生物统计方法在流行病学、临床医学上之应用

精品文档生物統計方法在流行病學、臨床醫學上之應用統計(Statistics)資料收集(collect)、偵測(monitor)、分析(analyze)、綜括(summary)、解釋(interpret)之科學。生物統計(Biostatistics)統計應用於生物(生命) 科學，主要包括下列領域: 公共衛生(Public Health)、醫藥(Medicine)、生態及環境(Ecological and environmental)。流行病學 ( Epidemiology )希臘原文 Epidemiology: Epi = among, demos = people, logos = doctrine. Websters dictionary: 1. The branch of medicine dealing with the incidence and prevalence of disease in large populations and with detection of the source and cause of epidemics. 2. The factors contributing to the presence or absence of a disease. (周碧瑟教授): 流行病學是研究人類疾病分佈及其決定因素的科學，疾病的發生以個人特性或環境的不同來衡量。（陳建仁教授）：流行病學是研究族群之健康狀態和健康事件之分布狀況及其決定因素，並應用研究成果以控制健康問題的學問。（引自：Last, 1988）。(林瑞雄教授):流行病學是一科學研究方法論，主要用以探討觀察值與期望值之不同，人、時、地為三大探討決定因素。常用的流行病學研究設計 橫斷型研究(cross sectional study) 病例對照研究法(case-control study) 世代(追蹤)研究法(cohort study, follow-up study, longitudinal study)資料整理與分析資料的型態 Nominal: unordered categories (for example: gender, blood type) Ordinal: ordered categories (for example: grade) Discrete: only whole numbers are possible, order and magnitude matters (for example: temperature) Continuous: any value is conceivable (for example: body height)資料的誤差 精確型：sex, age, genotype, 微小誤差型：身高，血、尿中之各種生理生化值 較大之誤差：生活史，態度資料檢查與處理 遺失值，不合理值等資料存檔與管理多維資料管理系統多重疾病照護與追蹤管理系統統計分析回答所要回答的問題 !列聯表分析法;Contingency Table Analysis有飲酒習慣無飲酒習慣Total高尿酸血症abm=a+b正常cdn=c+dt=a+cs=b+dN=m+n=t+sOdds of “exposed” vs. “non-exposed” in CASE group：a / m：b / m = a / bOdds of “exposed” vs. “non-exposed” in CONTROL group：c / n：d / n = c / dRatio of Odds (Odds Ratio)：a / b：c / d = ad / bcCornfield (1951): there are two assumptions in case-control study design1. Rare disease assumption: c/d is the estimation of (N1-A)/(N0-B), not N1/N0. Only rare disease = (N1-A)/(N0-B) N1/N02. The ratio of exposure/un-exposure is the same during the research period: c/d = N1/N0Miettinen (1976): density sampling (time match sampling): OR can be an estimator of RR (Relative Risk)(參照王榮德教授 流行病學方法論)對數型迴歸分析 Logistic Regression (Model)模型 (model)log(p/1-p)= 012p=Pr(disease|暴露，諸危險或干擾因子)解釋：log(Odds Ratio)在耦配(matching)設計下，必須另外採用