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    The assumption of independence of observations

    Generalized Estimating Equations (GEE) Homogeneity Of Variance Independence Of Observations Assumption Kurtosis Levene's Test Non-parametric Statistics Normality Outliers P-value Skewness Statistical Assumptions

    Independence of observations

    Each participant in a sample can only be counted as one observation

    As a biostatistician, I spend a lot of time testing for normality and homogeneity of variance.

    Skewness and kurtosis statistics are used to assess the normality of a continuous variable's distribution.  A skewness or kurtosis statistic above an absolute value of 2.0 is considered to be non-normal.  Distributions are often non-normal due to outliers in the distribution.  Any observation that falls more than 3.29 standard deviations away from the mean is considered an outlier.

    Levene's Test of Equality of Variances is used to measure for meeting the assumption of homogeneity of variance. Any Levene's Test with a p-value below .05 means that the assumption has been violated.  In the event that the assumption is violated, non-parametric tests can be employed.

    There is one more important statistical assumption that exists coincident with the aforementioned two, the assumption of independence of observations.  Simply stated, this assumption stipulates that study participants are independent of each other in the analysis. They are only counted once.

    In between-subjects designs, each study participant is a mutually exclusive observation that is completely independent from all other participants in all other groups.

    For within-subjects designs, each participant is independent of other participants.  There are just multiple observations of the outcome, per participant.

    With this being said, it is prevalent for researchers to take multiple measurements of an outcome and compare these multiple measurements in an independent fashion (oftentimes with differing numbers of observations across participants) or within-subjects (ALWAYS with differing numbers of observations of the outcome).  By default, these are not independent measures and violate the assumption of independence of observations.  What is one to do?

    The answer is generalized estimating equations (GEE).  This family of statistical tests are robust to multiple observations (or correlated observations) of an outcome and can be used for between-subjects, within-subjects, factorial, and multivariate analyses.
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    Ordinal measures becoming continuous with normality

    ANOVA Test Chi-square Classical Test Theory Continuous Friedman's ANOVA Independent Samples T-test Item Response Theory Kruskal-Wallis Kurtosis Logistic Regression Mann-Whitney U Non-parametric Statistics Normality Ordinal Parametric Statistics Regression Repeated-measures ANOVA Skewness Wilcoxon

    Ordinal measures and normality

    Ordinal level measurement can become interval level with assumed normality

    Here is an interesting trick I picked up along the way when it comes to ordinal outcomes and some unvalidated measures. If you run skewness and kurtosis statistics on the ordinal variable and its distribution meets the assumption of normality (skewness and kurtosis statistics are less than an absolute value of 2.0), then you can "upgrade" the variable to a continuous level of measurement and analyze it using more powerful parametric statistics.  

    This type of thinking is the reason that the SAT, ACT, GRE, MCAT, LSAT, and validated psychological instruments are perceived at a continuous level. The scores yielded from these instruments, by definition, are not continuous because a "true zero" does not exist. Scores from these tests are often norm- or criterion-referenced to the population so that they can be interpreted in the correct context. Therefore, with the subjectivity and measurement error associated with classical test theory and item response theory, the scores are actually ordinal.

    With that being said, if the survey instrument or ordinal outcome is used in the empirical literature often and it meets the assumption of normality as per skewness and kurtosis statistics, treat the ordinal variable as a continuous variable and run analyses using parametric statistics (t-tests, ANOVA, regression) versus non-parametric statistics (Chi-square, Mann-Whitney U, Kruskal-Wallis, McNemar's, Wicoxon, Friedman's ANOVA, logistic regression). 
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    Using naturally skewed continuous variables as outcome variables

    Kurtosis Listwise Deletion Logarithmic Transformations Non-parametric Statistics Outcome Outliers Skewness

    Transformed outcomes

    Some continuous variables will be naturally skewed

    In medicine, there is an important metric that signifies efficiency and quality in healthcare, length of stay (LOS) in the hospital. When thinking about the distribution of a variable such as LOS, you have to put it into a relative context. The vast majority of people will have an LOS of between 0-3 days given the type of treatment or injury that brought them to hospital. VERY FEW individuals will stay at the hospital one month, six months, or a year. Therefore, the distribution looks nothing like the normal curve and is extremely positively skewed.  

    As a researcher, you may want to predict for a continuous variable that has a natural and logical skewness to its distribution in the population. Yet, the assumption of normality is a central tenet of running statistical analyses. What is one to do in this situation?

    The answer is to first, run skewnessand kurtosis statistics to assess the normality of your continuous outcome.  If the either statistic is above an absolute value of 2.0, then the distribution is non-normal. Check for outliers in the distribution that are more than 3.29 standard deviations away from the mean. Make sure that the outlying observations were entered correctly.

    You now have a choice:

    1. You can delete the outlying observations in a listwise fashion. This should be done only if the number of outlying variables is less than 10% of the overall distribution. This is the least preferable choice.

    2. You can conduct a logarithmic transformation on the outcome variable. Doing this will normalize the distribution so that you can run the analysis using parametric statistics. The unstandardized beta coefficients, standard errors, and standardized beta coefficients are not interpretable, but the significance of the associations between the predictor variables and the transformed outcome can yield some inferential evidence.

    3. You can recode the continuous outcome variable into a lower level scale of measurement such as ordinal or categorical and run non-parametric statistics to seek out any associations. Of course, you are losing the precision and accuracy of continuous-level measurement and introducing measurement error into the outcome variable, but you will still be able to run inferential statistics.

    4. You can use non-parametric statistics without changing the skewed variable at all. That is one of the primary benefits of non-parametric statistics: They are robust to violations of normality and homogeneity of variance. Instead of interpreting means and standard deviations, you will interpret medians and interquartile ranges with non-parametric statistics. 

    Click on the Statistics button to learn more.
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    Meeting statistical assumptions

    Homogeneity Of Variance Kurtosis Levene's Test Missing Data Normality Skewness Statistical Assumptions

    Meeting statistical assumptions is IMPORTANT

    Statistics is a flawed mathematical science and assumptions MUST be met

    I've read in the literature that somewhere between 30-90% of all statistics reported in the medical literature are incorrectly conducted. First of all, that's a WIDE range and either extreme should be pretty frightening to consumers of healthcare and other related services. If your practitioner is using evidence-based practices, then one would hope that your treatment regimen does NOT fall within that range!

    Many times, statistics are incorrect because researchers do not check for the statistical assumptions associated with using their statistical tests. There are three fundamental statistical assumptions that all researchers should check before running any type of statistic:

    1. Normality - If you are using ANY continuous variables, then use skewness and kurtosis statistics to assess their normality. Any variables that have a skewness or kurtosis statistics above an absolute value of 2.0 are assumed to be non-normal.

    2. Homogeneity of variance - If you are using between-subjects analyses to compare independent groups on a continuous outcome, then use Levene's test to check for meeting the assumption of homogeneity of variance between your independent groups. This assumption assesses if the independent groups have similar variances associated with the outcome. If the p-value for Levene's test is LESS THAN .05, then the assumption has been violated.  

    3. "Missingness" - Missing data is a constant battle when conducting research. There are a litany of different reasons that lead to missing data but regardless, missing data can skew the results of a study by under-representation of the population of interest. If ANY of your variables have MORE THAN 20% of their observations missing, then that variable should be discarded.