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MAMCJMS_21_17R5

MAMC Journal of Medical Sciences

Original article

Comparative analysis of study design and statistical test


utilization in Indian Journal of Community Medicine, Indian
Journal of Public Health and Bulletin of the World Health
Organization
Sandeep Sachdeva, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To analyze study topic, study design, usage of statistical test, and other selected document parameters in published original
research articles. Materials and Methods: Three journals (1) Indian Journal of Community Medicine (IJCM), (2) Indian Journal of Public
Health (IJPH), and (3) Bulletin of World Health Organization (WHO) were reviewed and all original research article published during three
years, that is, January 2014 to December 2016, were considered, and selected document parameters were recorded using checklist. During this
period, IJCM released volumes 39 to 41, IJPH released 58 to 60, and WHO released 92 to 94. Results: A total of 318 original articles were
reviewed with the contribution of 28.9% in IJCM, 27.6% in IJPH, and 43.3% in WHO bulletin. Out of all the publications, highest (46.5%)
original article belonged to research domain category-I [communicable, maternal and child health (MCH)] followed by 104 (32.7%) category-
II (noncommunicable diseases) and 66 (20.8%) by category-III (health system, medical education, and environment). Overall 79.2% original
articles were cross-sectional in study design followed by cohort (15.4%), intervention/experimental study (3.4%), and case-control (1.8%).
Average number of authors per article in WHO bulletin was 8.1 [95% confidence interval (CI): 7.19.0] followed by IJCM 4.2 (95% CI:
3.84.6), and IJPH (3.84, 95% CI: 3.494.19). There were 95 (29.9%) articles where-in all the authors were from a single institution, whereas
in 223 (70.1%) articles coauthors were from different institutions. It was also found that most (80.1%) of the study papers did not contained
any background statement regarding statistical sample size estimation; 239 (75.2%) articles used statistical software; majority had utilized
SPSS (61.08%), followed by STATA (19.24%), SAS (8.76%), R-software (5.45%), EPI-info (3.76%), and EXCEL (1.25%); nearly 210 (66%)
original research articles utilized at least one of the inferential statistics (basic, advance, and survival analytical methods). Higher proportion of
advance (60.2%) inferential statistical test and survival analysis (92.3%) were used in Bulletin of WHO; 82% of references used were within
10 years of publications of articles in WHO while this figure was 66% (IJCM) and 63% (IJPH). Conclusion: This study provides an objective
snapshot of national and international public health journal that may aid researcher for better comprehension, situational, and trend analysis as
well as assist them in their future research endeavor.

Keywords: Author mapping, bibliometric evaluation, citation, document properties, developing countries, global burden of disease, research
publications, statistical test, study-design, study topic, statistical software

INTRODUCTION Address for correspondence: Dr. Sandeep Sachdeva, MD, DNB, Department
of Community Medicine, North DMC Medical College and Hindu Rao Hospital,
The conveyance of information by research publication is New Delhi-110007, India.
responsible for growth and development of the subject area, e-mail: sachdevadr@yahoo.in
journals as well as authors and readers. This further provides
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How to cite this article: Sachdeva S, Dwivedi N. Comparative analysis


DOI: of study design and statistical test utilization in Indian Journal of
10.4103/mamcjms.mamcjms_21_17 Community Medicine, Indian Journal of Public Health and Bulletin of
the World Health Organization. MAMC J Med Sci 2017;XX:XX.

2017 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 1


Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

new insights and inspiration for new researchers to work on that is, January 2014 to December 2016 were considered,
the same or related field. Role of scientific journal ranges downloaded from the respective website, and reviewed by
from building a collective knowledge base, communicating authors. Thus editorial, personal view-point, commentary,
information, validating the quality of research, distributing oration, review article, student research section, field report,
rewards, and building scientific communities across the essay, news or letters to editors were excluded from present
globe.[1-3] During last decade there has been increased analysis. During this period IJCM released volumes 39 to 41;
thrust being given to research in the developing countries IJPH released 58 to 60 and WHO released 92 to 94.
especially India due to various internal and external driving
For every original research article following document
forces. Interalia there has been rapid expansion of research
parameters were recorded using check-list: thematic topic of
publications and appearance of new journals with a
research domain, study design, statistical methods, software,
considerable fear of diluting the quality of research
inputs for proper calculation of sample size, number of authors,
standards. An attempt has been made in the present study
department, and institution of first/corresponding authors,
to undertake selective bibliometric evaluation of original
number of pages and references used. The research domain
research articles published in reputed national and
was classified and adapted according to global burden of
international public health journals.
disease[9] categories: category-I = communicable, maternal,
Bibliometrics are quantitative technique of measuring output, perinatal, congenital, food-borne, vaccine coverage, and
mapping pattern, emerging trend and obsolesce of nutritional disorders; category-II = noncommunicable
publications, authorship, citation impact, and use of diseases, mental health, associated risk factors, geriatrics,
literature. It encompasses measurement of properties of drug abuse, injuries, burn, occupational diseases, domestic
documents and document related processes.[4,5] However, violence, and oral health; and category-III = miscellaneous
surveying peer-reviewed medical journals for their (health systems research, medical education, environment, and
contents in terms of study design and statistical methods is information technology).
not an uncommon practice.[6-8] This review is expected to
Papers containing statistical analysis beyond descriptive
serve as an objective approach for improving the quantitative
statistics (percentage, mean, median, and standard
and qualitative content of journal and learning amongst
deviation) were classified into three categories of
readers as there are very limited studies available to throw
inferential statisticsbasic, advance, and survival analysis.
light on this dimension.
We utilized SPSS ver. 16 (IBM, Armonk, New York, USA) to
Indian Journal of Community Medicine (IJCM) and Indian summarize our study findings by descriptive statistics and
Journal of Public Health (IJPH) are peer-reviewed, calculating chi-square value.
historically trusted, widely acknowledged quarterly
English language publications in the domain of RESULTS
community medicine and public health managed by two
independent professional bodies in the country. Both these A total of 318 original articles were reviewed with the
free to access journals are indexed in large number of contribution of 28.9% in IJCM, 27.6% in IJPH and 43.3%
database and earliest records of IJPH available in in WHO bulletin with 256 (80.5%) original research articles
PubMed dates back to year 1961 and 1974 (IJCM) being full-length papers while rest (62, 19.5) were brief/
respectively. IJCM is available online (www.ijcm.org.in) shorter format of original research articles.
since September 15, 2007 and IJPH is available online Table 1 and Figure 1 depict thematic study domain of
(www.ijph.in) since September 25, 2010. For comparison published original research articles. Out of all the
purpose, we also evaluated international journal of publications, highest (46.5%) original article belonged to
public health, Bulletin of the World Health Organization research domain category-I (communicable, MCH etc.)
(available in PubMed since 1948) on the same followed by 104 (32.7%) category-II (noncommunicable
parameters. Both IJCM and IJPH publish peer reviewed diseases etc.) and 66 (20.8%) by category-III (health
quarterly (four issues per year) while bulletin of system, medical education, environment, etc.). Highest
the WHO is published on monthly bases (12 issues per research articles with category-I (communicable diseases,
year). SCImago Journal Rank of IJCM was 0.62 MCH etc.) domain was published in bulletin of WHO (70,
with 1.14 cites/document; IJPH was 0.44 with 0.83 cites 47.3%) followed by IJCM (41, 27.7%) and IJPH (37, 25.0%).
and Bulletin of the WHO was 2.82 with 4.97 cites/ Amongst noncommunicable category, both the Indian
documents. journals had similar but slightly higher publications than
WHO while category-III research domain was dominated
MATERIALS AND METHODS in WHO bulletin.
Three journals (1) IJCM, (2) IJPH, and (3) Bulletin of World The study design of 79.2% original research articles was
Health Organization (WHO) journal were reviewed. All cross-sectional in nature followed by cohort (15.4%),
original research published either as full-length paper or intervention/experimental study (3.4%) and case-control
brief/short communication during last three calendar years (1.8%). Details are shown in Table 2 and Figure 2.

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Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

Table 1: Broad thematic domain of original research publications (20142016)


Journal Research domain, n (%) Total
Category-I Category-II Category-III
IJCM 41 (44.56%)(27.7%) 37 (40.21%)(35.6%) 14 (15.21%)(21.2%) 92 (100%)(28.9%)
IJPH 37 (42.04%)(25.0%) 36 (40.90%)(34.6%) 15 (17.04%)(22.7%) 88 (100%)(27.7%)
WHO 70 (50.72%)(47.3%) 31 (22.46%)(29.8%) 37 (26.81%)(56.1%) 138 (100%)(43.4%)
Total 148 (46.54%)(100%) 104 (32.70%)(100%) 66 (20.75%)(100%) 318 (100%)(100%)
P = 0.01; Table depicting both column and row percentage in brackets; category-I (communicable, MCH etc.), category-II (noncommunicable diseases etc.),
and category-III (health system, medical education, and environment).

Table 2: Distribution of study design in original research articles (20142016)


Journal Study design, n (%) Total
Cross-sectional Cohort Case-control Intervention/experimental
IJCM 74 (80.4%)(29.3%) 13 (14.1%)(26.5%) 04 (4.3%)(66.6%) 01 (1.0%)(9.0%) 92 (100%)(28.9%)
IJPH 78 (88.6%)(30.9%) 08 (9.0%)(16.3%) 01 (1.1%)(16.6%) 01 (1.1%)(9.0%) 88 (100%)(27.6%)
WHO 100 (72.4%)(39.6%) 28 (20.2%)(57.1%) 01 (0.7%)(16.6%) 09 (6.5%)(81.8%) 138 (100%)(43.3%)
Total 252 (79.2%)(100%) 49 (15.4%)(100%) 06 (1.8%)(100%) 11 (3.4%)(100%) 318 (100%)(100%)
P = 0.009; Table depicting both column and row percentage in bracket.

Figure 2: Distribution of published original research articles by study


design

colleges, 18 (5.7%) were associated with hospitals other


than medical colleges, 29 (9.1%) were involved with
Figure 1: Research domain of published original articles according to
research institute, and 103 (32.4%) had professional
journal (201416), category-I (communicable, MCH etc), category-II linkage with other miscellaneous organization. Amongst all
(noncommunicable diseases etc), and category-III (health system, publications in Indian journals, there were 10 (5.8%) research
medical education, and environment). articles where-in there was international coauthorship/
collaboration seen. Selected details are shown in Table 3.
Average (mean) number of authors per article in WHO Highest number of research publication with a source of
bulletin was higher with 8.1 (95% CI: 7.19.0) followed funding was published in bulletin of WHO (98, 71.01%).
similarly by IJCM 4.2 (95% CI: 3.84.6), and IJPH (3.84,
There were 239 (75.2%) research articles that had utilized
95% CI: 3.494.19). There were 95 (29.9%) articles which
statistical software while 79 (24.8%) articles used none. Out
reported all the authors from a single institution and 223
of all the research articles using statistical software, majority
(70.1%) articles where-in authors were from more than two
had utilized SPSS (61.08%), followed by STATA (19.24%),
institutions. Is it a true indication of collaborative effort or
SAS (8.76%), R-software (5.45%), EPI-info (3.76%), and
reflection of gifted authorship, difficult to infer. Highest
EXCEL (1.25%).
articles with multiinstitutional associated authors were
reported in bulletin of WHO (93.4%) with similar Average (mean) number of references used were 35.4 (95%
representation in both Indian journals (50.0%). Overall, CI: 32.9138.01) in WHO bulletin while it was near similar in
168 (52.8%) authors were associated with medical both Indian journals (IJCM = 20.2 and IJPH = 17.8).

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Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

Table 3: Selected characteristic of published original research manuscript (20142016)


Parameters IJCM IJPH WHO
Avg. number of authors Mean (95% CI) 4.2 (3.84.68) 3.84 (3.494.19) 8.1 (7.189.08)
Authors involved (n, %) Single center 42 (45.65%) 44 (50%) 09 (6.52%)
Multi center* 50 (54.34%) 44 (50%) 129 (93.47%)
Funded research (n, %) Yes 08 (8.69%) 03 (3.40%) 98 (71.01%)
No 84 (91.3%) 85 (96.59%) 40 (28.98%)
Statistical software (n, %) Used 73 (79.34%) 62 (70.45%) 104 (75.38%)
Not used 19 (20.65%) 26 (29.54%) 34 (24.63%)
Statement regarding sample size estimation (n, %) Given 24 (26.0%) 30 (34.0%) 09 (6.52%)
Not given 68 (73.91) 58 (65.9%) 129 (93.47%)
Avg. sample size Median value 347 367 945
Number of pages per document Mean (95% CI) 5.52 (5.15.95) 5.28 (4.945.62) 9.40 (9.049.76)
Number of references Mean (95% CI) 20.26 (18.3422.18) 17.84 (16.1719.51) 35.46 (32.9138.01)
Time-frame of total references used (%) Within 10 years 66% 63% 82%
More than 10 years 34% 37% 18%
*
Two or more institutions.

However, utilization of more recent (within 10 years of


publications) references was reported in WHO bulletin Table 4: Type and frequency of inferential statistical
than the Indian journals (Table 3). This might be methods used in all published original articles
suggestive of stringent quality parameters, such as focus of (20142016)
journal on advancement of knowledge base, build upon the Type of inferential statistics N (%)
current evidence and transmission of latest information to the Basic test Chi-square 111 (52.8)
readers, and/or updated extensive literature review by z test 49 (23.3)
researchers. OR/RR/AOR 45 (21.4)
t test 36 (17.1)
Table 4 depicts range of statistical test utilized. It was Simple logistic regression 25 (11.9)
observed that all articles used descriptive statistics Correlation 22 (10.4)
(percentage, mean, median, and standard deviation) as per MannWhitney 17 (8.1)
Fisher 14 (6.7)
need. On further scrutiny, 210 (66%) original research articles One way ANOVA 14 (6.7)
utilized at least one of the inferential statistics (basic, KruskalWallis 13 (6.2)
advance, and survival analytical) methods, whereas 108 Wilcoxon test 06 (2.9)
(34%) articles used none, including policy-level research Advance test Multivariate logistic regression 63 (30.0)
papers. The number of statistical method exceeds the total Other miscellaneous 21 (10.0)
number of articles since some of them reported more than one Agreement checking 17 (8.1)
Sensitivity 14 (6.7)
statistical method; 92 (28.9%) articles used single statistical KolmogorovSmirnov test 07 (3.3)
method while 118 (37.1%) articles reported two or more Bayesian analysis 06 (2.9)
methods. Most commonly utilized statistical method was chi- Meta-analysis 06 (2.9)
square test (52.8%) followed by multivariate logistic M ANOVA 03 (1.4)
regression (30%), z test (23.3%), and so on. Kappa statistic 03 (1.4)
Normality checking 02 (0.9)
Table 5 depicts the usage pattern of inferential statistics. Out Wald 01 (0.4)
of all the inferential statistical methods employed, highest Survival analysis Kaplan Meier 10 (4.8)
Cox proportional HR 08 (3.8)
(352, 67.56%) were basic test followed by advance test (143,
Hazard ratio 05 (2.4)
27.44%) and only 26 (4.99%) had utilized survival analysis. ROC curve 02 (0.9)
Amongst basic statistical methods, 42.7% were applied in Log-rank test 01 (0.4)
WHO bulletin followed by IJCM (30.8%) and IJPH (26.5%),
respectively. Higher proportion of advance test (60.2%) and
survival analysis (92.3%) were used in Bulletin of the WHO. future albeit that would require capacity building.
Currently, many of the document properties such as
mapping and others are being undertaken by publication
DISCUSSION houses with increase usage of newer information
This study, probably first of its kind, carried out technology tools and process in the form of bibliometrics,
comprehensively and simultaneously on Indian and almetrics, and other measurement indicators. However, this
international public health journal revealed interesting study is unique considering that learning emerging from peer-
findings that may aid scholar to uptake high-quality review of content evaluation would still hold its superiority
research work with more advance statistical methods in and importance over artificial intelligence.

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Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

Table 5: Usage of inferential statistical methods according to journal


Journal Basic statistics Advance statistics Survival analysis Total N (%)
IJCM 109 (83.8%)(30.8%) 21 (16.1%)(14.7%) 0(0) 130 (100%)(24.95%)
IJPH 93 (70.9%)(26.5%) 36 (27.4%)(25.1%) 02 (1.5%)(7.7%) 131 (100%)(25.14%)
WHO 150 (57.6%)(42.7%) 86 (33.0%)(60.2%) 24 (9.2%)(92.3%) 260 (100%)(49.90%)
Total 352 (67.56%)(100%) 143 (27.44%)(100%) 26 (4.99%)(100%) 521 (100%)(100%)
Table depicting both column and row percentage.

The quality of publication in both Indian journals has evolved This is in contrast to Pakistan Journal of Medical Sciences
for better since last couple of years. Both the Indian (20052015), where nonclarity of research design ranged
community medicine (I = 44.5%, II = 40.2%, and III = from 5 to 16%.[15]
15.2%) and public health (I = 42.4%, II = 40.9%, and III =
An interesting study assessing the quality of reporting of
17.04%) journal have published similar proportion of original
cross-sectional studies (20102011) in IJCM described that
articles under broad three-research categories. However,
58% of the articles reported less than 15 items of the desirable
bulletin of the WHO published category-I = 50.7%,
22 in the Strengthening the Reporting of Observational
category-II = 22.4%, and category-III = 26.8%, reflecting
Studies in Epidemiology statement checklist.[16] This
the higher burden of communicable disease/maternal and
information is needed to give readers a clear idea as to
child health issues amongst substantial population of
what was planned and what was done. Similarly, in our
developing and under-developed countries of the world.
study, it was observed that most (80.1%) of the study
Another study (20042009) carried out on four Indian papers did not contain any background statement regarding
journals also depicted that 43% of all published articles statistical sample size estimation, which is very crucial to any
were on noncommunicable diseases (category-II). It was efficient study design. Another important aspect noted was
also reported that IJCM published about 30% of articles that 134 (42.1%) articles did not report clear inclusion/
on non-communicable diseases (NCDs).[10] In our study exclusion criteria for the sample recruitment. One of the
(20142016), higher proportion (40.2%) of articles on probable reasons for this could be the word-count
NCDs were published reflecting the time evolution and restriction imposed by journals in manuscript.
priority being received by NCDs in the recent times. Since Rigby et al. found that articles reporting no statistics
developing country like India is undergoing epidemiological constituted 29.1, 32.4, and 40.7% studies in the British
transition and experiencing double burden of disease, both the Medical Journal, British Journal of General Practice, and
Indian journal seems to be adequately reflecting the ground- Family Practice, respectively.[17] Nonutilization of statistics
realities. in our analysis was 34%. On a corollary, 66% of articles had
Considering the feasibility and applicability perspective, utilized some statistical test that is in contrast as reported in
cross-sectional studies are easy to conduct, and hence the study published in Journal of Family and Community
predominance (79.2%) of such designs in public health Medicine (71%) and Chinese Medical Journal (78.1%).[11,18]
research articles as noted in present analysis. This finding Majority of health journals prescribe Vancouver style of
seems to corroborate with other studies done amongst reference formatting with increase focus on recent journal
international primary care, general, community medicine, publications as references. Number of references/article
or public health journal too.[11] There are limited studies allowed is directly related to type of manuscript, strength/
available on public health journals for comparison purpose detail of write-up, word-limit restriction, and/or number of
especially in Indian setting. However, this is in contrast to pages per articles and should be visualized accordingly. The
another study, evaluating predominantly 14 Indian clinical Indian journals prescribe limits of 6 authors with 30 references
journals wherein 60.8% research articles were prospective in full-length original articles and up to 6 authors with 10
study and least common was cross-sectional study (6.2%) references in short/brief research article. In our analysis, mean
design.[12] McDermott, way back in 1991, found that 35.0% number of references used with 20.2 (95% CI: 18.322.1) in
papers published in JAMA, The Lancet, and New England IJCM and 17.8 (95% CI: 16.119.5).
Journal of Medicine were clinical trials.[13] Another recent
study carried on these three clinical journals for the period Both the Indian journals have evolved for better in terms of
(20052009) reflected randomized clinical trial (30.9%), quality of research and publications yet the difference
clinical trial (3.7%), cohort and case-control studies observed on review of literature could perhaps be due to
(19.2%), cross-sectional studies (2.4%), and case reports specialty (clinical vs. public health journal). The scope of
(43.8%).[14] publication in Indian journals could be enhanced with young
public health researchers exploring clinical epidemiology in
In our analysis, there was no article with ambiguous research future. Both Indian journals have demonstrated certain
design in any of the three journals that is suggestive of good- strength and similarities in present study and discussed by
quality research/write-up and/or editorial screening decision. authors elsewhere also.[19,20] Introspection and constructive

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Sachdeva and Dwivedi: Comparative analysis of study design and statistical test utilization

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Nil. statistical methods in Indian Medical Journals. J Pharm Negative
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in study design, gender issues, and other characteristics of clinical
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Gen Intern Med 1995;10:13-18.
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