Hypothesis Testing - Chi Squared Test

6/17/22, 10:39 AM Hypothesis Testing - Chi Squared Test
Hypothesis Testing - Chi Squared Test
Author:
Lisa Sullivan, PhD
Professor of Biostatistics
Boston University School of Public Health
Introduction
This module will continue the discussion of hypothesis testing, where a specific statement or hypothesis is
generated about a population parameter, and sample statistics are used to assess the likelihood that the hypothesis
is true. The hypothesis is based on available information and the investigator's belief about the population
parameters. The specific tests considered here are called chi-square tests and are appropriate when the outcome is
discrete (dichotomous, ordinal or categorical). For example, in some clinical trials the outcome is a classification
such as hypertensive, pre-hypertensive or normotensive. We could use the same classification in an observational
study such as the Framingham Heart Study to compare men and women in terms of their blood pressure status -
again using the classification of hypertensive, pre-hypertensive or normotensive status.
The technique to analyze a discrete outcome uses what is called a chi-square test. Specifically, the test statistic
follows a chi-square probability distribution. We will consider chi-square tests here with one, two and more than two
independent comparison groups.
Learning Objectives
After completing this module, the student will be able to:
1. Perform chi-square tests by hand

2. Appropriately interpret results of chi-square tests
3. Identify the appropriate hypothesis testing procedure based on type of outcome variable and number of
samples
Tests with One Sample, Discrete Outcome

https://sphweb.bumc.bu.edu/otlt/mph-modules/bs/bs704_hypothesistesting-chisquare/bs704_hypothesistesting-chisquare_print.html 1/16
Here we consider hypothesis testing with a discrete outcome variable in a single population. Discrete variables are
variables that take on more than two distinct responses or categories and the responses can be ordered or
unordered (i.e., the outcome can be ordinal or categorical). The procedure we describe here can be used for
dichotomous (exactly 2 response options), ordinal or categorical discrete outcomes and the objective is to compare
the distribution of responses, or the proportions of participants in each response category, to a known distribution.
The known distribution is derived from another study or report and it is again important in setting up the hypotheses
that the comparator distribution specified in the null hypothesis is a fair comparison. The comparator is sometimes
called an external or a historical control.
In one sample tests for a discrete outcome, we set up our hypotheses against an appropriate comparator. We select
a sample and compute descriptive statistics on the sample data. Specifically, we compute the sample size (n) and
the proportions of participants in each response
category ( , , ... ) where k represents the number of response categories. We then determine the
appropriate test statistic for the hypothesis test. The formula for the test statistic is given below.
Test Statistic for Testing H0: p1 = p 10 , p2 = p 20 , ..., pk = p k0
We find the critical value in a table of probabilities for the chi-square distribution with degrees of freedom (df) = k-1.
In the test statistic, O = observed frequency and E=expected frequency in each of the response categories. The
observed frequencies are those observed in the sample and the expected frequencies are computed as described
below. χ2 (chi-square) is another probability distribution and ranges from 0 to ∞. The test above statistic formula
above is appropriate for large samples, defined as expected frequencies of at least 5 in each of the response
categories.
When we conduct a χ2 test, we compare the observed frequencies in each response category to the frequencies we
would expect if the null hypothesis were true. These expected frequencies are determined by allocating the sample
to the response categories according to the distribution specified in H0. This is done by multiplying the observed
sample size (n) by the proportions specified in the null hypothesis (p 10 , p 20 , ..., p k0 ). To ensure that the sample
size is appropriate for the use of the test statistic above, we need to ensure that the following: min(np10 , n p20 , ...,
n pk0 ) > 5.
The test of hypothesis with a discrete outcome measured in a single sample, where the goal is to assess whether
the distribution of responses follows a known distribution, is called the χ2 goodness-of-fit test. As the name
indicates, the idea is to assess whether the pattern or distribution of responses in the sample "fits" a specified
population (external or historical) distribution. In the next example we illustrate the test. As we work through the
example, we provide additional details related to the use of this new test statistic.
Example:
A University conducted a survey of its recent graduates to collect demographic and health information for future
planning purposes as well as to assess students' satisfaction with their undergraduate experiences. The survey
revealed that a substantial proportion of students were not engaging in regular exercise, many felt their nutrition was
poor and a substantial number were smoking. In response to a question on regular exercise, 60% of all graduates
reported getting no regular exercise, 25% reported exercising sporadically and 15% reported exercising regularly as
undergraduates. The next year the University launched a health promotion campaign on campus in an attempt to
increase health behaviors among undergraduates. The program included modules on exercise, nutrition and
smoking cessation. To evaluate the impact of the program, the University again surveyed graduates and asked the
same questions. The survey was completed by 470 graduates and the following data were collected on the exercise
question:
No Regular Sporadic Regular Total

Exercise Exercise Exercise
Number of 255 125 90 470
Students
Based on the data, is there evidence of a shift in the distribution of responses to the exercise question following the
implementation of the health promotion campaign on campus? Run the test at a 5% level of significance.
In this example, we have one sample and a discrete (ordinal) outcome variable (with three response options). We
specifically want to compare the distribution of responses in the sample to the distribution reported the previous year
(i.e., 60%, 25%, 15% reporting no, sporadic and regular exercise, respectively). We now run the test using the five-
step approach.
Step 1. Set up hypotheses and determine level of significance.
The null hypothesis again represents the "no change" or "no difference" situation. If the health promotion campaign
has no impact then we expect the distribution of responses to the exercise question to be the same as that
measured prior to the implementation of the program.
H0: p1=0.60, p2=0.25, p3=0.15, or equivalently H0: Distribution of responses is 0.60, 0.25, 0.15
H1: H0 is false. α =0.05
Notice that the research hypothesis is written in words rather than in symbols. The research hypothesis as stated
captures any difference in the distribution of responses from that specified in the null hypothesis. We do not specify
a specific alternative distribution, instead we are testing whether the sample data "fit" the distribution in H0 or not.
With the χ2 goodness-of-fit test there is no upper or lower tailed version of the test.
Step 2. Select the appropriate test statistic.
The test statistic is:
We must first assess whether the sample size is adequate. Specifically, we need to check min(np0, np1, ..., n pk) >
5. The sample size here is n=470 and the proportions specified in the null hypothesis are 0.60, 0.25 and 0.15. Thus,
min( 470(0.65), 470(0.25), 470(0.15))=min(282, 117.5, 70.5)=70.5. The sample size is more than adequate so the
formula can be used.
Step 3. Set up decision rule.
The decision rule for the χ2 test depends on the level of significance and the degrees of freedom, defined as
degrees of freedom (df) = k-1 (where k is the number of response categories). If the null hypothesis is true, the
observed and expected frequencies will be close in value and the χ2 statistic will be close to zero. If the null
hypothesis is false, then the χ2 statistic will be large. Critical values can be found in a table of probabilities for the χ2
distribution. Here we have df=k-1=3-1=2 and a 5% level of significance. The appropriate critical value is 5.99, and
the decision rule is as follows: Reject H0 if χ2 > 5.99.
Step 4. Compute the test statistic.
We now compute the expected frequencies using the sample size and the proportions specified in the null
hypothesis. We then substitute the sample data (observed frequencies) and the expected frequencies into the
formula for the test statistic identified in Step 2. The computations can be organized as follows.
No Regular Sporadic Exercise Regular Exercise Total

Exercise
Observed Frequencies (O) 255 125 90 470
Expected Frequencies (E) 470(0.60) 470(0.25) 470(0.15) 470
=282 =117.5 =70.5
Notice that the expected frequencies are taken to one decimal place and that the sum of the observed frequencies
is equal to the sum of the expected frequencies. The test statistic is computed as follows:
Step 5. Conclusion.
We reject H0 because 8.46 > 5.99. We have statistically significant evidence at α=0.05 to show that H0 is false, or
that the distribution of responses is not 0.60, 0.25, 0.15. The p-value is p < 0.005.
In the χ2 goodness-of-fit test, we conclude that either the distribution specified in H0 is false (when we reject H0) or
that we do not have sufficient evidence to show that the distribution specified in H0 is false (when we fail to reject
H0). Here, we reject H0 and concluded that the distribution of responses to the exercise question following the
implementation of the health promotion campaign was not the same as the distribution prior. The test itself does not
provide details of how the distribution has shifted. A comparison of the observed and expected frequencies will
provide some insight into the shift (when the null hypothesis is rejected). Does it appear that the health promotion
campaign was effective?
Consider the following:

Observed 255 125 90 470
Frequencies (O)
Expected 282 117.5 70.5 470
Frequencies (E)
If the null hypothesis were true (i.e., no change from the prior year) we would have expected more students to fall in
the "No Regular Exercise" category and fewer in the "Regular Exercise" categories. In the sample, 255/470 = 54%
reported no regular exercise and 90/470=19% reported regular exercise. Thus, there is a shift toward more regular
exercise following the implementation of the health promotion campaign. There is evidence of a statistical
difference, is this a meaningful difference? Is there room for improvement?
Example:
The National Center for Health Statistics (NCHS) provided data on the distribution of weight (in categories) among
Americans in 2002. The distribution was based on specific values of body mass index (BMI) computed as weight in
kilograms over height in meters squared. Underweight was defined as BMI< 18.5, Normal weight as BMI between
18.5 and 24.9, overweight as BMI between 25 and 29.9 and obese as BMI of 30 or greater. Americans in 2002 were
distributed as follows: 2% Underweight, 39% Normal Weight, 36% Overweight, and 23% Obese. Suppose we want
to assess whether the distribution of BMI is different in the Framingham Offspring sample. Using data from the
n=3,326 participants who attended the seventh examination of the Offspring in the Framingham Heart Study we
created the BMI categories as defined and observed the following:

Underweight Normal Weight Overweight Obese Total
BMI<18.5 BMI 18.5-24.9 BMI 25.0-29.9 BMI > 30

# of Participants 20 932 1374 1000 3326
H0: p1=0.02, p2=0.39, p3=0.36, p4=0.23 or equivalently
H0: Distribution of responses is 0.02, 0.39, 0.36, 0.23
H1: H0 is false. α=0.05
The formula for the test statistic is:
We must assess whether the sample size is adequate. Specifically, we need to check min(np0, np1, ..., n pk) > 5.
The sample size here is n=3,326 and the proportions specified in the null hypothesis are 0.02, 0.39, 0.36 and 0.23.
Thus, min( 3326(0.02), 3326(0.39), 3326(0.36), 3326(0.23))=min(66.5, 1297.1, 1197.4, 765.0)=66.5. The sample
size is more than adequate, so the formula can be used.
Here we have df=k-1=4-1=3 and a 5% level of significance. The appropriate critical value is 7.81 and the decision
rule is as follows: Reject H0 if χ2 > 7.81.
hypothesis. We then substitute the sample data (observed frequencies) into the formula for the test statistic
identified in Step 2. We organize the computations in the following table.
Underweight Normal Overweight Obese Total
BMI<18.5 BMI 18.5- BMI 25.0-29.9 BMI > 30

24.9
Observed Frequencies 20 932 1374 1000 3326
(O)
Expected Frequencies 66.5 1297.1 1197.4 765.0 3326
(E)
The test statistic is computed as follows:
Step 5. Conclusion.
We reject H0 because 233.53 > 7.81. We have statistically significant evidence at α=0.05 to show that H0 is false or
that the distribution of BMI in Framingham is different from the national data reported in 2002, p < 0.005.
Again, the χ2 goodness-of-fit test allows us to assess whether the distribution of responses "fits" a specified
distribution. Here we show that the distribution of BMI in the Framingham Offspring Study is different from the
national distribution. To understand the nature of the difference we can compare observed and expected
frequencies or observed and expected proportions (or percentages). The frequencies are large because of the large
sample size, the observed percentages of patients in the Framingham sample are as follows: 0.6% underweight,
28% normal weight, 41% overweight and 30% obese. In the Framingham Offspring sample there are higher
percentages of overweight and obese persons (41% and 30% in Framingham as compared to 36% and 23% in the
national data), and lower proportions of underweight and normal weight persons (0.6% and 28% in Framingham as
compared to 2% and 39% in the national data). Are these meaningful differences?
In the module on hypothesis testing for means and proportions, we discussed hypothesis testing applications with a
dichotomous outcome variable in a single population. We presented a test using a test statistic Z to test whether an
observed (sample) proportion differed significantly from a historical or external comparator. The chi-square
goodness-of-fit test can also be used with a dichotomous outcome and the results are mathematically equivalent.
In the prior module, we considered the following example. Here we show the equivalence to the chi-square
goodness-of-fit test.
Example:
The NCHS report indicated that in 2002, 75% of children aged 2 to 17 saw a dentist in the past year. An investigator
wants to assess whether use of dental services is similar in children living in the city of Boston. A sample of 125
children aged 2 to 17 living in Boston are surveyed and 64 reported seeing a dentist over the past 12 months. Is
there a significant difference in use of dental services between children living in Boston and the national data?
We presented the following approach to the test using a Z statistic.
Step 1. Set up hypotheses and determine level of significance
H0: p = 0.75
H1: p ≠ 0.75 α=0.05
We must first check that the sample size is adequate. Specifically, we need to check min(np0, n(1-p0)) = min(
125(0.75), 125(1-0.75))=min(94, 31)=31. The sample size is more than adequate so the following formula can be
used
This is a two-tailed test, using a Z statistic and a 5% level of significance. Reject H0 if Z < -1.960 or if Z > 1.960.
We now substitute the sample data into the formula for the test statistic identified in Step 2. The sample proportion
is:
Step 5. Conclusion.
We reject H0 because -6.15 < -1.960. We have statistically significant evidence at a =0.05 to show that there is a
statistically significant difference in the use of dental service by children living in Boston as compared to the national
data. (p < 0.0001).
We now conduct the same test using the chi-square goodness-of-fit test. First, we summarize our sample data as
follows:
Saw a Dentist Did Not See a Total

Dentist
in Past 12
Months in Past 12
Months
# of 64 61 125
Participants
H0: p1=0.75, p2=0.25 or equivalently H0: Distribution of responses is 0.75, 0.25
We must assess whether the sample size is adequate. Specifically, we need to check min(np0, np1, ...,npk>) > 5.
The sample size here is n=125 and the proportions specified in the null hypothesis are 0.75, 0.25. Thus, min(
125(0.75), 125(0.25))=min(93.75, 31.25)=31.25. The sample size is more than adequate so the formula can be
used.
Here we have df=k-1=2-1=1 and a 5% level of significance. The appropriate critical value is 3.84, and the decision
rule is as follows: Reject H0 if χ2 > 3.84. (Note that 1.962 = 3.84, where 1.96 was the critical value used in the Z test
for proportions shown above.)
hypothesis. We then substitute the sample data (observed frequencies) into the formula for the test statistic
identified in Step 2. We organize the computations in the following table.
Saw a Dentist Did Not See a Dentist Total
in Past 12 Months in Past 12 Months

Observed Frequencies (O) 64 61 125

Expected Frequencies (E) 93.75 31.25 125
(Note that (-6.15)2 = 37.8, where -6.15 was the value of the Z statistic in the test for proportions shown above.)
Step 5. Conclusion.
We reject H0 because 37.8 > 3.84. We have statistically significant evidence at α=0.05 to show that there is a
statistically significant difference in the use of dental service by children living in Boston as compared to the national
data. (p < 0.0001). This is the same conclusion we reached when we conducted the test using the Z test above.
With a dichotomous outcome, Z2 = χ2 ! In statistics, there are often several approaches that can be used to test
hypotheses.
Tests for Two or More Independent Samples, Discrete Outcome
Here we extend that application of the chi-square test to the case with two or more independent comparison groups.
Specifically, the outcome of interest is discrete with two or more responses and the responses can be ordered or
unordered (i.e., the outcome can be dichotomous, ordinal or categorical). We now consider the situation where
there are two or more independent comparison groups and the goal of the analysis is to compare the distribution of
responses to the discrete outcome variable among several independent comparison groups.
The test is called the χ2 test of independence and the null hypothesis is that there is no difference in the distribution
of responses to the outcome across comparison groups. This is often stated as follows: The outcome variable and
the grouping variable (e.g., the comparison treatments or comparison groups) are independent (hence the name of
the test). Independence here implies homogeneity in the distribution of the outcome among comparison groups.
The null hypothesis in the χ2 test of independence is often stated in words as: H0: The distribution of the outcome
is independent of the groups. The alternative or research hypothesis is that there is a difference in the
distribution of responses to the outcome variable among the comparison groups (i.e., that the distribution of
responses "depends" on the group). In order to test the hypothesis, we measure the discrete outcome variable in
each participant in each comparison group. The data of interest are the observed frequencies (or number of
participants in each response category in each group). The formula for the test statistic for the χ2 test of
independence is given below.
Test Statistic for Testing H0: Distribution of outcome is independent of groups
and we find the critical value in a table of probabilities for the chi-square distribution with df=(r-1)*(c-1).
Here O = observed frequency, E=expected frequency in each of the response categories in each group, r = the
number of rows in the two-way table and c = the number of columns in the two-way table. r and c correspond to the
number of comparison groups and the number of response options in the outcome (see below for more details). The
observed frequencies are the sample data and the expected frequencies are computed as described below. The
test statistic is appropriate for large samples, defined as expected frequencies of at least 5 in each of the response
categories in each group.
The data for the χ2 test of independence are organized in a two-way table. The outcome and grouping variable are
shown in the rows and columns of the table. The sample table below illustrates the data layout. The table entries
(blank below) are the numbers of participants in each group responding to each response category of the outcome
variable.
Table - Possible outcomes are are listed in the columns; The groups being compared are listed in rows.
Outcome Variable
Grouping Response Response ... Response Row
Variable Option 1 Option 2 Option c Totals
Group 1
Group 2
.
.
Group r
Column N
Totals
In the table above, the grouping variable is shown in the rows of the table; r denotes the number of independent
groups. The outcome variable is shown in the columns of the table; c denotes the number of response options in the
outcome variable. Each combination of a row (group) and column (response) is called a cell of the table. The table
has r*c cells and is sometimes called an r x c ("r by c") table. For example, if there are 4 groups and 5 categories in
the outcome variable, the data are organized in a 4 X 5 table. The row and column totals are shown along the right-
hand margin and the bottom of the table, respectively. The total sample size, N, can be computed by summing the
row totals or the column totals. Similar to ANOVA, N does not refer to a population size here but rather to the total
sample size in the analysis. The sample data can be organized into a table like the above. The numbers of
participants within each group who select each response option are shown in the cells of the table and these are the
observed frequencies used in the test statistic.
The test statistic for the χ2 test of independence involves comparing observed (sample data) and expected
frequencies in each cell of the table. The expected frequencies are computed assuming that the null hypothesis is
true. The null hypothesis states that the two variables (the grouping variable and the outcome) are independent. The
definition of independence is as follows:
Two events, A and B, are independent if P(A|B) = P(A), or equivalently, if P(A and B) = P(A) P(B).
The second statement indicates that if two events, A and B, are independent then the probability of their intersection
can be computed by multiplying the probability of each individual event. To conduct the χ2 test of independence, we
need to compute expected frequencies in each cell of the table. Expected frequencies are computed by assuming
that the grouping variable and outcome are independent (i.e., under the null hypothesis). Thus, if the null hypothesis
is true, using the definition of independence:
P(Group 1 and Response Option 1) = P(Group 1) P(Response Option 1).
The above states that the probability that an individual is in Group 1 and their outcome is Response Option 1 is
computed by multiplying the probability that person is in Group 1 by the probability that a person is in Response
Option 1. To conduct the χ2 test of independence, we need expected frequencies and not expected probabilities. To
convert the above probability to a frequency, we multiply by N. Consider the following small example.
Response 1 Response 2 Response 3 Total

Group 1 10 8 7 25
Group 2 22 15 13 50
Group 3 30 28 17 75
Total 62 51 37 150
The data shown above are measured in a sample of size N=150. The frequencies in the cells of the table are the
observed frequencies. If Group and Response are independent, then we can compute the probability that a person
in the sample is in Group 1 and Response category 1 using:
P(Group 1 and Response 1) = P(Group 1) P(Response 1),
P(Group 1 and Response 1) = (25/150) (62/150) = 0.069.
Thus if Group and Response are independent we would expect 6.9% of the sample to be in the top left cell of the
table (Group 1 and Response 1). The expected frequency is 150(0.069) = 10.4. We could do the same for Group 2
and Response 1:
P(Group 2 and Response 1) = P(Group 2) P(Response 1),
P(Group 2 and Response 1) = (50/150) (62/150) = 0.138.
The expected frequency in Group 2 and Response 1 is 150(0.138) = 20.7.
Thus, the formula for determining the expected cell frequencies in the χ2 test of independence is as follows:
Expected Cell Frequency = (Row Total * Column Total)/N.
The above computes the expected frequency in one step rather than computing the expected probability first and
then converting to a frequency.
Example:
In a prior example we evaluated data from a survey of university graduates which assessed, among other things,
how frequently they exercised. The survey was completed by 470 graduates. In the prior example we used the χ2
goodness-of-fit test to assess whether there was a shift in the distribution of responses to the exercise question
following the implementation of a health promotion campaign on campus. We specifically considered one sample
(all students) and compared the observed distribution to the distribution of responses the prior year (a historical
control). Suppose we now wish to assess whether there is a relationship between exercise on campus and students'
living arrangements. As part of the same survey, graduates were asked where they lived their senior year. The
response options were dormitory, on-campus apartment, off-campus apartment, and at home (i.e., commuted to and
from the university). The data are shown below.

Dormitory 32 30 28 90
On-Campus 74 64 42 180
Apartment
Off-Campus 110 25 15 150
Apartment
At Home 39 6 5 50
Total 255 125 90 470
Based on the data, is there a relationship between exercise and student's living arrangement? Do you think where a
person lives affect their exercise status? Here we have four independent comparison groups (living arrangement)
and a discrete (ordinal) outcome variable with three response options. We specifically want to test whether living
arrangement and exercise are independent. We will run the test using the five-step approach.

H0: Living arrangement and exercise are independent
The null and research hypotheses are written in words rather than in symbols. The research hypothesis is that the
grouping variable (living arrangement) and the outcome variable (exercise) are dependent or related.
The condition for appropriate use of the above test statistic is that each expected frequency is at least 5. In Step 4
we will compute the expected frequencies and we will ensure that the condition is met.
The decision rule depends on the level of significance and the degrees of freedom, defined as df = (r-1)(c-1), where
r and c are the numbers of rows and columns in the two-way data table. The row variable is the living arrangement
and there are 4 arrangements considered, thus r=4. The column variable is exercise and 3 responses are
considered, thus c=3. For this test, df=(4-1)(3-1)=3(2)=6. Again, with χ2 tests there are no upper, lower or two-tailed
tests. If the null hypothesis is true, the observed and expected frequencies will be close in value and the χ2 statistic
will be close to zero. If the null hypothesis is false, then the χ2 statistic will be large. The rejection region for the χ2
test of independence is always in the upper (right-hand) tail of the distribution. For df=6 and a 5% level of
significance, the appropriate critical value is 12.59 and the decision rule is as follows: Reject H0 if c 2 > 12.59.
We now compute the expected frequencies using the formula,
Expected Frequency = (Row Total * Column Total)/N.
The computations can be organized in a two-way table. The top number in each cell of the table is the observed
frequency and the bottom number is the expected frequency. The expected frequencies are shown in parentheses.

(48.8) (23.9) (17.2)

On-Campus 74 64 42 180
Apartment
(97.7) (47.9) (34.5)
Off-Campus 110 25 15 150
Apartment
(81.4) (39.9) (28.7)
At Home 39 6 5 50
(27.1) (13.3) (9.6)

Total 255 125 90 470
Notice that the expected frequencies are taken to one decimal place and that the sums of the observed frequencies
are equal to the sums of the expected frequencies in each row and column of the table.
Recall in Step 2 a condition for the appropriate use of the test statistic was that each expected frequency is at least
5. This is true for this sample (the smallest expected frequency is 9.6) and therefore it is appropriate to use the test
statistic.
Step 5. Conclusion.
We reject H0 because 60.5 > 12.59. We have statistically significant evidence at a =0.05 to show that H0 is false or
that living arrangement and exercise are not independent (i.e., they are dependent or related), p < 0.005.
Again, the χ2 test of independence is used to test whether the distribution of the outcome variable is similar across
the comparison groups. Here we rejected H0 and concluded that the distribution of exercise is not independent of
living arrangement, or that there is a relationship between living arrangement and exercise. The test provides an
overall assessment of statistical significance. When the null hypothesis is rejected, it is important to review the
sample data to understand the nature of the relationship. Consider again the sample data.

On-Campus 74 64 42 180
Apartment
Off-Campus 110 25 15 150
Apartment
At Home 39 6 5 50
Total 255 125 90 470
Because there are different numbers of students in each living situation, it makes the comparisons of exercise
patterns difficult on the basis of the frequencies alone. The following table displays the percentages of students in
each exercise category by living arrangement. The percentages sum to 100% in each row of the table. For
comparison purposes, percentages are also shown for the total sample along the bottom row of the table.
No Regular Sporadic Regular

Dormitory 36% 33% 31%
On-Campus 41% 36% 23%
Apartment
Off-Campus 73% 17% 10%
Apartment
At Home 78% 12% 10%
Total 54% 27% 19%
From the above, it is clear that higher percentages of students living in dormitories and in on-campus apartments
reported regular exercise (31% and 23%) as compared to students living in off-campus apartments and at home
(10% each).
Test Yourself
Pancreaticoduodenectomy (PD) is a procedure that is associated with considerable morbidity. A study was recently
conducted on 553 patients who had a successful PD between January 2000 and December 2010 to determine
whether their Surgical Apgar Score (SAS) is related to 30-day perioperative morbidity and mortality. The table below
gives the number of patients experiencing no, minor, or major morbidity by SAS category.
Surgical Apgar No Minor Major morbidity or

Score morbidity morbidity mortality
0-4 21 20 16
5-6 135 71 35
7-10 158 62 35
Question: What would be an appropriate statistical test to examine whether there is an association between
Surgical Apgar Score and patient outcome? Using 14.13 as the value of the test statistic for these data, carry out
the appropriate test at a 5% level of significance. Show all parts of your test.
Answer
In the module on hypothesis testing for means and proportions, we discussed hypothesis testing applications with a
dichotomous outcome variable and two independent comparison groups. We presented a test using a test statistic Z
to test for equality of independent proportions. The chi-square test of independence can also be used with a
dichotomous outcome and the results are mathematically equivalent.
In the prior module, we considered the following example. Here we show the equivalence to the chi-square test of
independence.
Example:
A randomized trial is designed to evaluate the effectiveness of a newly developed pain reliever designed to reduce
pain in patients following joint replacement surgery. The trial compares the new pain reliever to the pain reliever
currently in use (called the standard of care). A total of 100 patients undergoing joint replacement surgery agreed to
participate in the trial. Patients were randomly assigned to receive either the new pain reliever or the standard pain
reliever following surgery and were blind to the treatment assignment. Before receiving the assigned treatment,
patients were asked to rate their pain on a scale of 0-10 with higher scores indicative of more pain. Each patient
was then given the assigned treatment and after 30 minutes was again asked to rate their pain on the same scale.
The primary outcome was a reduction in pain of 3 or more scale points (defined by clinicians as a clinically
meaningful reduction). The following data were observed in the trial.
Number with Reduction Proportion with Reduction
Treatment Group n of 3+ Points of 3+ Points

New Pain Reliever 50 23 0.46
Standard Pain Reliever 50 11 0.22
We tested whether there was a significant difference in the proportions of patients reporting a meaningful reduction
(i.e., a reduction of 3 or more scale points) using a Z statistic, as follows.
Step 1. Set up hypotheses and determine level of significance
H0: p1 = p2
H1: p1 ≠ p2 α=0.05
Here the new or experimental pain reliever is group 1 and the standard pain reliever is group 2.
We must first check that the sample size is adequate. Specifically, we need to ensure that we have at least 5
successes and 5 failures in each comparison group or that:
In this example, we have
Therefore, the sample size is adequate, so the following formula can be used:
Reject H0 if Z < -1.960 or if Z > 1.960.
We now substitute the sample data into the formula for the test statistic identified in Step 2. We first compute the
overall proportion of successes:
We now substitute to compute the test statistic.
Step 5. Conclusion.
We reject H0 because . We have statistically significant evidence at α=0.05 to show that there is a
difference in the proportions of patients on the new pain reliever reporting a meaningful reduction (i.e., a reduction of
3 or more scale points) as compared to patients on the standard pain reliever.
We now conduct the same test using the chi-square test of independence.
H0: Treatment and outcome (meaningful reduction in pain) are independent
The condition for appropriate use of the above test statistic is that each expected frequency is at least 5. In Step 4
we will compute the expected frequencies and we will ensure that the condition is met.
For this test, df=(2-1)(2-1)=1. At a 5% level of significance, the appropriate critical value is 3.84 and the decision rule
is as follows: Reject H0 if χ2 > 3.84. (Note that 1.962 = 3.84, where 1.96 was the critical value used in the Z test for
proportions shown above.)
We now compute the expected frequencies using:
The computations can be organized in a two-way table. The top number in each cell of the table is the observed
frequency and the bottom number is the expected frequency. The expected frequencies are shown in parentheses.
# with Reduction # with Reduction
Treatment Group of 3+ Points of <3 Points Total

New Pain Reliever 23 27 50
(17.0) (33.0)
Standard Pain Reliever 11 39 50
(17.0) (33.0)
Total 34 66 100
A condition for the appropriate use of the test statistic was that each expected frequency is at least 5. This is true for
this sample (the smallest expected frequency is 22.0) and therefore it is appropriate to use the test statistic.
(Note that (2.53)2 = 6.4, where 2.53 was the value of the Z statistic in the test for proportions shown above.)
Step 5. Conclusion.
We reject H0 because . We have statistically significant evidence at α=0.05 to show that H0 is false or
that treatment and outcome are not independent (i.e., they are dependent or related). This is the same conclusion
we reached when we conducted the test using the Z test above. With a dichotomous outcome and two independent
comparison groups, Z2 = χ2 ! Again, in statistics there are often several approaches that can be used to test
hypotheses.
Chi-Squared Tests in R
The video below by Mike Marin demonstrates how to perform chi-squared tests in the R programming language.
Answer to Problem on Pancreaticoduodenectomy and Surgical Apgar Scores

We have 3 independent comparison groups (Surgical Apgar Score) and a categorical outcome variable
(morbidity/mortality). We can run a Chi-Squared test of independence.
Step 1:
H0: Apgar scores and patient outcome are independent of one another.
HA: Apgar scores and patient outcome are not independent.
Step 2:
(We were given the chi-squared value)
Step 3:
Therefore reject H0 if
Step 4:
Chi-squared = 14.3
Step 5:
Since 14.3 is greater than 9.49, we reject H0.
There is an association between Apgar scores and patient outcome. The lowest Apgar score group (0 to 4) experienced the highest
percentage of major morbidity or mortality (16 out of 57=28%) compared to the other Apgar score groups.

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6/17/22, 10:39 AM Hypothesis Testing - Chi Squared Test

Hypothesis Testing - Chi Squared Test

Lisa Sullivan, PhD

Boston University School of Public Health

After completing this module, the student will be able to:

1. Perform chi-square tests by hand

Tests with One Sample, Discrete Outcome

Test Statistic for Testing H0: p1 = p 10 , p2 = p 20 , ..., pk = p k0

No Regular Sporadic Regular Total

Step 1. Set up hypotheses and determine level of significance.

H1: H0 is false. α =0.05

Step 2. Select the appropriate test statistic.

The test statistic is:

Step 3. Set up decision rule.

Step 4. Compute the test statistic.

No Regular Sporadic Exercise Regular Exercise Total

=282 =117.5 =70.5

Consider the following:

No Regular Sporadic Regular Total

Underweight Normal Weight Overweight Obese Total

BMI<18.5 BMI 18.5-24.9 BMI 25.0-29.9 BMI > 30

Step 1. Set up hypotheses and determine level of significance.

H0: p1=0.02, p2=0.39, p3=0.36, p4=0.23 or equivalently

H0: Distribution of responses is 0.02, 0.39, 0.36, 0.23

H1: H0 is false. α=0.05

Step 2. Select the appropriate test statistic.

The formula for the test statistic is:

Step 3. Set up decision rule.

Step 4. Compute the test statistic.

Underweight Normal Overweight Obese Total

BMI<18.5 BMI 18.5- BMI 25.0-29.9 BMI > 30

The test statistic is computed as follows:

We presented the following approach to the test using a Z statistic.

Step 1. Set up hypotheses and determine level of significance

H1: p ≠ 0.75 α=0.05

Step 2. Select the appropriate test statistic.

Step 3. Set up decision rule.

Step 4. Compute the test statistic.

Saw a Dentist Did Not See a Total

Step 1. Set up hypotheses and determine level of significance.

H0: p1=0.75, p2=0.25 or equivalently H0: Distribution of responses is 0.75, 0.25

H1: H0 is false. α=0.05

Step 2. Select the appropriate test statistic.

The formula for the test statistic is:

Step 3. Set up decision rule.

Step 4. Compute the test statistic.

Saw a Dentist Did Not See a Dentist Total

in Past 12 Months in Past 12 Months

Observed Frequencies (O) 64 61 125

The test statistic is computed as follows:

Tests for Two or More Independent Samples, Discrete Outcome

Test Statistic for Testing H0: Distribution of outcome is independent of groups

P(Group 1 and Response Option 1) = P(Group 1) P(Response Option 1).

Response 1 Response 2 Response 3 Total

P(Group 1 and Response 1) = P(Group 1) P(Response 1),

P(Group 1 and Response 1) = (25/150) (62/150) = 0.069.

P(Group 2 and Response 1) = P(Group 2) P(Response 1),

P(Group 2 and Response 1) = (50/150) (62/150) = 0.138.

The expected frequency in Group 2 and Response 1 is 150(0.138) = 20.7.

Expected Cell Frequency = (Row Total * Column Total)/N.