C K 0 0 B A UXTNG CAN BO QUAN LY Y TE BO MON THONG KE - TIN HQC I G I A N G A THONG KE Y TE (DUNG CHO BAC ST CHUYEN KHOA SAU DAI HQC CHUY£ n NGANH Y TE CONG C0NG) NHA XUAT BAN Y HOC ■ _ J T R l/d N G CAN BO QUAN LY Y TE Bo m on Thong ke - Tin hpc Bai giang THONG KE Y TE DUNG CHO BAC SY CHUYEN KHOA SAU DAI HOC CH UYEN NGANH Y T E CONG CONG NHA XUAT BAN Y HOC HA NOI - 1997 B a n bien soan: T hacsl : NGUYEN D l/C AN B dcsl : TRAN THI TUtJNG VY B dc si : TRAN THI LlTU Cit n h a n : PHAN VU D lfiM HANG Ldl NOI DAU Tap bai giang dugc bien soan voi muc tieu la trinh bay nhirng van de c a s a cua Thong ke y te, diroc ung dung Nganh Doi tirgng cua tap bai giang chu yeu la cac hoc vien chuyen khoa cap mot cua Tnrong Can bo Quan ly Y te Nhirng bai giang da ft nhidu dugc Bo mon Thong ke dua vao giang day nhi6u nam cho cac lop bac sy chuyen tu va chuyen khoa cap mot trucmg Vc noi dung khoa hoc, cac bai giang dugc xem xet sira chua va b6 sung ciin than; c a c vi du va bai tap gSn ly luan vo'i thu'c ti6n cua Nganh Y te Viet Nam Noi dung cua tap bai giang dugc chia ba phan: • Phfin thir nhat: Thong ke mo ta • Phan thu hai: Suy luan thong ke • Ph^n thu' ba: Bo chi so thong ke y te co ban va phan loai thong ke Quoc te benh tat Ian tlur X Tap bai giang gio'i thieu voi cac hgc vien cua Truong Can bo Quan ly Y te co su tham khao cua cac tai lieu: Betty R Kirkwood Essentials Scientific Publications, 19S8 of Medical Statistics Blackwell Phirong phap nghien cuu khoa hoc y hoc, Hoc vien quan y, Nha xuat ban quan doi nhan dan, Ha Noi, 1995 Dr J.F Osborn Intensive Course in Medical Statistics London School o f Hygiene and Tropical Medicine Centre for Population Studies, Department o f Epidemiology and Population Sciences, 1991 Phuong phap nghien cuu y te To chii'c Y te The gioi, Khu vuc l ay Thai Binh Duong, Manila, 1992 Vien Vc sinh Dich td hgc Ha Noi, 1993 PGS, PTS Pham Huy DCing Chi so y te cho tuyen co so' xa, phuong Khoa hgc y te cong cong Viet Nam, Truong dai hgc Y Ha Noi, 1990 va mot so tai lieu khac Chung toi hy vgng rang voi noi dung nhu tren, tap bai giang co the: phu hop voi cac hgc vien chuyen khoa cap mot, chuyen nghanh y te cong cong cua Truong C B Q L Y T Ha Noi Vi kien thiic va kinh nghiem han che, chac chdn rang tap bai giang nhi6u thieu sot Chung toi rat mong nhan dugc nhung y kien phe binh va dong gop cua ban va ngoai nganh de tap bai giang cang chat lugng hon v6 n6i dung, phong phu hon vt hinh thuc, da dang hon v6 cac loai bai tap Xin chan cam on Ha Noi, I thdng nam 9 Tran Thi Liru THONG KE Y TE MUC TIEU MON HOC • • ♦ Trinh bay dudc cac so lieu nghien ctiu bAng bang thong ke, thi, bieu va cac chi so thong ke thich hdp ♦ Kiem dinh dtfdc so trung binh, so' titdng doi bang test t , x ' tieu chuan hoa ♦ Danh gia dudc mol lien he tUdng quan gitia cac hien tadng nghien cCtu ♦ Trinh bay dudc viec phan loai thong ke quoc te" cac benh tat (sUa doi lan thuf mUdi) va cac qui tac hu6ng dan ma hoa tu vong ♦ Phan tich dudc cac so lieu thong ke y te ♦ Biet xay dung va to chiic cac nghien cCfu thong ke y te NOIDUNG Bai Bai Do thi, bieu thong ke y te" Bai Phep vi tri va bien thien Cac phan phoi tan so - Trung binh, trung vi, mode - Do bien thien, phudng sai, lech tieu chuan, he so bien thien Bai Xac suat, cac luat phan phoi xac suat cua dai ludng ngau nhien - Bien co* ngau nhien - khai niem xac suat - Dinh nghla co dien ve xac suat, dinh nghia thong ke ve xac suat - Phan loai sU kien ngau nhien - Phan phoi nhi thtic, phan phoi poisson, phan phoi chu^n - Lien he giuta ba luat phan phoi - Ung dung va tAm quan cua phan phoi chu&n Bai Cac phan phoi mau va cac khoang tin cay Bai Bai Bai Bai Cac phep kiem dinh co y nghia Kiem dinh gia thuyet thong ke Lien he tUdng quan va hoi qui Phudng phap tieu chuftn hoa - Phudng phap true tiep - Phudng phap gian tiep Bai 10 Thong ke tinh hinh mac benh cua nhan dan Bai 11 Bo chi so' thong ke y te cd ban Phu luc Phan loai thong ke quoc te cac benh tat va cac qui t&c hu6ng d^n ma hoa tii vong GIClI THIEU Thong ke y te la mot mon khoa hoc ting dung, ngUdi ta da svt dung cac phudng phap thong ke y te vao cong tac nghien ctiu y te No la mot nhQng mon khoa hoc cd sd c&n thiet cho viec dieu tra, danh gia cac van de y te : Tit sinh ly hoc te bao den nghien ciiu stic khoe cong dong v.v Mac du tvf lau sinh hoc da ufng dung cac phudng phap cua khoa hoc thong ke mot cach rong rai, nhung chi mot vai nam gan day, thong ke y te mdi thtfc sU la van de noi com Su dung thong ke y te doi hoi phai dudc dao tao kien thtic ca ve toan hoc va y hoc Tuy nhien de hieu va ap dung dudc cac phudng phap thong ke cd ban doi hoi phai biet mot it toan hoc dang ke L6p hoc chuyen khoa mot cua TrUdng Can bo Quan ly Y te khong can biet trudc kien thtic toan hoc hoac thong ke, ma mot it kien thiic neu ckn se dudc gi6i thieu qua trinh hoc tap Cac phudng phap thorig ke cd ban dudc chia hai ph^n chinh : Trong ph^n thti nhat chung ta co mot tap hdp so' lieu dudc quan sat va can tom tat chung, xay dilng chung cac bang qua co the hieu dudc de dang va mo ta dudc nhflng dac trUng cua chung Cac phudng phap sik dung cho muc dich thUdng dudc goi la thong ke mo ta NgUdc l a i , chung ta co the tong quat hoa cac thong tin tren m lu quan sat Vi du: Co the chung ta muon ket luan rang , nhin chung dung thuoc A tot hdn dung thuoc B cho nhiing benh nhan co chan doan dac biet , vi vay chung ta phai sU dung cac phep thu co y nghia va cac khoang tin cay Cac phudng phap sU dung cho muc dich dudc goi la phudng phap suy luan thong ke Cac nha nghien cilu sinh y hoc, cac bac sy lam cong tac quan ly y te va y te cong cong , cac nha chilc trach c&n lam gi ? chdc r&ng ho c4n mot it thdi gian de hoc nhflng tu tUdng cd ban cua thong ke , muc dich la hieu day du y nghia, cach trinh bay va cac ky hieu thong ke nhu: p, t, X’ , r v.v va cac th u at ngiJ chuyen mon khac ma ho se tim thay cac bao cao cung nhvt cac tap chi chuyen nganh B a i l CAC PHAN PHOI TAN SO MUC TIEU Hoan bai hoc vien co the: • Phan loai cac bien dinh tinh , dinh ltfdng, rdi rac, lien tuc • Chia khoang bien thien cua mot day so' lieu cac khoang cach to, va chi ro cac gia tri nao nam d khoang cach to nao • Cho mot tap hdp lieu ban d&u, xay dung phan phoi t&n so ,t&n suat va tan suat tich luy • Ve bieu phan phoi tin so' co khoang cach to blng va khong bang • Ve bieu tin suat tich luy, va xac dinh trung vi Trong mot cuoc dieu tra thong ke, so' lieu thu th&p thudng chua dudc sap xep, cho ta mot hinh anh hon don, kho nhin , kho rut qui luat cua hien tUdng nghien ciiu De trinh bay cac ket qua nghien ciiu ngUdi ta thudng dung hinh thtfc: bang, thi hoac cac tham so' dac trung De bieu di§n cac so lieu ro hdn c&n s£p xep chung theo thti tu, thudng tti nho den 16n Nhu vay ta se thay dudc tinh chat phan phoi va tinh quy luat cua chung, dong thdi cung biet dudc bien thien la hieu so cua gia tri 16n nhat va gia tri nho nhat cua day Neu bang so' lieu chila toan bo day so' se rat kho nhin Thong thudng ngUdi ta tap hdp hoac nhieu gia tri quan sat vao mot to Muc dich va y nghia cua phan to thong ke - La can ci'i vao mot hoac mot so' dac tinh de phan chia cac ddn vi cua hien tUdng nghien ciiu cac to co tinh chat khac - La sap xep co he thong cac so lieu ban d&u de thay ro ph&n, cd cau nhutng net gio'ng nhau, khac cua hien tUdng nghien ciiu - Bu6c d&u chuan bi cho tinh toan phan tich sau Mot vai y nghia - To: La so lifdng cac gia tri quan sat nam mot gidi han nhat dinh - Gi6i han to: Do tri so' 16n nhat va tri so be nhat cua to tao nen - Tri so giuta: So' trung binh cong cua gicfi han to - Khoang cach to (k) ( ky hieu la h ,d ) la tri so cua tri so giCta lien tiep < „ r - To md: La to bao gom cac gia tri nam du6i hoac tren mot gia tri gidi han Vi du: Tren 100 tuoi, du