛𝑒𝑥𝑝𝑜𝑠𝑒 𝑑 𝑔𝑟𝑜𝑢𝑝

Online calculator: www.hutchon.net/confidRR.htm

Interpreting the odds ratio: (the same of OR)

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• If the risk ratio is 1, the risk of disease is the same in the exposed and unexposed
groups.
• If the risk ratio is 2, the exposure of interest doubles the risk of disease.
• If the risk ratio is 0.5, the exposure of interest halves the risk of disease.
• If the risk ratio is 0.25, the exposure of interest reduces the risk of disease by
75%.

What is the difference between the odds ratio and risk ratio?
“The odds ratio is interpreted in the same way as the risk ratio”

• Odds and odds ratio are calculated in case–control studies.

• Risk and risk ratio are calculated in cohort studies.

• When the disease is rare, the odds ratio is approximately equal to the risk ratio.
In case–control studies, the incidence rate of disease cannot be calculated, as we
don’t know the size of the population from which the cases were drawn.
However, in cohort studies, a set number of ‘healthy’ individuals susceptible to
the disease are recruited at the start of the study period. These subjects are then
followed up longitudinally over time, and new cases of disease recorded, thus
allowing us to calculate the incidence rate and risk ratio.
In case–control studies, provided the outcome event is rare, the odds is
approximately the same as the risk and so the odds ratio is an estimate of the risk
ratio, and is interpreted in a similar way.

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Calculating OR and RR Using SPSS

1- Data coding
2- Click Data menu, point weight cases, the weight cases by (frequency)
3- In Data View, click the Analyze menu, point to Descriptive Statistics, and then click
Crosstabs. The Crosstabs dialog box opens.
4- Select exposure to move it to the Row(s) box.
5- Select the disease to move it to the Column(s)
6- Select Cells dialog box
7- Select Rows from percentage list then continue.
8- Select Statistics dialog box
9- Select Risk then continue

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Risk Estimate

95% Confidence Interval

OR
Value Lower Upper

Odds Ratio for Exposure

(smoking) (smoker / non 14.043 3.325 59.301
smoker)
For cohort Disease (Cancer)
7.393 1.939 28.187 RR
= cancer
For cohort Disease (Cancer)
.526 .470 .590
= no cancer
N of Valid Cases 1298

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