Chapter 3

Probability
The Basis of the Statistical
inference
• Key words:

• Probability, objective Probability,

subjective Probability, equally likely
Mutually exclusive, multiplicative rule
Conditional Probability, independent events, Bayes
theorem

Dr.Elias 2
3.1 Introduction
• The concept of probability is frequently encountered in
everyday communication. For example, a physician may
say that a patient has a 50-50 chance of surviving a certain
operation.
Another physician may say that she is 95 percent certain
that a patient has a particular disease.
• Most people express probabilities in terms of percentages.
• But, it is more convenient to express probabilities as
fractions. Thus, we may measure the probability of the
occurrence of some event by a number between 0 and 1.
• The more likely the event, the closer the number is to one.
An event that can't occur has a probability of zero, and an
event that is certain to occur has a probability of one.

Dr.Elias 3
3.2 Two views of Probability objective and

subjective:
• *** Objective Probability
• ** Classical and Relative
• Some definitions:
1.Equally likely outcomes:
Are the outcomes that have the same chance of
occurring.
2.Mutually exclusive:
Two events are said to be mutually exclusive if they
cannot occur simultaneously such that A & B =Φ .

Dr.Elias 4
• The universal Set (S): The set all possible outcomes.
• The empty set Φ : Contain no elements.
• The event ,E : is a set of outcomes in S which has a
certain characteristic.
• Classical Probability : If an event can occur in N
mutually exclusive and equally likely ways, and if m
of these possess a triat, E, the probability of the
occurrence of event E is equal to m/ N .
• For Example: in the rolling of the die , each of the six
sides is equally likely to be observed . So, the
probability that a 4 will be observed is equal to 1/6.

Dr.Elias 5
• Relative Frequency Probability:
• Def: If some posses is repeated a large number of
times, n, and if some resulting event E occurs m
times , the relative frequency of occurrence of E ,
m/n will be approximately equal to probability of E .
P(E) = m/n .
• *** Subjective Probability :
• Probability measures the confidence that a particular
individual has in the truth of a particular proposition.
• For Example : the probability that a cure for cancer
will be discovered within the next 10 years.

Dr.Elias 6
 3.3 Elementary Properties of Probability:

• Given some process (or experiment ) with n

mutually exclusive events E1, E2, E3,…………,
En, then
• 1-P(Ei ) 0, i= 1,2,3,……n
• 2- P(E1 )+ P(E2) +……+P(En )=1
• 3- P(Ei +EJ )=P(Ei )+ P(EJ )
Ei ,EJ are mutually exclusive

Dr.Elias 7
 Rules of Probability
• 1-Addition Rule
• P(A U B)= P(A) + P(B) – P (A∩B )

• 2- If A and B are mutually exclusive (disjoint) ,then

• P (A∩B ) = 0
• Then , addition rule is
• P(A U B)= P(A) + P(B) .
• 3- Complementary Rule
• P(A' )= 1 – P(A)
• where, A' = = complement event
• Consider the following example

Dr.Elias 8
 Table in Example
Family history of Early = 18 Later >18 Total
Mood Disorders (L)
(E)

Negative(A) 28 35 63

Bipolar 19 38 57
Disorder(B)
Unipolar (C) 41 44 85

Unipolar and 53 60 113

Bipolar(D)
Total 141 177 318

Dr.Elias 9
 **Answer the following questions:
Suppose we pick a person at random from this sample.
1-The probability that this person will be 18-years old or younger?
2-The probability that this person has family history of mood orders
Unipolar(C)?
3-The probability that this person has no family history of mood
orders Unipolar( )?
4-The probability that this person is 18-years old or younger or has
no family history of mood orders Unipolar (C))?
5-The probability that this person is more than18-years old and has
family history of mood orders Unipolar and Bipolar(D)?

Dr.Elias 10
 Conditional Probability:

P(A\B) is the probability of A assuming that B has

happened.

P( A  B)
• P(A\B)= P( B) , P(B)≠ 0

P( A  B)
• P(B\A)= P ( A) , P(A)≠ 0

Dr.Elias 11
 Example Continued
From previous example, answer
• suppose we pick a person at random and find he is 18
years or younger (E),what is the probability that this
person will be one with Negative family history of
mood disorders (A)?
• suppose we pick a person at random and find he has
family history of mood (D) what is the probability that
this person will be 18 years or younger (E)?

Dr.Elias 12
 Calculating a joint Probability :
• Example Continued
• Suppose we pick a person at random from the
318 subjects. Find the probability that he will
early (E) and has no family history of mood
disorders (A).

Dr. Elias 13
 Multiplicative Rule:
• P(A∩B)= P(A\B)P(B)
• P(A∩B)= P(B\A)P(A)
• Where,
• P(A): marginal probability of A.
• P(B): marginal probability of B.
• P(B\A):The conditional probability.

Text Book : Basic Concepts and

14
Methodology for the Health Sciences
 Example Continued
• From previous example, we wish to compute
the joint probability of Early age at onset(E)
and a negative family history of mood
disorders(A) from a knowledge of an
appropriate marginal probability and an
appropriate conditional probability.

Text Book : Basic Concepts and

Methodology for the Health Sciences
15
 Independent Events:
• If A has no effect on B, we said that A,B are
independent events.
• Then,
• 1- P(A∩B)= P(B)P(A)
• 2- P(A\B)=P(A)
• 3- P(B\A)=P(B)

Dr.Elias 16
 Example
• In a certain high school class consisting of 60 girls
and 40 boys, it is observed that 24 girls and 16 boys
wear eyeglasses . If a student is picked at random
from this class ,the probability that the student
wears eyeglasses , P(E), is 40/100 or 0.4 .
• What is the probability that a student picked at
random wears eyeglasses given that the student is a
boy?
• What is the probability of the joint occurrence of the
events of wearing eye glasses and being a boy?

Dr.Elias 17
 Example 3.4.8 Page 69
• Suppose that of 1200 admission to a general
hospital during a certain period of time,750 are
private admissions. If we designate these as a set A,
then compute P(A) , P(A).

Dr.Elias 18
 Marginal Probability:
• Definition:
• Given some variable that can be broken down into m
categories designated

by A , A ,......., A ,......., A and another jointly occurring

1 2 i m

variable that is broken down into n categories

B , B ,......., B ,......., B
1 2 j n designated by
, the marginal probability of A with all the categories of
i
B . That is,
P( Ai )   P( Ai  B j ), for all value of j
• Example
• Use data of Table, and rule of marginal Probabilities
to calculate P(E).

Dr. Elias 19
Q1: In a study of violent victimization of women and
men, Porcelli et al. (A-2) collected information
from 679 women and 345 men aged 18 to 64
years at several family practice centers in the
metropolitan Detroit area. Patients filled out a
health history questionnaire that included a
question about victimization. The following table
shows the sample subjects cross-classified by sex
and type of violent victimization reported. The
victimization categories are defined as no
victimization, partner victimization (and not by
others), victimization by persons other than

Dr.Elias 20
partners (friends, family members, or strangers),
and those who reported multiple victimization.

No Partners Nonpartners Multiple Total

Victimization Victimization
Women 611 34 16 18 679

Men 308 10 17 10 345

Total 919 44 33 28 1024

(a) Suppose we pick a subject at random from this

group. What is the probability that this subject
will be a women?

Dr.Elias 21
(b) What do we call the probability calculated in part
a?
(c) Show how to calculate the probability asked for
in part a by two additional methods.
(d) If we pick a subject at random, what is
probability that the subject will be a women and
have experienced partner abuse?
(e) What do we call the probability calculated in part
d?
(f) Suppose we picked a man at random. Knowing
this information, what is the probability that he

Dr.Elias 22
experienced abuse from nonpartners?
(g) What do we call the probability calculated in
part f?
(h) Suppose we pick a subject at random. What
is the probability that it is a man or someone
who experienced abuse from a partner?
(i) What do we call the method by which you
obtained the probability in part h?

Dr.Elias 23
Q2: Fernando et al. (A-3) studied drug-sharing
among injection drug users in the South Bronx in
New York City. Drug users in New York City use the
term “split a bag” or “get down on a bag” to refer
to the practice of diving a bag of heroin or other
injectable substances. A common practice
includes splitting drugs after they are dissolved in
a common cooker, a procedure with considerable
HIV risk. Although this practice is common, little is
known about the prevalence of such practices.
The researchers asked injection drug users in four
neighborhoods in the South Bronx if they ever

Dr.Elias 24
“got down on” drugs in bags or shots. The results
classified by gender and splitting practice are
given below: Gender Split Drugs Never Split Total
Drugs
State the Male 349 324 673
following Female 220 128 348

probabilities in Total 569 452 1021

words and calculate:

(a) P( Male  Split Drugs) Ans: 0.3418
(b) P(Male  Split Drugs) Ans: 0.8746
(c) P( Male Split Drugs) Ans: 0.6134
Dr.Elias 25
(d) P(Male) Ans: 0.6592

Q3: Laveist and Nuru-Jeter (A-4) conducted a

study to determine if doctor-patient race
concordance was associated with greater
satisfaction with care. Toward that end, they
collected a national sample of African-
American, Caucasian, Hispanic, and Asian-
American respondents. The following table
classifies the race of the subjects as well as
the race of their physician:

Dr.Elias 26
 Patient Race
Physician’s Caucasian African- Hispanic Asian- Total
Race American American
White 779 436 406 175 1796
African- 14 162 15 5 196
American
Hispanic 19 17 128 2 166
Asian/Pacific 68 75 71 203 417
-Island
Other 30 55 56 4 145
Total 910 745 676 389 2720

(a) What is the probability that a randomly

selected subject will have an Asian/Pacific-
Islander physician? Ans: 0.1533
Dr.Elias 27
(b) What is the probability that an African-American
subject will have an African- American physician?
Ans: 0.2174
(c) What is the probability that a randomly selected
subject in the study will be Asian-American and
have an Asian/Pacific-Islander physician? Ans:
0.075
(d) What is the probability that a subject chosen at
random will be Hispanic or have a Hispanic
physician? Ans: 0.2625
(e) Use the concept of complementary events to find
the probability that a subject chosen at
Dr.Elias 28
random in the study does not have a white
physician? Ans: 0.3397

Q4:
If the probability of left-handedness in a certain
group of people is 0.5, what is the probability
of right-handedness (assuming no
ambidexterity)?

Dr.Elias 29
Q5:
The probability is 0.6 that a patient selected at
random from the current residents of a certain
hospital will be a male. The probability that
the patient will be a male who is in for surgery
is 0.2. A patient randomly selected from
current residents is found to be a male; what
is the probability that the patient is in the
hospital for surgery?
Ans: 0.3333

Dr.Elias 30
Q6:
In a certain population of hospital patients the
probability is 0.35 that a randomly selected
patient will have heart disease. The
probability is 0.86 that a patient with heart
disease is a smoker. What is the probability
that a patient randomly selected from the
population will be a smoker and have heart
disease?
Ans: 0.301

Dr.Elias 31
Baye's Theorem

Dr.Elias 32
In this case if the patient has to do
a blood test in the laboratory,
some time the result is
Positive(he has the disease) and if
the result is negative
(he doesn't has the disease)

Dr.Elias 33
So, we have the following cases
The patient has the The patient doesn't has
disease the disease
(D) (D)

Specificity
Lab result is A symptom
Negative wrong result
P(T|D)
(T)
Lab result is Sensitivity
positive A symptom wrong result
(T) P(T|D)
Dr.Elias 34
Definition.1

The sensitivity of the symptom

This is the probability of a positive result given that the
subject has the disease. It is denoted by P(T|D)

Definition.2

The specificity of the symptom

This is the probability of negative result given that the
subject does not have the disease. It is denoted by
P(T|D)

Dr.Elias 35
Definition 3:
The predictive value positive of the symptom
This is the probability that the subject has the
disease given that the subject has a positive
screening test result.
It is calculated using bayes theorem through the
following formula
P(T | D) P( D)
P( D | T ) 
P(T | D) P( D)  P(T | D) P( D)
Where P(D) is the rate of the disease

Dr.Elias 36
Which is given by
P(D) = 1 – P(D)
P(T/ D) = 1 - P(T/ D)
Note that the numerator is equal to sensitivity
times rate of the disease, while the
denominator is equal to sensitivity times rate
of the disease plus 1 minus the specificity
times one minus the rate of the disease

Dr.Elias 37
Definition.4
The predictive value negative of the symptom

This is the probability that a subject does not have the

disease given that the subject has a negative
screening test result .It is calculated using Bayes
Theorem through the following formula

P(T | D) P( D)
P( D | T ) 
P(T | D) P( D)  P(T | D) P( D)
where,

p(T | D)  1  P(T | D)
Text Book : Basic Concepts and
38
Methodology for the Health Sciences
Example

A medical research team wished to evaluate a proposed screening test for

Alzheimer’s disease. The test was given to a random sample of 450 patients
with Alzheimer’s disease and an independent random sample of 500 patients
without symptoms of the disease. The two samples were drawn from
populations of subjects who were 65 years or older. The results are as follows.

Test Result Yes (D) No (D ) Total

Positive(T) 436 5 441
Negativ(T ) 14 495 509
Total 450 500 950

Dr.Elias 39
In the context of this example
a)What is a false positive?
A false positive is when the test indicates a positive result (T) when
the person does not have the disease D

b) What is the false negative?

A false negative is when a test indicates a negative result ( T )
when the person has the disease (D).

c) Compute the sensitivity of the symptom.

436
P(T | D)   0.9689
450
d) Compute the specificity of the symptom.
495
P(T | D)   0.99
500
Dr. Elias 40
e) Suppose it is known that the rate of the disease in the general population
is 11.3%. What is the predictive value positive of the symptom and the
predictive value negative of the symptom
The predictive value positive of the symptom is calculated as
P(T | D) P( D)
P( D | T ) 
P(T | D) P( D)  P(T | D) P( D)
(0.9689)(0.113)
  0.925
(0.9689)(0.113)  (.01)(1 - 0.113)

The predictive value negative of the symptom is calculated as

P(T | D) P( D)
P( D | T ) 
P(T | D) P( D)  P(T | D) P( D)
(0.99)(0.887)
  0.996
(0.99)(0.887)  (0.0311)(0.113)

Dr.Elias 41
Q1; A medical research team wishes to assess
the usefulness of a certain symptom (call it S)
in the diagnosis of a particular disease. In a
random sample of 775 patients with the
disease, 744 reported having the symptom. In
an independent random sample of 1380
subjects without the disease, 21 reported that
they had the symptom.
(a) In the context of this exercise, what is a false
positive?
(b) What is a false negative?

Dr.Elias 42
(c) Compute the sensitivity of the symptom.
(d) Compute the specificity of the symptom.
(e) Suppose it is known that the rate of the diseases
in the general population is 0.001. what is the
predictive value positive of the symptom?
(f) What is the predictive value negative of the
symptom?
(g) Find the predictive value positive and the
predictive value negative for the symptom for the
following hypothetical diseases rates: 0.0001, 0.01
and 0.1
Dr.Elias 43
(h) What do you conclude about the predictive
value of the symptom on the basis of the results
obtained in part g?

Q2:
Dorsay and Helms (A-6) performed a retrospective
study of 71 knees scanned by MRI. One of the
indicators they examined was the absence of the
“bow-tie sign” in the MRI as evidence of a
bucket-handle or “bucket-handle type” tear of
the meniscus.
Dr.Elias 44
In the study, surgery confirmed that 43 of the 71
cases were bucket-handle tears. The cases
may be cross-classified by “bow-tie sign”
status and surgical results as follows:
Tear Surgically Tear Surgically Total
Confirmed (D) Confirmed As Not
Present ( D)
Positive Test 38 10 48
(absent bow-tie sign)
(T)
Negative Test 5 18 23
(bow-tie present)( T )

Total 43 28 71

Dr.Elias 45
(a) What is the sensitivity of testing to see if the
absent bow-tie sign indicates a meniscal tear?
Ans: 0.8837
(b) What is the specificity of testing to see if the
absent bow-tie sign indicates a meniscal tear?
Ans: 0.6229
(c) What additional information would you need to
determine the predictive value of the test?

Dr.Elias 46
(d) Suppose it is known that the rate of the
disease in the general population is 0.1, what
is the predictive value positive of the
symptom? Ans: 0.20659
(e) What is predictive value negative of the
symptom? Ans: 0.9797

Dr.Elias 47