VARIABILITY

Yulia Sofiatin
Research scenario :
An investigator wanted to study
the effect of treatment A and B on BP
reduction in patients with
Hypertension
The investigator asked 4 GPs to collect
the data
 Normal BP
Treatment A

High BP

Normal BP

Treatment B

High BP
 Result

60 70 80 90 100

Within individual:
1 observer
2 observers
between visits
Among patients
Variability
is a natural characteristic of the
system that produces the population
of interest
is inherent in the population
cant be reduced through study or
measurement
What are the possible errors that
could occur during the study ?

The measurement of blood pressure depends on :

- The patient

- Manometer
Variability

- The GPs
What are the consequences of
variability?
random error X PRECISION

systematic error = BIAS

Random Error

the result of fluctuations around a true

value because of sampling variability.
can occur during data collection, coding,
transfer, or analysis
examples:
poorly worded questions,
misinterpretation an individual answer
error during coding
effects measurement in a transient,
inconsistent manner
impossible to correct
 Variability in Medical Research
Cholesterol level in a population

25%

40%
0%

110 150 200 350

Which is the normal values?

Prevalence of certain condition in different set of samples?

SAMPLING VARIABILITY
Hypothetical study

Diet MI +

High cholesterol
population

Drug MI -
200 subjects

2000 subjects Design?

Measure?
Result?
Precission
is a measure of random error
inversely related to random error
to reduce random error is to increase
precision.
Confidence intervals demonstrate the
precision of relative risk estimates
Variability in Medical Research

B
B
A
A

0% 5% 10% 15% 20%

200 subjects

2000 subjects

SAMPLING VARIABILITY
Reducing random error

increase the sample size

reduce the variability in measurement in
the study
more accurate measuring device
increasing the number of measurements
Systematic Error

The presence of a difference between

the true value (in the population)
the observed value (in the study)
from any cause other than sampling
variability
Example: poor calibration
How does our body respond to glucose intake?

Variability due to diet

How do age alter our condition?

Variability due to age and sex

Does environment alter our condition?

Variability due to environment

Does our gene alter the condition?

Variability due to genetic difference

Does the alteration of other component in our
environment alter our condition?

Variability due to bacterial mutation

What is the effect of poor calibration of the
measurement?

60 70 80 90 100

Measurement variability
How do we react to different pace?

Variability due to observation

Variability in Medical Research
Variability within the individual
Diurnal variation
Age, diet, exercise
Environmental
Variability within population
Genetic variability
Environment variability

Variability related to measurement

Poor calibration
Lack of precision
Observer
To error is human
Any epidemiologic study presents many,
many opportunities for error in relation to:
Selection of study participants

Classification and measurement

Comparison and interpretation

We need to consider validity

exercise
Choose one of an article you will use
for your thesis
List the possible variability which
could alter the result of the study
How will you cope with those
variability?